Initial assessment involves a thorough history, including chest discomfort and related symptoms as well as risk factors, in order to assess the likelihood of coronary artery disease. This is followed by appropriate noninvasive testing guided by the probability of disease.
Management should focus on lifestyle modification, with emphasis on smoking cessation, weight management, physical activity, lipid control, and blood pressure control.
Antiplatelet therapy should be prescribed for all patients.
A stepwise addition of beta-blockers, calcium-channel antagonists, and/or long-acting nitrates should be provided to patients with chronic anginal symptoms.
Patients with persistent angina despite lifestyle modification and guideline-directed medical therapy may warrant revascularization for reduction of symptoms.
Additionally, patients with high-risk coronary anatomy, as determined by noninvasive testing, may benefit from revascularization concurrent with initiation of lifestyle modification and medical therapy.
- typical angina symptoms
- atypical angina symptoms
- symptoms of low-risk unstable angina
- normal exam
- known medical history of exacerbating factor
- nonanginal chest pain
- epigastric discomfort
- jaw pain
- arm pain
- dyspnea on exertion
- perspiration (diaphoresis)
- mitral regurgitation murmur
- bibasilar rales
- aortic outflow murmur
- carotid bruit
- diminished peripheral pulses
- signs of abdominal aortic aneurysm
- retinopathy seen on fundoscopic examination
- xanthomas or xanthelasma
1st Tests To Order
- resting ECG
- fasting lipid profile
- fasting blood glucose
Other Tests to Consider
- hemoglobin A1C
- stress exercise ECG without imaging
- stress myocardial perfusion imaging
- stress echocardiography
- coronary angiography
- coronary computer tomography angiography (CCTA)
- cardiac magnetic resonance (CMR)
- coronary artery calcium scoring
- cardiac positron emission tomography (PET) scan
- lifestyle education
- antiplatelet therapy
- antianginal therapy
- statin or other lipid-lowering therapy
- antihypertensive therapy
- blood sugar control
- with acute anginal symptoms
- sublingual nitroglycerin