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Coronary Risk Stratification of Chest Pain

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101. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg . 1999;118(5):866-873. doi: Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr . 2003;27(1):1-9. doi: Lee EH, Kim WJ, Kim JY, et al. Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery (...) . 2018;105(1):321-328. doi: Day TG, Perring RR, Gofton K. Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery? Interact Cardiovasc Thorac Surg . 2008;7(5):888-890. doi: Halm MA. To strip or not to strip? physiological effects of chest tube manipulation. Am J Crit Care . 2007;16(6):609-612. Boyacıoğlu K, Kalender M, Özkaynak B, Mert B, Kayalar N, Erentuğ V. A new use of Fogarty catheter: chest tube clearance. Heart Lung Circ . 2014;23(10):e229-e230. doi: Grieshaber P, Heim

2020 ERAS Society

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. 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

105. 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

106. 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

107. 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

108. 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

109. 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

110. 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

111. 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

112. 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

113. 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

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. 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

116. 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

117. 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

118. AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart.

evaluation for coronary artery disease within the preceding one (1) year Suspected coronary artery disease in symptomatic patients who have not had evaluation of coronary artery disease (MPI, stress echo, cardiac PET, coronary CTA or cardiac catheterization) within the preceding sixty (60) days ? Chest pain ? With intermediate or high pretest probability of CAD (Table 1); OR ? With low or very low pretest probability of CAD (Table 1) and high risk of CAD (SCORE) ? Atypical symptoms: shortness of breath (...) who have not undergone evaluation for coronary artery disease within the preceding one (1) year Suspected coronary artery disease in symptomatic patients who have not had evaluation of coronary artery disease (MPI, stress echo, cardiac PET, coronary CTA or cardiac catheterization) within the preceding sixty (60) days ? Chest pain ? With intermediate or high pretest probability of CAD (Table 1); OR ? With low or very low pretest probability of CAD (Table 1) and high risk of CAD (SCORE) ? Atypical

2019 AIM Specialty Health

119. Type 2 Diabetes Mellitus and Heart Failure Full Text available with Trip Pro

in the risk of incident HF in men and a 4-fold increase in women, even after adjustment for other cardiovascular risk factors. In patients with known coronary artery disease (CAD) in the Heart and Soul Study, DM was also associated with a higher adjusted risk of incident HF (hazard ratio [HR], 3.34 [95% CI, 1.65–6.76]). The risk of HF associated with DM might be even higher in younger adults and women. DM is also an important predictor of the development of symptomatic HF in patients with asymptomatic (...) (95% CI, 1.51–2.28) Similar in men and women … Retrospective cohort of Kaiser Permanente Northwest Database 8231 +DM, 8845 no DM Up to 6 rates (person-years): DM: 30.9/1000 No DM: 12.4/1000 Rate ratio, 2.5 (95% CI, 2.3–2.7) … … CAD indicates coronary artery disease; DM, diabetes mellitus; ellipses (…), not reported; HF, heart failure; HR, hazard ratio; MESA, Multi-Ethnic Study of Atherosclerosis; NHANES, National Health and Nutrition Examination Survey; and RR, relative risk. The risk of HF

2019 American Heart Association

120. Primary Care Corner with Geoffrey Modest MD: Chest pain prediction tool

Primary Care Corner with Geoffrey Modest MD: Chest pain prediction tool Primary Care Corner with Geoffrey Modest MD: Chest pain prediction tool | BMJ EBM Spotlight by by Dr Geoffrey Modest The second article on the ED evaluation of chest pain involved an instrument to predict/stratify cardiac risk, finding it to be quick, reliable and efficient (see doi:10.7326/M16-1600). Details: –Nine Dutch hospitals assessed the HEART instrument prospectively to evaluate unselected patients presenting to EDs (...) with chest pain, in a sequence where every 6 weeks, 1 hospital was randomly switched to using the instrument. Publicly-funded study. –3648 patients (1827 receiving usual care, 1821 HEART care) –Exclusion criteria included evident ST-segment elevation MI. –The HEART score is based on History, Electrocardiogram, Age, Risk Factors, and Troponin levels , with each having a score range of 0-2 (go to for HEART score calculator): –score of 0-3 is low-risk, and the patient was to be discharged with reassurance

2017 Evidence-Based Medicine blog

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