Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- chest pain
- dyspnoea on exertion
- hypotension
- rales
- S3 gallop
- hypertension
- nausea
- diaphoresis
- tachycardia
- indigestion
Other diagnostic factors
- unilateral weakness, numbness, and/or tingling
- headache
- intermittent claudication
- bruits
- aphasia
- hemisensory loss
- cranial nerve palsies
- seizures
- vertigo
- limb pain at rest
- diminished/absent lower extremity pulses
- ulcers or gangrene
- peripheral oedema
- smooth shiny skin with hair loss
- pallor
Risk factors
- cigarette smoking
- hypertension
- dyslipidaemia
- poor glycaemic control
- physical inactivity
- overweight and obesity
- albuminuria
- chronic kidney disease (CKD)
- elevated C-reactive protein
- family history of CVD
- female sex
- gestational diabetes
- mental illness
- metabolic dysfunction-associated steatotic liver disease (previously non-alcoholic fatty liver disease)
- atrial fibrillation
Diagnostic investigations
Investigations to consider
- B natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-proBNP)
- transthoracic doppler echocardiogram
- exercise ECG
- exercise (stress) imaging test
- pharmacological (stress) imaging test
- cardiac MRI or stress cardiac MRI
- ankle-brachial index (ABI)
- CT coronary angiography
- CT coronary calcium scan
- invasive coronary angiography
- non-contrast head CT
- brain MRI
- duplex ultrasonography of carotid arteries
- C-reactive protein
- chest x-ray
Treatment algorithm
Contributors
Authors
Mohamed Al-Kazaz, MD
Assistant Professor of Medicine (Cardiology)
Section Chief, General Cardiology
Division of Cardiology, Department of Medicine
Northwestern University Feinberg School of Medicine
Bluhm Cardiovascular Institute
Northwestern Memorial Hospital
Chicago
IL
Disclosures
MA is a speaker for Kiniksa Pharmaceuticals in relation to pericarditis/rilonacept.
Acknowledgements
Dr Mohamed Al-Kazaz would like to gratefully acknowledge Dr Alexander Meyer, Dr Laura Davidson, Dr Charles Davidson, and Dr Leonard E. Egede, the previous contributors to this topic, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK.
Disclosures
AM, LD, CD, and LE declare that they have no competing interests. LEE is an author of a number of references cited in this topic. SV not disclosed.
Peer reviewers
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Disclosures
IM declares that he has no competing interests.
David Leehey, MD
Medical Director
Hines VA Hospital
Hines
IL
Disclosures
DL declares that he has no competing interests.
References
Key articles
Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.Full text Abstract
American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care 2024 Jan 1;47(suppl 1):S1-321.Full text
Joseph JJ, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation. 2022 Mar;145(9):e722-59.Full text Abstract
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.Full text Abstract
Writing Committee Members; Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2022 Jan 18;79(2):e21-129.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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