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Coronary Risk Stratification of Chest Pain

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101. AIM Clinical Appropriateness Guidelines for Genetic Testing for Hereditary Cardiac Disease

disease sufficient to cause global systolic dysfunction (Haas 2015). The symptoms of DCM are similar to heart failure including shortness of breath, chest pain/tightness, fainting episodes and cardiac arrhythmias. The most serious complication of DCM is sudden, irregular heart rhythms that can be life threatening. Some individuals with DCM will have no symptoms throughout their lifetime. DCM is a heterogeneous condition caused by ischemia, systemic disease (e.g. mitochondrial or muscular dystrophy (...) , Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm. 2019 May 9.pii:S1547-5271. PubMed PMID: 31078652. Selected References 1 Arbustini E, Weidemann F, Hall JL. Left ventricular noncompaction: a distinct cardiomyopathy or a trait shared by different cardiac diseases? J Am Coll Cardiol. 2014 Oct

2020 AIM Specialty Health

102. Updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension Full Text available with Trip Pro

and echocardiography. If these investigations suggest the presence of PH/PHVD, chest X-ray and/or chest CT should be considered, followed by additional investigations. If PH/PHVD is severe, and the patient presents severely ill in overt heart failure and/or pulmonary vascular crisis, cardiac catheterization may be postponed and pharmacotherapy including intravenous prostanoids started immediately. CPET, cardiopulmonary exercise testing; CT, computed tomography; CTEPH, chronic thromboembolic pulmonary hypertension (...) , RP et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J . 2019 ; 53 , x 6 Lammers, AE, Apitz, C, Zartner, P et al. Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart . 2016

2019 International Society for Heart and Lung Transplantation

103. Stratification Protocols and Clinical, Physical and Biochemical Parameters to Forecast Cardiovascular Intercurrences.

will be stratified like less, medium and high cardiovascular risk. There will be used protocols of the organizations below: American College of Sports Medicine, Sociedade Brasileira de Cardiologia, American Heart Association, Frederic J. Pashkow protocol, American Association of Cardiovascular and Pulmonary Rehabilitation, Société Française de Cardiologie and Sociedad Española de Cardiología Cardiovascular signals [ Time Frame: 6 months ] Signals like pulse rate changes, increased SBP and DBP during exercise (...) effects, cardiovascular rehabilitation programs (CVRP) have been associated with the appearance of signs and symptoms. Risk stratification protocols are used to stratify into risk trials for an occurrence of events during physical exercise, although studies investigating their efficacy in predicting signs and symptoms during VCTV are inconclusive. In addition, several clinical, physical and biochemical parameters have been used in the literature as risk markers for the appearance of adverse events

2018 Clinical Trials

104. Opioid Treatments for Chronic Pain

, Pharm.D. Judith Turner, Ph.D. Ian Blazina, M.P.H. Brian Chan, M.D. Ximena Levander, M.D. Marian McDonagh, Pharm.D. Shelley Selph, M.D., M.P.H. Rongwei Fu, Ph.D. Miranda Pappas, M.A. AHRQ Publication No. 20-EHC011 April 2020 ii Key Messages Purpose of Review To assess the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies Key Messages • Opioids are associated with small improvements versus placebo in pain (...) The purpose of this review is to update the 2014 AHRQ report 7 on opioids for chronic pain. This update includes new evidence for questions covered in the 2014 AHRQ report, including efficacy and harms, comparisons with nonopioid therapies, dosing strategies, dose-response relationships, risk mitigation strategies, discontinuation and tapering of opioid therapy, and population differences. This review is one of three concurrent AHRQ systematic reviews on treating chronic pain; the other reviews address

2020 Effective Health Care Program (AHRQ)

105. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group Full Text available with Trip Pro

considered for sections pertaining to risk mitigation and complications. Keywords used to address guideline topics were tailored to individual questions and included ‘facet’, ‘low back pain’, ‘zygapophysial’, ‘zygapophyseal’, ‘radiofrequency’, ‘denervation’, ‘ablation’ and ‘arthritis’. Conclusions for each topic were graded on a scale from A to D, or as insufficient, according to the US Preventative Services Task Force grading of evidence guidelines, with the level of certainty rated as high, medium (...) and risks. This position appears to be supported by interventional pain researchers since the inclusion criteria within prospective studies of facet joint interventions usually, but not always, include a preceding trial of conservative treatment. Yet, there is no existing evidence that demonstrates the appropriate timing or optimal duration of conservative treatments for chronic LBP. Rationale for continued or concurrent conservative care and PT and clinical trials A common rationale for combined

2020 American Society of Regional Anesthesia and Pain Medicine

106. Novel Biomarkers: Utility in Patients with Acute Chest Pain and Relationship to Coronary Artery Disease on Coronary CT Angiography Full Text available with Trip Pro

Novel Biomarkers: Utility in Patients with Acute Chest Pain and Relationship to Coronary Artery Disease on Coronary CT Angiography Acute chest pain remains one of the most common patient presentations encountered in the emergency department. With the evolution of biomarkers and improvement in cardiac imaging there has been advancement in risk stratification of patients, but millions of dollars continue to be spent in the assessment of chest pain. Investigators have explored possible comparative (...) alternatives to the traditional work up of chest pain. In this review, we will discuss the current state of biomarker use in the evaluation of acute chest pain. We will review established and emerging circulating biomarkers and their addition to cardiac CT for appropriate diagnosis of coronary artery disease.

2014 Current cardiovascular imaging reports

107. Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry. Full Text available with Trip Pro

Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry. Symptom-based pretest probability scores that estimate the likelihood of obstructive coronary artery disease (CAD) in stable chest pain have moderate accuracy. We sought to develop a machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS (...) for all comparisons. CACS, age, and gender were the highest ranking features.A ML model incorporating clinical features in addition to CACS can accurately estimate the pretest likelihood of obstructive CAD on CCTA. In clinical practice, the utilization of such an approach could improve risk stratification and help guide downstream management.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

2019 European Heart Journal

108. BTS Guidelines for the outpatient management of pulmonary embolism

antagonists Online appendices Online appendix 1: Clinical questions and Literature Search details Online appendix 2: Evidence tables Online appendix 3: Example of Patient information Online appendices are available at www.brit-thoracic. org.uk i ABBREVIATIONS USED IN THIS GUIDELINE cTnl Cardiac troponin I cTnT Cardiac troponin T CTPA Computerised Tomography Pulmonary Angiogram DOAC Direct Oral Anticoagulant DVT Deep Vein Thrombosis HASBLED Bleeding Risk scoring system HIT Heparin induced thrombocytopenia (...) BTS Guidelines for the outpatient management of pulmonary embolism Thorax An international journal of RESPIRATORY MEDICINE thorax.bmj.com July 2018 Volume 73 Supplement 2 BRITISH THORACIC SOCIETY GUIDELINE FOR THE INITIAL OUTPATIENT MANAGEMENT OF PULMONARY EMBOLISM British Thoracic Society Outpatient Management of Pulmonary Embolism Guideline Development GroupHealthcare providers need to use clinical judgement, knowledge and expertise when deciding whether it is appropriate to apply

2018 British Thoracic Society

109. Pulmonary Embolism Diagnosis and Treatment

a short in-hospital observation period. The recent American College of Chest Physicians Guidelines (2016) suggest treatment at home or early discharge over standard discharge for patients with low-risk PE (2B recommendation). Many physicians still have concerns regarding the outpatient treatment or early discharge of low-risk PE patients (Singer 2016). The purpose of this guideline is five-fold: • Provide an evidence-based approach to the diagnosis and management of acute pulmonary embolism (...) of this guideline, the recommendations for treatment of pulmonary embolism (see p. 9) can also be applied to patients with DVT. Symptoms of pulmonary embolism • Pleuritic chest pain • Shortness of breath • Dyspnea • Tachycardia • Hypoxemia Abbreviations ACCP American College of Chest Physicians PERC Pulmonary Embolism Rule-out Criteria DOACs Direct oral anticoagulants PESI Pulmonary Embolism Severity Index DVT Deep vein thrombosis SSPE Subsegmental pulmonary embolism LMWH Low molecular weight heparin UFH

2017 Kaiser Permanente Clinical Guidelines

110. Appropriate Use Criteria: Imaging of the Chest

for cardiac and coronary artery imaging. Please review guidelines for cardiac CT and CCTA. ? Pulmonary embolus is rare in the absence of elevated blood D-dimer levels and certain specific risk factors. Common Diagnostic Indications Indications for chest CTA are contained in general chest, thoracic aorta and great vessel, and pulmonary artery and vein. General Chest Developmental anomalies of the thoracic vasculature ? Examples of congenital thoracic vascular anomalies include but are not limited (...) , depending on the specific clinical indication. Technology Considerations ? In the majority of clinical situations, chest radiographs should be performed prior to advanced imaging with CT, preferably within 30 days of the chest CT exam request. ? CT chest is not appropriate for cardiac and coronary artery imaging. Please see guidelines for cardiac CT and CCTA. ? When the purpose of the study is imaging of the heart, including the coronary arteries, do not request both a chest CT and a dedicated cardiac

2018 AIM Specialty Health

111. Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders. Full Text available with Trip Pro

and cTnT led to their worldwide use as biomarkers for acute myocardial infarction (AMI) beginning more than 30 years ago. Over these years, high sensitivity antibodies (hs-cTnI and hs-cTnT) have been developed. Together with careful determination of history, physical examination, and EKG, determination of serum levels using hs-cTnI and hs-cTnT permits risk stratification of patients presenting in the Emergency Department (ED) with chest pain. With the ability to determine serum levels (...) Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders. Cardiac troponin I (cTnI), the inhibitory-unit, and cardiac troponin T (cTnT), the tropomyosin-binding unit together with the Ca-binding unit (cTnC) of the hetero-trimeric troponin complex signal activation of the sarcomeres of the adult cardiac myocyte. The unique structure and heart myocyte restricted expression of cTnI

2020 Journal of Molecular and Cellular Cardiology

112. Asymptomatic Patient at Risk for Coronary Artery Disease

contrast 2 O X-ray chest 2 ? Fluoroscopy heart 2 ?? Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 4 Asymptomatic Patient at Risk for CAD ASYMPTOMATIC PATIENT AT RISK FOR CORONARY ARTERY DISEASE Expert Panel on Cardiac Imaging: James P. Earls, MD 1 ; Pamela K. Woodard, MD 2 ; Suhny Abbara, MD 3 ; Scott R. Akers, MD 4 ; Philip A. Araoz, MD 5 ; Kristopher Cummings, MD 6 ; Ricardo C. Cury, MD 7 (...) Clinical Condition: Asymptomatic Patient at Risk for Coronary Artery Disease Variant 1: Low risk. Radiologic Procedure Rating Comments RRL* CT coronary calcium 3 In patients with strong family history, this study may be of value. ??? Fluoroscopy heart 2 ?? US echocardiography transthoracic resting 2 O X-ray chest 1 ? CTA coronary arteries with IV contrast 1 ??? MRI heart with stress without and with IV contrast 1 O MRI heart with stress without IV contrast 1 O MRI heart function and morphology without

2013 American College of Radiology

113. Chest Pain

, Precordial Pain From Related Chapters II. Risk Factors See s See III. Epidemiology Acute and Chest Pain are the two most commonly litigated ED claims IV. Precautions No single finding is absolutely pathognomonic nor completely reassuring in Chest Pain presentation Risk stratification, evaluation and management is based on an overall analysis of all clinical data Approach should be based on combination of factors Exam, ekg and s Consider atypical presentations of coronary syndromes in atypical patients (...) (diagnosis) , chest pain , Pain chest , Pain in chest , Thoracic pain , Thorax pain , Chest pain NOS , Nonspecific chest pain , Chest Pain [Disease/Finding] , Pain;chest , pain thoracic , thoracic pain , thorax pain , Pain, Chest , [D]Chest pain (situation) , [D]Chest pain, unspecified (situation) , Chest pain NOS (finding) , [D]Chest pain NOS (situation) , Thorax painful , chest pain or discomfort reported as pain , chest pain or discomfort reported as pain (symptom) , reported chest pain , thoracodynia

2018 FP Notebook

114. Sufentanil citrate (Dzuveo) - Pain

Sufentanil citrate (Dzuveo) - Pain 30 Churchill Place ? Canary Wharf ? London E14 5EU ? United Kingdom An agency of the European Union Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5555 Send a question via our website www.ema.europa.eu/contact © European Medicines Agency, 2018. Reproduction is authorised provided the source is acknowledged. 26 April 2018 EMA/302958/2018 Committee for Medicinal Products for Human Use (CHMP) Assessment report Dzuveo International non-proprietary name (...) for future quality development 15 2.3. Non-clinical aspects 15 2.3.1. Introduction 15 2.3.2. Pharmacology 15 2.3.3. Pharmacokinetics 15 2.3.4. Toxicology 16 2.3.5. Ecotoxicity/environmental risk assessment 17 2.3.6. Discussion on non-clinical aspects 17 2.3.7. Conclusion on non-clinical aspects 18 2.4. Clinical aspects 18 2.4.1. Introduction 18 2.4.1. Pharmacokinetics 22 2.4.2. Pharmacodynamics 23 2.4.3. Discussion on clinical pharmacology 23 2.4.4. Conclusions on clinical pharmacology 24 2.5. Clinical

2018 European Medicines Agency - EPARs

115. Percutaneous endoscopic laser balloon pulmonary vein isolation for atrial fibrillation

electrical stimulation of the atrial walls, which stop contracting as they fibrillate. This causes the ventricle to beat at an irregular and sometimes rapid rate. Patients with AF may be asymptomatic or have palpitations, dizziness, shortness of breath, fatigue and chest pain. 2.2 AF is associated with increased risk of embolic stroke from atrial thrombus, and death. Depending on risk stratification, oral anticoagulation treatment may be indicated. Such treatment is associated with risk of haemorrhage (...) should be done only in units with arrangements for emergency cardiac surgical support. 1.5 Clinicians should enter details about all patients having percutaneous endoscopic laser balloon pulmonary vein isolation for atrial fibrillation onto the UK Central Cardiac Audit Database and review local clinical outcomes. 2 2 Indications and current treatments Indications and current treatments 2.1 Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. It is caused by the uncoordinated

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

116. Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain. (Abstract)

Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain. We sought to determine whether persons with intermediate risk factors for cardiovascular disease presenting to an emergency department with chest pain and chronic kidney disease (CKD) were triaged effectively by chest pain units (CPUs). CPUs evaluate patients with intermediate risk and acute chest pain effectively. CKD is a risk factor for poor outcomes once (...) that CKD is a strong predictor of hospitalization and overall long-term mortality in patients presenting with chest pain to the emergency department. Current risk factor stratification scoring systems should consider CKD as a predictor of increased risk in patients with chest pain.Copyright © 2012. Published by Mosby, Inc.

2012 Translational research : the journal of laboratory and clinical medicine

117. How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain? (Abstract)

How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain? To investigate the prognostic utility of Heart Foundation (Australia) risk stratification table in an ED chest pain population.A planned sub-study of a prospective observational study of adult patients with potentially cardiac chest pain who underwent evaluation for acute coronary syndrome (ACS) was conducted. Data collected included demographical, clinical, ECG, biomarker (...) ; 109 had MI (14.2%, 95% confidence interval [CI] 11.9-16.8%). There were 88 MACE at 7 days (13.5%, 95% CI 11.1-16.4%) and 93 MACE at 30 days (14.4%%, 95% CI 11.9-17.3%). Diagnostic performance (c-statistic) of the National Heart Foundation risk classification for ACS, MI, 7 and 30 day MACE was 0.74 for each (95% CI 0.71-0.77). Although sensitivity of the high-risk classification for MI, 7 and 30 day MACE was high (99-100%), specificity was low (48-50%).The Heart Foundation risk classification shows

2012 Emergency medicine Australasia

118. Management of Heart Failure (4th Edition)

(CABG) or percutaneous coronary intervention (PCI)) should be considered in patients with HF and suitable coronary anatomy. Key message 7: Asymptomatic LV Dysfunction ? Identify patients who are at high risk of developing LV dysfunction and treat the underlying disease appropriately. ? ACE-I and ß-blockers (post MI) have been shown to slow down the onset of symptoms and reduce cardiac morbidity. Key message 8:Heart Failure with Preserved LV Function (HFpEF) ? HFpEF is a common cause of HF (...) bypass graft (CABG) or percutaneous coronary intervention (PCI)) should be considered in patients with HF and suitable coronary anatomy. Key message 7: Asymptomatic LV Dysfunction ? Identify patients who are at high risk of developing LV dysfunction and treat the underlying disease appropriately. ? ACE-I and ß-blockers (post MI) have been shown to slow down the onset of symptoms and reduce cardiac morbidity. Key message 8:Heart Failure with Preserved LV Function (HFpEF) ? HFpEF is a common cause

2019 Ministry of Health, Malaysia

119. Heart Disease and Stroke Statistics Full Text available with Trip Pro

Cardiac Arrest, Ventricular Arrhythmias, and Inherited Channelopathies e377 18. Subclinical Atherosclerosis e401 19. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris e415 20. Cardiomyopathy and Heart Failure e438 21. Valvular Diseases e455 22. Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism), Chronic Venous Insufficiency, Pulmonary Hypertension e472 23. Peripheral Artery Disease and Aortic Diseases e481 Outcomes 24. Quality of Care e497 25. Medical Procedures (...) % (15.5%, 16.2%). According to national Medicare data from July 2015 through June 2016, the median (interquartile range) hospital risk-standardized mortality rate for HF was 11.6% (10.8%, 12.4%), and the median (interquartile range) risk-standardized 30-day readmission rate was 21.4% (20.8%, 22.1%). Medical Procedures (Chapter 25) Data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database indicate that a total of 159 869 procedures involved isolated coronary artery bypass grafting

2019 American Heart Association

120. AIM Clinical Appropriateness Guidelines for Genetic Testing for Hereditary Cardiac Disease

Dilated cardiomyopathy (DCM) is characterized by enlargement of the left ventricle of the heart and systolic impairment, in the absence of abnormal loading conditions or coronary artery disease sufficient to cause global systolic dysfunction (Haas 2015). The symptoms of DCM are similar to heart failure including shortness of breath, chest pain/tightness, fainting episodes and cardiac arrhythmias. The most serious complication of DCM is sudden, irregular heart rhythms that can be life threatening. Some (...) Rights Reserved. 9 genes) or targeted (LMNA and SCN5A) DCM genetic testing for patients with DCM and significant cardiac conduction disease (i.e. first, second or third degree heart block) and/or family history of premature unexplained death. In addition, they state that genetic testing can be useful for patients with familial DCM to confirm diagnosis, to recognize those who are at highest risk of arrhythmia and syndromic features, to facilitate cascade screening within the family and to help

2019 AIM Specialty Health

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