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Coronary Risk Stratification of Chest Pain

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241. Cardiac Telerehabilitation: Attendance and Effectiveness

revascularization surgery, provided they are considered of low and moderate risk for the practice of physical exercise of moderate intensity, according to the risk stratification proposed by the American Association of Cardiovascular and Pulmonary Rehabilitation. Volunteers will be recruited at the outpatient at the University Hospital's Cardiac Rehabilitation Centre. The study will be made in conformity with the CONSORT guidelines for non-pharmacological interventions. After being invited to the study (...) by telephone and to compare the treatment adherence, the effects in the functional capacity, and the control of coronary risk factors in relation to the traditional cardiac rehabilitation offered mostly supervised and center based. Condition or disease Intervention/treatment Phase Cardiovascular Diseases Coronary Disease Other: TeleRehab Other: CentreRehab Not Applicable Detailed Description: This study will be developed with patients with coronary disease submitted to angioplasty or myocardial

2018 Clinical Trials

242. Evaluation of BIomarkers for POstoperative Complications in Non-cardiac Surgery Patients

5, 2018 Last Update Posted : December 5, 2018 See Sponsor: Technische Universität München Information provided by (Responsible Party): Technische Universität München Study Details Study Description Go to Brief Summary: Aim of this study is to evaluate whether IPF, hsTnT and NT pro-BNP can be used as biomarkers for perioperative risk stratification predicting postoperative complications in patients undergoing elective non-cardiac surgery. Condition or disease Perioperative/Postoperative (...) information Study Type : Observational [Patient Registry] Estimated Enrollment : 2000 participants Observational Model: Other Time Perspective: Prospective Target Follow-Up Duration: 6 Months Official Title: Evaluation of IPF, hsTnT and Pro-BNP as Biomarkers for Perioperative Risk Stratification Among Patients Undergoing Elective Non-cardiac Surgery Actual Study Start Date : June 19, 2017 Estimated Primary Completion Date : March 2019 Estimated Study Completion Date : March 2019 Resource links provided

2018 Clinical Trials

243. Reducing the Risk - Thrombosis and Embolism during Pregnancy and the Puerperium

D P DRCOG Green-top Guideline No. 37a © Royal College of Obstetricians and Gynaecologists 8 of 40 Warfarin Warfarin use in pregnancy is restricted to the few situations where heparin is considered unsuitable, e.g. some women with mechanical heart valves. Women receiving long-term anticoagulation with warfarin can be converted from LMWH to warfarin postpartum when the risk of haemorrhage is reduced, usually 5–7 days after delivery. Warfarin is safe in breastfeeding. Dextran Dextran should (...) . For the diagnosis and management of acute VTE in pregnancy, please refer to Green-top Guideline No. 37b. 1 For anticoagulation for mechanical heart valves in pregnancy, the reader is directed to the chapter covering this within the proceedings of the RCOG study group on heart disease. 2 A summary of the guideline for antenatal and postnatal thromboprophylaxis is given in Appendix I. 2. Introduction and background epidemiology Pulmonary embolism (PE) remains a leading direct cause of maternal death in the UK

2015 Royal College of Obstetricians and Gynaecologists

244. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

Guidelines 1. Introduction These guidelines are intended to apply to adult patients with stable known or suspected ischemic heart disease (IHD), including those with new-onset chest pain (ie, low-risk unstable angina) or stable pain syndromes. Patients who have “ischemic equivalents,” such as dyspnea or arm pain with exertion, are included in the latter group. Many patients with IHD may become asymptomatic with appropriate therapy. Accordingly, the follow-up sections of this guideline pertain to patients (...) is useful to a) ascertain the cause of chest pain or anginal equivalent symptoms, b) define coronary anatomy in patients with “high-risk” noninvasive stress test findings (Section 3.3 in the 2012 full-text guideline) as a requisite for revascularization, c) determine whether severe CAD may be the cause of depressed left ventricular ejection fraction, d) assess for possible ischemia-mediated ventricular arrhythmia, e) evaluate cardiovascular risk among certain recipient and donor candidates for solid

2014 American Heart Association

245. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Full Text available with Trip Pro

on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Methods— Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant (...) , there has never been an American Heart Association (AHA)/American Stroke Association guideline dedicated to stroke risk and prevention in women. This endeavor is important because women differ from men in a multitude of ways, including genetic differences in immunity, , coagulation, , hormonal factors, reproductive factors including pregnancy and childbirth, and social factors, , all of which can influence risk for stroke and impact stroke outcomes. This document provides a new stroke prevention

2014 American Heart Association

246. Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease Full Text available with Trip Pro

Heart Association, Inc. In the present report, we will focus on pretest IHD risk as it relates to elevated risk of coronary events. Some general rules were synthesized from available evidence. IHD risk increases with age and is exacerbated in the woman with multiple risk factors or comorbidities. , , , , The classification of IHD risk in women refers solely to women who present for evaluation of suspected IHD who have chest pain symptoms or some ischemic equivalent, including excessive dyspnea (...) 5–43 21–70 20–79 51–92 55 4–21 23–59 10–47 45–79 38–82 80–95 65 9–29 49–69 20–51 71–86 56–84 93–97 This table, taken from the recent guidelines on stable ischemic heart disease, reports the significant overlap in the estimated CAD likelihood values for women and men with nonanginal chest pain, atypical angina, and typical angina, respectively. Values indicate percentage with significant CAD. The first value listed is the percentage for a low-risk, mid-decade patient without diabetes mellitus

2014 American Heart Association

247. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Full Text available with Trip Pro

in patients with aortic dissection. Computed tomography (CT) of the chest with intravenous contrast can help exclude pulmonary embolism and aortic dissection. Transthoracic echocardiography can identify a pericardial effusion and tamponade physiology and may also be useful to detect regional wall motion abnormalities. Transesophageal echocardiography can identify a proximal aortic dissection. In low-risk patients with chest pain, coronary CT angiography can result in a more rapid, more cost-effective (...) Estimation of Risk e355 3.3.2.4. Electrocardiogram e355 3.3.2.5. Physical Examination e357 3.4. Cardiac Biomarkers and the Universal Definition of MI: Recommendations e357 3.4.1. Biomarkers: Diagnosis e357 3.4.2. Biomarkers: Prognosis e357 3.4.3. Cardiac Troponins e357 3.4.3.1. Prognosis e358 3.4.4. CK-MB and Myoglobin Compared With Troponin e359 3.5. Immediate Management e359 3.5.1. Discharge From the ED or Chest Pain Unit: Recommendations e359 Early Hospital Care e359 4.1. Standard Medical Therapies

2014 American Heart Association

248. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: Executive Summary

or Outpatient Facility Presentation 2358 3.3. Prognosis–Early Risk Stratification 2359 3.4. Cardiac Biomarkers and the Universal Definition of Myocardial Infarction 2362 3.4.1. Biomarkers: Diagnosis 2362 3.4.2. Biomarkers: Prognosis 2363 3.5. Discharge From the ED or Chest Pain Unit 2363 Early Hospital Care: Recommendations 2363 4.1. Standard Medical Therapies 2363 4.1.1. Oxygen 2363 4.1.2. Nitrates 2363 4.1.3. Analgesic Therapy 2364 4.1.4. Beta-Adrenergic Blockers 2364 4.1.5. Calcium Channel Blockers 2365 (...) Stratification Figure 2. Global Registry of Acute Coronary Events Risk Calculator for In-Hospital Mortality for Acute Coronary Syndrome. Class I In patients with chest pain or other symptoms suggestive of ACS, a 12-lead electrocardiogram (ECG) should be performed and evaluated for ischemic changes within 10 minutes of the patient’s arrival at an emergency facility. (Level of Evidence: C ) If the initial ECG is not diagnostic but the patient remains symptomatic and there is a high clinical suspicion for ACS

2014 American Heart Association

249. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

heart disease (IHD), including those with new-onset chest pain (i.e., low-risk unstable angina) or stable pain syndromes. Patients Downloaded From: http://content.onlinejacc.org/ on 08/05/2014MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT Fihn, SD et al. 2014 Stable Ischemic Heart Disease Focused Update Page 8 who have “ischemic equivalents,” such as dyspnea or arm pain with exertion, are included in the latter group. Many patients with IHD may become asymptomatic with appropriate therapy. Accordingly (...) ). It specifically addresses the role of coronary angiography for the diagnosis of CAD in patients with suspected SIHD. Coronary angiography for risk stratification has been addressed in Section 3.3 of the 2012 SIHD full-text guideline (4). Recommendations for use of coronary angiography in the following specific clinical circumstances have been addressed in other guidelines or statements and will not be discussed further here: • Patients with heart failure and/or reduced ejection fraction (13) • Patients who

2014 Society for Cardiovascular Angiography and Interventions

250. Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Stroke Profile (FSP) uses a Cox proportional hazards model with risk factors as covariates and points calculated according to the weight of the model coefficients. 16 Independent stroke predictors include age, systolic blood pressure (SBP), hypertension, diabetes mellitus, current smoking, established cardiovascular disease (CVD; myocardial infarction [MI], angina or coronary insuffi- ciency, congestive heart failure, and intermittent claudication), atrial fibrillation (AF), and left ventricular (...) independently validated. Recent guideline statements from the AHA/American Stroke Association have emphasized the importance of includ- ing both stroke and coronary heart disease events as outcomes in risk prediction instruments intended for primary preven- tion. 24 The AHA/American College of Cardiology (ACC) CV Risk Calculator is available online for use in estimating risk at http://my.americanheart.org/cvriskcalculator. Assessing the Risk of First Stroke: Summary and Gaps An ideal stroke risk assessment

2014 American Heart Association

251. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. (Abstract)

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations (...) stratification of ACS; provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST segment elevation myocardial infarction; risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS; administration of antithrombotic therapies in the acute setting and considerations affecting their long term use; and implementation of an individualised secondary prevention plan that includes both pharmacotherapies

2016 Medical Journal of Australia

252. Growth-Differentiation Factor-15 in the Early Diagnosis and Risk Stratification of Patients with Acute Chest Pain. Full Text available with Trip Pro

Growth-Differentiation Factor-15 in the Early Diagnosis and Risk Stratification of Patients with Acute Chest Pain. Growth differentiation factor-15 (GDF-15) is a stress-responsive marker that might aid in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction (AMI).In a prospective, international multicenter study, GDF-15, high-sensitivity cardiac troponin T (hs-cTnT), and B-type natriuretic peptide (BNP) were measured in 646 unselected patients (...) presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. The primary prognostic end point was all-cause mortality during a median follow-up of 26 months.AMI was the adjudicated final diagnosis in 115 patients (18%). GDF-15 concentrations at presentation were significantly higher in AMI patients compared to patients with other diagnoses. The diagnostic accuracy of GDF-15 at presentation for the diagnosis of AMI as quantified

2011 Clinical Chemistry

253. B-type Natriuretic Peptide in the Early Diagnosis and Risk Stratification of Acute Chest Pain. (Abstract)

B-type Natriuretic Peptide in the Early Diagnosis and Risk Stratification of Acute Chest Pain. Myocardial ischemia is a strong trigger of B-type natriuretic peptide (BNP) release. As ischemia precedes necrosis in acute myocardial infarction, we hypothesized that BNP might be useful in the early diagnosis and risk stratification of patients with acute chest pain.In a prospective, international multicenter study, BNP was measured in 1075 unselected patients with acute chest pain. The final (...) reclassification improvement for BNP was 0.10 (P=.04), and integrated discrimination improvement 0.068 (P=.01).BNP accurately predicts mortality in unselected patients with acute chest pain independently of and more accurately than cardiac troponin T, but does not seem to help in the early diagnosis of acute myocardial infarction.Copyright © 2011 Elsevier Inc. All rights reserved.

2011 American Journal of Medicine

254. Congestive Heart Failure and Pulmonary Edema (Diagnosis)

shows an enlarged cardiac silhouette and edema at the lung bases, signs of acute heart failure. Signs and symptoms Signs and symptoms of heart failure include the following: Exertional dyspnea and/or dyspnea at rest Orthopnea Acute pulmonary edema Chest pain/pressure and palpitations Tachycardia Fatigue and weakness Nocturia and oliguria Anorexia, weight loss, nausea Exophthalmos and/or visible pulsation of eyes Distention of neck veins Weak, rapid, and thready pulse Rales, wheezing S 3 gallop (...) deleterious. In the case of infective endocarditis, the additional valvular damage that ensues may precipitate cardiac decompensation. Patients with heart failure, particularly when confined to bed, are at high risk of developing pulmonary emboli, which can increase the hemodynamic burden on the right ventricle (RV) by further elevating RV systolic pressure, possibly causing fever, tachypnea, and tachycardia. Intense, prolonged physical exertion or severe fatigue, such as may result from prolonged travel

2014 eMedicine Emergency Medicine

255. Congestive Heart Failure and Pulmonary Edema (Follow-up)

ejection fraction and angina have demonstrated symptomatic and survival improvement with coronary artery bypass grafting (CABG) in studies; however, the trials did not include individuals with heart failure or those with severely reduced ejection fractions. [ ] In patients with angina and ventricular dysfunction, evaluation with coronary angiography should not be delayed (see ). Noninvasive cardiac testing is not recommended in patients with significant ischemic chest pain, as revascularization (...) fraction but without angina, it has not yet been determined whether routine evaluation of possible myocardial ischemia/viability and coronary artery disease should be performed. [ ] For patients with heart failure from LV dysfunction without chest pain and without a history of coronary artery disease, coronary angiography may be useful in young patients to exclude congenital coronary anomalies. However, because clinical outcomes have not been shown to improve in patients without angina, coronary

2014 eMedicine Emergency Medicine

256. Congestive Heart Failure and Pulmonary Edema (Treatment)

ejection fraction and angina have demonstrated symptomatic and survival improvement with coronary artery bypass grafting (CABG) in studies; however, the trials did not include individuals with heart failure or those with severely reduced ejection fractions. [ ] In patients with angina and ventricular dysfunction, evaluation with coronary angiography should not be delayed (see ). Noninvasive cardiac testing is not recommended in patients with significant ischemic chest pain, as revascularization (...) fraction but without angina, it has not yet been determined whether routine evaluation of possible myocardial ischemia/viability and coronary artery disease should be performed. [ ] For patients with heart failure from LV dysfunction without chest pain and without a history of coronary artery disease, coronary angiography may be useful in young patients to exclude congenital coronary anomalies. However, because clinical outcomes have not been shown to improve in patients without angina, coronary

2014 eMedicine Emergency Medicine

257. Congestive Heart Failure and Pulmonary Edema (Overview)

shows an enlarged cardiac silhouette and edema at the lung bases, signs of acute heart failure. Signs and symptoms Signs and symptoms of heart failure include the following: Exertional dyspnea and/or dyspnea at rest Orthopnea Acute pulmonary edema Chest pain/pressure and palpitations Tachycardia Fatigue and weakness Nocturia and oliguria Anorexia, weight loss, nausea Exophthalmos and/or visible pulsation of eyes Distention of neck veins Weak, rapid, and thready pulse Rales, wheezing S 3 gallop (...) deleterious. In the case of infective endocarditis, the additional valvular damage that ensues may precipitate cardiac decompensation. Patients with heart failure, particularly when confined to bed, are at high risk of developing pulmonary emboli, which can increase the hemodynamic burden on the right ventricle (RV) by further elevating RV systolic pressure, possibly causing fever, tachypnea, and tachycardia. Intense, prolonged physical exertion or severe fatigue, such as may result from prolonged travel

2014 eMedicine Emergency Medicine

258. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

to lymphoedema. 49 The most important method of spread to bone is via the circulatory system, particularly the venous system. 11 The retrograde venous route is probably the most important cause of metastasis to vertebrae. 11 There is a communication between veins of the breast and the plexus of Batson in the thoracic region and therefore cancers of the breast and lungs often metastasise to thoracic vertebrae. 11 Lungs drain their blood through pulmonary veins to the left side of the heart, which can (...) result from pathological fractures. 10,59 Pain is usually sharp, shooting or stabbing in nature 59 and often radiates towards limb, chest or upper abdomen. 18 An intense or burning type of pain is felt when a nerve root is impeded by intradural extramedullary metastases. 59 Motor dysfunction is the second most commonly found clinical manifestation in patients with spinal metastasis. 10,59 It is estimated that approximately 35–75% of patients will present with this dysfunction. 10 Again this happens

2013 NIHR HTA programme

259. Usefulness of computed tomographic coronary angiography in patients with acute chest pain with and without high-risk features (Abstract)

Usefulness of computed tomographic coronary angiography in patients with acute chest pain with and without high-risk features The accuracy of 64-slice computed tomographic coronary angiography (CTA) and its ability to direct revascularization in patients with acute chest pain syndrome (ACPS) was investigated. A total of 107 patients with ACPS presenting to the emergency department and referred to cardiology were prospectively enrolled and underwent CTA. From the clinical features, the patients (...) were categorized as having high-risk acute coronary syndrome features or no high-risk features. At the treating physician's discretion, the patients underwent risk stratification with either invasive coronary angiography (ICA) or technetium-99m single photon emission computed tomography. All tests were interpreted by experts unaware of the clinical information. All 52 patients with high-risk acute coronary syndrome features underwent ICA. Of the 55 patients with no high-risk features, 36 underwent

2010 EvidenceUpdates

260. Novel Risk Markers and Risk Assessments for Cardiovascular Disease. Full Text available with Trip Pro

in a separate cohort in most cases. Risk markers related to atherosclerosis, thrombosis, inflammation, cardiac injury, and fibrosis are introduced in the context of their pathophysiology. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. Subsequently the prognostic ability of these risk markers in coronary artery disease, heart failure, and atrial fibrillation is discussed in detail.© 2017 American Heart Association, Inc. (...) Novel Risk Markers and Risk Assessments for Cardiovascular Disease. The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk

2017 Circulation Research

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