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Coronary Risk Stratification of Chest Pain


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201. Myocardial Ischemia - Nuclear Medicine and Risk Stratification

). In patients with ischemic heart disease who undergo revascularization based on PET viability assessment with F-18 FDG, those with a low myocardial perfusion reserve were at an increased risk of adverse cardiac events. [ ] Currently, nuclear myocardial scans include both perfusion and gated wall motion images. Coronary artery blood flow can be assessed, and the scans can also be used to accurately determine the left ventricular ejection fraction, the end-systolic volume of the left ventricle, regional wall (...) , determining this probability is important for increasing the test’s clinical value. In their landmark CAD risk analysis article, Diamond and Forrester described the relationship between clinical symptoms and angiographically significant CAD. [ ] The authors described 3 types of chest pain: nonanginal, atypical, and typical. The benefit of their categorization is the ease of its use and its powerful risk stratification. Disease is categorized on the basis of 3 symptoms, which are assessed

2014 eMedicine Radiology

202. Acute Coronary Syndromes Guidelines

and Thoracic Surgeons AUSTRALIAN & NEW ZEALAND SOCIETY OF CARDIAC & THORACIC SURGEONS Available online at ScienceDirect He art Lung and Circulation Contents Vol . 25 No . 9 ( September 2016 ) NATIONAL HEART FOUNDATION OF AUSTRALIA AND CARDIAC SOCIETY OF AUSTRALIA AND NEW ZEALAND: AUSTRALIAN CLINICAL GUIDELINES FOR THE MANAGEMENT OF ACUTE CORONARY SYNDROMES 2016 895 National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines (...) of Australia Executive Summary These clinical guidelines have been developed to assist in the management of patients presenting with chest pain sus- pected to be due to an acute coronary syndrome (ACS) and those with con?rmed ACS. These guidelines should be read in conjunction with the ACS Clinical Care Standards developed by the Australian Commission for Safety and Quality in Health Care (ACSQHC) [1] and the Australian acute coronary syndromes capability framework developed by the Heart Foundation [2

2016 Cardiac Society of Australia and New Zealand

203. Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

; the Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; and the Council on Cardiovascular and Stroke Nursing Marie-France Hivert , Ross Arena , Daniel E. Forman , Penny M. Kris-Etherton , Patrick E. McBride , Russell R. Pate , Bonnie Spring , Jennifer Trilk , Linda V. Van Horn , and William E. Kraus and On behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; the Behavior Change (...) and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria

2016 American Heart Association

204. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

ag- gregation, and deceased fibrinolysis by cocaine predis- pose to coronary and microvascular disease. 97 Treatment Other than abstinence, very little is known about treat- ment of cocaine-induced cardiac dysfunction. Indeed, there are case reports of reversibility of cardiac function after cessation of drug use. 99 Early reports of cocaine- induced hypertension and myocardial ischemia caused by unopposed a-effects of ß 1 -adrenergic blocking agents in cocaine-related chest pain resulted (...) . ß- Blockers can be used to increase diastolic filling time and control heart rate in the setting of atrial fibrillation, but they should be used cautiously if at all when cardiac output is low and there is severe restrictive physiology. They probably should be avoided in AL amyloidosis. In patients with amyloid cardiomyopathy, risk of intra- cardiac thrombus is high in the setting of atrial fibrillation and even in the setting of sinus rhythm. Thrombus forma- tion in the atria has been

2016 American Heart Association

205. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science Full Text available with Trip Pro

as appropriate. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive external peer review and approval by the AHA Science Advisory and Coordinating Committee. Table 3. Search Terms 1. Chest pain OR myocardial infarction OR angina OR myocardial ischemia OR heart attack OR heart infarction OR heart muscle ischemia OR ischemic heart disease OR cardiovascular disease OR coronary heart disease OR coronary artery (...) , perceptions, psychosocial characteristics, and behaviors. Sex- and gender-specific science addresses how experiences of the same disease, for example, ischemic heart disease (IHD), are similar and different with respect to biological sex and gender. For instance, women tend to have smaller coronary arteries than men, and women have less obstructive IHD than men. However, gender differences, which are influenced by ethnicity, culture, and socioeconomic environment, are intimately involved in risk factors

2016 American Heart Association

206. Evidence-Based Policy Making: Assessment of the American Heart Association?s Strategic Policy Portfolio Full Text available with Trip Pro

and regular CR (federal) AHA guidelines: Class I, LOE A Assure adequate coverage/reimbursement for comprehensive stroke rehabilitation (federal) AHA guidelines: Class I, LOE A Broadly implement automatic and coordinated referral strategies (federal/state) AHA guidelines: Class III ACC indicates American College of Cardiology; AED, automated external defibrillator; AHA, American Heart Association; CHD, coronary heart disease; CPR, cardiopulmonary resuscitation; CR, cardiac rehabilitation; CVD (...) for the AHA Policy Portfolio Aligned With the Indicators for the AHA’s 2020 Impact Goal: CVD and Stroke Mortality Indicators Policy Interventions Cited Evidence Reviews Acute event: improve systems of care (acute response, acute care, and palliative care) for CHD, stroke, heart failure, and other CVDs Support robust STEMI systems of care (state/local) ACC/AHA guidelines recommend PCI as the preferred strategy in STEMI, including those patients presenting >3 h after onset of chest painAHA/ACC guidelines

2016 American Heart Association

207. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death Full Text available with Trip Pro

become increasingly proactive and focused on protecting high-risk patient subgroups from arrhythmic death. The most obvious candidates are those with a history of cardiac arrest or sustained ventricular tachyarrhythmias, in whom ICDs are effective. ICDs are also beneficial for the primary prevention of SCD in patients with certain forms of structural heart disease associated with risk of malignant arrhythmias (such as hypertrophic cardiomyopathy) or primary electric disease (such as long-QT syndrome (...) during the early period after diagnosis of nonischemic cardiomyopathy may result in improved ventricular function and decreased future risk of SCD; 50% of patients with newly diagnosed nonischemic cardiomyopathy will demonstrate a 10% improvement in LVEF with the initiation of medical therapy. , Although the rationale and reasons for postponing ICD implantation are sensible, the current evidence base is incomplete. For example, the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) excluded

2016 American Heart Association

208. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers

Association (AHA) describe HF as a progressive disorder. This process begins with risk factors known to be associated with the development of HF, including the toxicity of chemotherapy and/or radiation (RT; stage A), and is commonly progressive after structural changes to the heart occur. The initial manifestation may be asymptomatic cardiac dysfunction (stage B), which precedes eventual development of overt signs and symptoms (stages C and D). In patients with cancer, onset of either asymptomatic (...) or symptomatic disease may also be responsible for interruption or discontinuation of cancer-directed therapy, potentially reducing the chance for long-term survival. In children (≤ 21 years old at diagnosis) with cancer, the short- and long-term risk of cardiac dysfunction associated with therapeutic exposures, such as anthracycline chemotherapy (eg, doxorubicin, epirubicin, daunorubicin) or use of chest-directed RT. is well described. This led to the development of evidence-based guidelines to direct

2016 American Society of Clinical Oncology Guidelines

209. Back pain - low (without radiculopathy)

. Management of non-specific low back pain involves: Assessing the person's risk of back pain disability using a risk stratification tool. Providing adequate analgesia (an NSAID first-line, or codeine with or without paracetamol if an NSAID is contraindicated or not tolerated). If the paraspinal muscles are in spasm, a short course of a benzodiazepine such as diazepam can also be considered. Providing information about the expected time course of pain, self-help measures, advice about staying active (...) , using clinical judgement. If an for the low back pain has been identified, manage according to the specific diagnosis. If non-specific low back pain is suspected, assess the person using a risk stratification tool such as to identify modifiable risk factors (biomedical, psychological and social) for back pain disability. Quality of life, pain severity, function, and psychological distress are the most important factors to guide the person's management. People with low back pain who are likely

2018 NICE Clinical Knowledge Summaries

210. Risk stratification in patients with unstable angina using absolute serial changes of 3 high-sensitive troponin assays. (Abstract)

Risk stratification in patients with unstable angina using absolute serial changes of 3 high-sensitive troponin assays. It is unknown whether unstable angina (UA) results in previously nondetectable low-level myocardial necrosis. We compared the pattern of myocardial necrosis between patients with UA, acute myocardial infarction (AMI), and noncardiac chest pain (NCCP) using 3 high-sensitive cardiac troponin (hs-cTn) assays.In a multicenter study, we enrolled 842 unselected patients with acute (...) chest pain in the emergency department. Roche hs-cTnT, Beckman Coulter hs-cTnI, and Siemens hs-cTnI were determined in a blinded fashion at presentation and after 1, 2, 3, and 6 hours. The final diagnosis was adjudicated by 2 independent cardiologists.A change in hs-cTn of ≥2 ng/L within the first hour after presentation as assessed with Roche hs-cTnT, Beckman Coulter hs-cTnI, and Siemens hs-cTnI was observed in 26%, 31%, and 32% of patients with UA (n = 115) compared with 91%, 92%, and 96

2013 American Heart Journal

211. Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging. Full Text available with Trip Pro

Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging. To evaluate the incremental prognostic value of reserve-pulse pressure (reserve-PP: exercise-PP minus rest-PP) to standard risk factors among patients with suspected coronary artery disease (CAD) but normal exercise myocardial perfusion imaging (MPI).We studied 4269 consecutive symptomatic patients without known CAD who were referred for exercise MPI but had normal MPI (...) results (mean age 58 ± 12 years, 56% females, 84% referred for evaluation of chest pain or dyspnoea, 95% with intermediate pretest likelihood of CAD). There were 202 deaths over 5.1 ± 1.4 years of follow-up. Reserve-PP was abnormal (<44 mmHg increase in PP from rest) in 1894 patients (44%). Patients with an abnormal reserve-PP had a higher risk of death compared with patients with normal reserve-PP [hazard ratio (HR): 2.47, 95% CI, 1.8-3.3]. In multivariable models adjusting for age, sex, ejection

2013 European Heart Journal

212. Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone? Full Text available with Trip Pro

chest pain admitted thorough the emergency department. None had prior coronary artery disease. CACS was calculated using the Agatston method. EATv and ITFv were semiautomatically calculated. Median patient follow-up was 3.3 years. Mean patient age was 54.4±13.7 years and Framingham risk score 8.2±8.2. The 45 patients (5.9%) with major acute cardiac events (MACE) were older (64.8±13.9 versus 53.7±13.4 years), more frequently male (60% versus 40%), and had a higher median Framingham risk score (16 (...) Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone? Noncontrast cardiac computed tomography allows calculation of coronary artery calcium score (CACS) and measurement of epicardial adipose tissue (EATv) and intrathoracic fat (ITFv) volumes. It is unclear whether fat volume information contributes to risk stratification.Cardiac computed tomography was performed in 760 consecutive patients with acute

2013 Circulation. Cardiovascular imaging

213. Coronary endothelial function testing provides superior discrimination compared to standard clinical risk scoring in prediction of cardiovascular events Full Text available with Trip Pro

% of patients [NRI 0.12 (95% CI -0.02 to 0.26)], and the combined microvascular and epicardial CEF correctly reclassified 22.8% of patients [NRI 0.23 (95% CI 0.08-0.37)].CEF testing is safe and adds value to the FRS, with superior discrimination and risk stratification compared with FRS alone in patients presenting with chest pain or suspected ischemia. (...) was evaluated using intracoronary acetylcholine in 470 patients who presented with chest pain and nonobstructive coronary artery disease. CV events were assessed after a median follow-up of 9.7 years. The association between CEF and CV events was examined, and the net reclassification improvement index (NRI) was used to compare the incremental contribution of CEF when added to FRS.The mean age was 53 years, and 68% of the patients were women with a median FRS of 8. Complications (coronary dissection

2016 Coronary artery disease

214. Point-of-Care (POC) testing for a panel of cardiac markers

. Epub 2011/04/07. eng. 18. Macdonald SP, Nagree Y. Rapid risk stratification in suspected acute coronary syndrome using serial multiple cardiac biomarkers: a pilot study. Emergency medicine Australasia : EMA. 2008 Oct;20(5):403-9. PubMed PMID: 18973637. Epub 2008/11/01. eng. 19. Ng SM, Krishnaswamy P, Morissey R, Clopton P, Fitzgerald R, Maisel AS. Ninety-minute accelerated critical pathway for chest pain evaluation. The American journal of cardiology. 2001 Sep 15;88(6):611-7. PubMed PMID: 11564382 (...) for the emergency department-based detection of acute coronary syndromes. Archives of pathology & laboratory medicine. 2002 Dec;126(12):1487-93. PubMed PMID: 12456209. Epub 2002/11/29. eng. 25. Hillis GS, Zhao N, Taggart P, Dalsey WC, Mangione A. Utility of cardiac troponin I, creatine kinase- MB(mass), myosin light chain 1, and myoglobin in the early in-hospital triage of "high risk" patients with chest pain. Heart (British Cardiac Society). 1999 Nov;82(5):614-20. PubMed PMID: 10525520. Pubmed Central PMCID

2014 Publication 4878904

215. Point-of-care testing for heart-type fatty acid binding protein

infarction (AMI), compared to routine clinical practice? Background, Current practice and Advantages over Existing Technology: When blood flow to the myocardium is acutely obstructed, a person will typically suffer more prolonged chest pain of recent onset; this is referred to as acute coronary syndrome (ACS). When the obstruction leads to myocardial necrosis (cell death), this results in an acute myocardial infarction (AMI) or ‘heart attack’, and the release of a series of biomarkers from myocytes (...) necrosis. Current practice in the UK is that assessment of chest pain of recent onset is based on a combination of history, physical examination, electrocardiography (ECG) and cardiac markers, usually a cTn taken on arrival in hospital and then again 10-12 hours after the onset of symptoms [1]. Point-of-care testing for heart-type Fatty Acid Binding Protein Horizon Scan Report 0039 May 2014 When it comes to AMI, time is of the essence, with a rapid reduction in salvageable myocardium over time

2014 Publication 4878904

216. Cardiac Screening With Electrocardiography, Stress Echocardiography, or Myocardial Perfusion Imaging: Advice for High-Value Care From the American College of Physicians

. Chou. Final approval of the article: R. Chou. Collection and assembly of data: R. Chou. Abstract Background: Cardiac screening in adults with resting or stress electrocardiography, stress echocardiography, or myocardial perfusion imaging can reveal findings associated with increased risk for coronary heart disease events, but inappropriate cardiac testing of low-risk adults has been identified as an important area of overuse by several professional societies. Methods: Narrative review based (...) on published systematic reviews; guidelines; and articles on the yield, benefits, and harms of cardiac screening in low-risk adults. Results: Cardiac screening has not been shown to improve patient outcomes. It is also associated with potential harms due to false-positive results because they can lead to subsequent, potentially unnecessary tests and procedures. Cardiac screening is likely to be particularly inefficient in adults at low risk for coronary heart disease given the low prevalence and predictive

2015 American College of Physicians

217. Transitions of Care in Heart Failure Full Text available with Trip Pro

needs, and were at high risk for rehospi- talization and mortality, 83 especially if they had 1 or more of the following: renal insufficiency; low-cardiac-output states; diabetes mellitus; chronic obstructive pulmonary disease (...) . A link to the “Copyright Permissions Request Form” appears on the right side of the page. Downloaded from by on March 27, 2019Albert et al Transitions of Care in Heart Failure 385 transition programs are discussed, this introduction describes the scope of the problem. Symptomatic HF is a complex clinical syndrome defined by characteristic symptoms of dyspnea and fatigue. Signs of circulatory congestion typically result from impairment of cardiac structure or function involving

2015 American Heart Association

218. Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome Full Text available with Trip Pro

with advanced CKD and dialysis were less likely to have chest pain on admission (40.4% and 41.1%, respectively) than those without CKD (61.6%). Similar observations were made in the SWEDEHEART registry [Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies]; however, up to two thirds of patients with stage 4 and 5 CKD in that registry had chest pain at presentation. 15 The USRDS-NRMI study also showed that MI patients (...) . Washam Duke Heart Center None None None None None None None L. Kristin Newby Duke University Medical Center Amylin*; Bristol Myers- Squibb*; Duke†; Eli Lilly & Co*; GlaxoSmithKline†; Johnson & Johnson*; Merck & Co†; NIH†; Regado Biosciences* None None None None Amgen†; AstraZeneca*; Cubist*; Daiichi Sankyo*; Genentech*; GlaxoSmithKline*; Novartis* American Heart Journal*; Society of Chest Pain Centers*; JAHA* Amber L. Beitelshees University of Maryland None None None None None None None Mauricio G

2015 American Heart Association

219. Treatment of Hypertension in Patients With Coronary Artery Disease Full Text available with Trip Pro

CAD IIa/B ACS IIa/C HF IIa/B <130/80 CAD IIb/B Post–myocardial infarction, stroke or TIA, carotid artery disease, PAD, AAA IIb/B AAA indicates abdominal aortic aneurysm; ACS, acute coronary syndrome; BP, blood pressure; CAD, coronary artery disease; HF, heart failure; PAD, peripheral arterial disease; and TIA, transient ischemic attack. 1. Relationship Between Hypertension and CAD 1.1. Epidemiology of Hypertension and CAD Hypertension is a major independent risk factor for CAD for all age/race/sex (...) , with a significant association of lower BP with lower stroke deaths and HF but not with a lower rate of myocardial infarction (MI) in patients >80 years of age. Several studies (Heart Outcomes Prevention Evaluation [HOPE], Survival and Ventricular Enlargement [SAVE], and European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease [EUROPA]) have shown a beneficial effect of angiotensin-converting enzyme (ACE) inhibitors on CVD outcomes in individuals, some hypertensive

2015 American Heart Association

220. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 4: Congenital Heart Disease

death (SCD). , Patients with associated pulmonary hypertension secondary to the above-mentioned lesions that is hemodynamically significant can develop acute symptoms, including reduced exercise capacity or, more importantly, arrhythmias, syncope, chest pain, or sudden death. , For the purposes of this document, pulmonary hypertension is defined as a mean pulmonary artery pressure >25 mm Hg or a pulmonary vascular resistance index of >3 Wood units. Patients with right-to-left shunting may become (...) -headedness, dizziness, syncope, chest pain, or pallor on exercise deserve a full evaluation. Annual reevaluation is required for all patients with AS, because the disease can progress. Patients with severe AS are at risk of sudden death, particularly with exercise. Mild AS is defined as a mean Doppler gradient of <25 mm Hg or a peak instantaneous Doppler gradient <40 mm Hg. On evaluation, patients should have a normal ECG, normal exercise tolerance, and no history of exercise-related chest pain, syncope

2015 American Heart Association

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