Summary
Definition
History and exam
Key diagnostic factors
- chest pain
- risk factors for cardiovascular disease
- marked sweating
- cardiogenic shock
- acute heart failure
Other diagnostic factors
- nausea and vomiting
- arrhythmias
- heart murmur
- epigastric pain
- dyspnoea
- syncope
- back pain
Risk factors
- smoking
- hypertension
- diabetes
- obesity and metabolic syndrome phenotype
- sedentary behaviour and physical inactivity
- dyslipidaemia
- chronic kidney disease
- atherosclerosis (history of angina, myocardial infarction, stroke, transient ischaemic attack, peripheral vascular disease)
- family history of premature coronary artery disease
- age >60 years
- cocaine use
- depression
- stent thrombosis or restenosis
- sleep apnoea
- surgical procedures (including intra-operative and postoperative periods)
Diagnostic investigations
1st investigations to order
- ECG
- high-sensitivity troponin
- chest x-ray
- full blood count
- urea, electrolytes, and creatinine
- liver function tests
- blood glucose
- C-reactive protein
Treatment algorithm
Contributors
Expert advisers
Shrilla Banerjee, MD, FRCP
Consultant Interventional Cardiologist
East Surrey Hospital
Surrey and Sussex Healthcare NHS Trust
UK
Disclosures
SB has received speaker fees for educational lectures (presentation content was her own) and meeting participation from Menarini, Edwards Lifesciences, Abbott Vascular, and Shockwave IVL. She has also participated in an Advisory Board for Sahajanand Medical Technologies Limited. SB has received travel sponsorship from Biosensors International to attend the PCR meeting in Paris in 2022. She has prepared a manuscript on coronary microvascular dysfunction for Abbott for Cardiovascular News (no royalties).
Adam Hartley, MBBS, BSc, MRCP
Wellcome Trust Clinical Research Fellow
Imperial College London
Specialist Registrar in Cardiology
Imperial College Healthcare NHS Trust
London
UK
Disclosures
AH declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Resham Baruah MBBS, BSc MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
London
UK
Cody S Deen, MD
Assistant Professor of Medicine
Director of Cardiology
Hillsborough Hospital
University of North Carolina
Hillsborough
NC
Disclosures
RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim. CSD was previously the Director of Cardiac Rehab for Chatham Hospital, which was financially set up as a consultancy relationship, until 2017. CSD has spoken (unpaid) at the Update in Cardiology and Update in Internal Medicine Conferences at UNC for the last 5 years. CSD has served as the PI for the Dal-GeneE (site now closed) and the ACCELERATE Trials at the University of North Carolina (trial now completed). Each trial required paid travel to an investigator meeting.
Peer reviewers
Gavin Galasko, BM, BCh, MA, DM (Oxon), FRCP
Consultant Interventional Cardiologist
Director of Research, Development and Innovation
Blackpool Teaching Hospitals NHS Foundation Trust
Blackpool
UK
Disclosures
GG declares that he has no competing interests.
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