最后审阅: 18 九月 2021
最后更新: 04 九月 2020

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 典型心绞痛症状
  • 不典型心绞痛症状
  • 低风险的不稳定型心绞痛的症状
  • 查体正常

其他诊断因素

  • 加重因素
  • 非心绞痛胸痛
  • 上腹不适
  • 下颌疼痛
  • 手臂疼痛
  • 劳力性呼吸困难
  • 恶心/呕吐
  • 出汗(多汗
  • 疲劳
  • 缺氧
  • 心动过速
  • S3
  • 二尖瓣关闭不全杂音
  • 两侧肺底啰音
  • 主动脉流出道杂音
  • 颈动脉杂音
  • 外周血管搏动减弱
  • 腹主动脉瘤的征象
  • 眼底检查检出视网膜病变
  • 黄色瘤或黄斑瘤

危险因素

  • 老年
  • 吸烟
  • 高血压
  • 低密度脂蛋白胆固醇升高
  • 孤立的低水平高密度脂蛋白胆固醇
  • 糖尿病
  • 缺乏运动
  • 肥胖
  • 非法用药
  • 男性
  • 缺血性心脏病家族史
  • 高甘油三酯血症
  • 精神紧张/抑郁症
  • 血浆生物标志物
  • 空气污染

诊断性检查

首要检查

  • 静息心电图 (ECG)
  • 血红蛋白
  • 血脂检查
  • 空腹血糖和 HbA1c (糖化血红蛋白)

需考虑的检查

  • 运动心电图(不联合影像学检查
  • 运动或药物负荷试验联合影像学检查
  • 心脏 CT 血管造影术(CCTA
  • 侵入性冠状动脉血管造影
  • 甲状腺刺激激素
  • 胸部 X 线检查(CXR
  • 静息超声心动图

新兴检查

  • CT 心肌灌注(CTP)和血流储备分数 CT(FFRCT
  • 冠状动脉钙化 (CAC) 积分

治疗流程

持续性治疗

撰稿人

作者

Douglas Berger, MD, MLitt

General Medicine Service

Veterans Affairs (VA) Puget Sound Health Care System

Assistant Professor

University of Washington

Seattle

WA

利益声明

DB declares that he has no competing interests.

Stephan D. Fihn, MD, MPH

Head, Division of General Internal Medicine

Professor of Medicine and Health Services

University of Washington

Seattle

WA

利益声明

SDF declares that he has no competing interests.

鸣谢

Dr Douglas Berger and Dr Stephan D. Fihn would like to gratefully acknowledge Dr Karen E. Segerson, Dr Mark C. Zaros, Dr Joy Bucher, and Dr Steven M. Bradley, previous contributors to this topic.

利益声明

KES, MCZ, JB, and SMB declare that they have no competing interests.

同行评议者

Syed Wamique Yusuf, MD, MRCPI, FACC

Associate Professor

University of Texas MD Anderson Cancer Center

Department of Cardiology

Houston

TX

利益声明

SWY declares that he has no competing interests.

John R. Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

利益声明

JRC declares that he has no competing interests.

Michael A. Spinelli, MD

Fellow

Albert Einstein College of Medicine

Montefiore Medical Center

Bronx

NY

利益声明

MAS declares that he has no competing interests.

Katherine Wu, MD

Associate Professor of Medicine

Division of Cardiology

Johns Hopkins Medical Institutions

Baltimore

MD

利益声明

KW declares that she has no competing interests.

Daniel Lenihan, MD

Professor of Cardiovascular Medicine

Director of Clinical Research

Vanderbilt University

Nashville

TN

利益声明

DL declares that he has no competing interests.

Gianluca Rigatelli, MD, PhD, FACP, FACC, FESC, FSCAI

Director

Section of Transcatheter Treatment of Congenital Heart Disease in the Adult

Rovigo General Hospital

Rovigo

Italy

利益声明

GR declares that he has no competing interests.

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