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Diamond and Forrester Chest Pain Prediction Rule

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1. Diamond and Forrester Chest Pain Prediction Rule

Diamond and Forrester Chest Pain Prediction Rule Diamond and Forrester Chest Pain Prediction Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Diamond and Forrester Chest Pain Prediction Rule Diamond and Forrester Chest Pain Prediction Rule Aka: Diamond and Forrester Chest Pain Prediction Rule From Related Chapters II. Criteria Substernal Exertional relieved with rest III. Interpretation Typical : 3 criteria from above Age 30-39: 76% likelihood (intermediate) in men and 26% in women (intermediate) Age 40-49: 87% likelihood (high) in men and 55% in women (intermediate) Age 50-59: 93% likelihood (high) in men and 73% in women

2018 FP Notebook

2. Diamond and Forrester Chest Pain Prediction Rule

Diamond and Forrester Chest Pain Prediction Rule Diamond and Forrester Chest Pain Prediction Rule Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer (...) Administration 4 Diamond and Forrester Chest Pain Prediction Rule Diamond and Forrester Chest Pain Prediction Rule Aka: Diamond and Forrester Chest Pain Prediction Rule From Related Chapters II. Criteria Substernal Exertional relieved with rest III. Interpretation Typical : 3 criteria from above Age 30-39: 76% likelihood (intermediate) in men and 26% in women (intermediate) Age 40-49: 87% likelihood (high) in men and 55% in women (intermediate) Age 50-59: 93% likelihood (high) in men and 73% in women

2015 FP Notebook

3. Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease

in terms of outcomes [25,43]. In addition, the use of stress MPI improved clinical decision making for chest pain patients [44]. CT Coronary Calcium CCS can be used as a diagnostic tool when evaluating patients with chest pain [45]. In patients presenting with stable angina, a positive CCS score is more accurate than clinical risk stratification tools, such as the Diamond Forrester risk stratification tool, for determining which patients have CAD [46]. CCS is also predictive of which patients may have (...) , et al. A comparison of Diamond Forrester and coronary calcium scores as gatekeepers for investigations of stable chest pain. Int J Cardiovasc Imaging 2013;29:1547-55. 47. Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology 2012;264:637-49. 48. Kim YJ, Hur J, Lee HJ, et al. Meaning of zero coronary calcium score in symptomatic patients referred for coronary computed tomographic angiography. Eur Heart J

2018 American College of Radiology

4. Triple rule-out computed tomography for risk stratification of patients with acute chest pain. (PubMed)

" if it revealed clinically significant cardiovascular disease including obstructive coronary artery disease, pulmonary thromboembolism, or acute aortic syndrome. The clinical endpoint was occurrence of a major adverse cardiovascular event (MACE) within 30 days, defined by a composite of all cause death, myocardial infarction, revascularization, major cardiovascular surgery, or thrombolytic therapy. Clinical risk scores for acute chest pain including TIMI, GRACE, Diamond-Forrester, and HEART were determined (...) Triple rule-out computed tomography for risk stratification of patients with acute chest pain. Clinical evidence supporting triple rule-out computed tomography (TRO-CT) for rapid screening of cardiovascular disease is limited. We investigated the clinical value of TRO-CT in patients with acute chest pain.We retrospectively enrolled 1024 patients who visited the emergency department (ED) with acute chest pain and underwent TRO-CT using a 128-slice CT system. TRO-CT was classified as "positive

2016 Journal of cardiovascular computed tomography

5. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. (PubMed)

A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. The aim was to validate, update, and extend the Diamond-Forrester model for estimating the probability of obstructive coronary artery disease (CAD) in a contemporary cohort.Prospectively collected data from 14 hospitals on patients with chest pain without a history of CAD and referred for conventional coronary angiography (CCA) were used. Primary outcome was obstructive CAD, defined (...) as ≥ 50% stenosis in one or more vessels on CCA. The validity of the Diamond-Forrester model was assessed using calibration plots, calibration-in-the-large, and recalibration in logistic regression. The model was subsequently updated and extended by revising the predictive value of age, sex, and type of chest pain. Diagnostic performance was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) and reclassification was determined. We included 2260 patients

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2011 European Heart Journal

6. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication

impairment, and anatomic factors. Invasive treatments for IC should provide predictable functional improvements with reasonable durability. A minimum threshold of a >50% likelihood of sustained efficacy for at least 2 years is suggested as a benchmark. Anatomic patency (freedom from restenosis) is considered a prerequisite for sustained efficacy of revascularization in IC. Endovascular approaches are favored for most candidates with aortoiliac disease and for selected patients with femoropopliteal (...) | | | as additional factors associated with the onset of PAD. Elevated markers of inflammation, including high-sensitivity C-reactive protein, interleukin-6, fibrinogen, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, asymmetric dimethylarginine, β-2 macroglobulin, and cystatin C are novel risk factors whose clinical utility for predicting PAD onset or progression is not yet clear. x 23 Ridker, P.M., Buring, J.E., Shih, J., Matias, M., and Hennekens, C.H. Prospective study

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2015 Society for Vascular Surgery

7. Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

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 (...) Patterns of Symptom Presentation in Women Both the 2005 document and previous reviews recognize that for women and men, the most common presentation of myocardial ischemia is chest pain or discomfort; however, along the spectrum of ischemic symptoms, women have a different pattern and distribution of non–chest-related pain symptoms. Compared with men, women’s ischemic symptoms are more often precipitated by mental or emotional stress and less frequently by physical exertion. Studies that have

2014 American Heart Association

8. Diagnosis and Management of Bronchiolitis Obliterans Syndrome: An Official ATS/ERS/ISHLT Clinical Practice Guideline

is usually performed to identify the likely cause. 9) Routine postero-anterior and lateral chest radiographs are neither sensitive nor specific for diagnosing BOS. 10) The findings of air trapping with expiratory views and/or mosaic attenuation patterns on HRCT imaging of the thorax support the presence of BOS, but lack sensitivity and specificity. 11) Thoracic imaging assists in making a diagnosis of BOS by ruling out other causes of allograft function decline. 12) Surveillance bronchoscopy can safely (...) gain ii) Abdominal distention iii) Hyperinflation of native lung in SLT for emphysema iv) Pleural complications 1. Pneumothorax 2. Pleural effusion 3. Pleural fibrosis 4. Bronchopleural fistula c) Impaired graft inflation i) Pain (vertebral fracture, fracture of ribs and/or sternum) ii) Ventilatory compromise 1. Diaphragmatic dysfunction or paralysis 2. Chest wall myopathy iii) Other (cerebrovascular accident, Parkinson’s disease, etc.) d) Drug reaction (e.g. sirolimus, everolimus and amiodarone) e

2014 American Thoracic Society

9. Management of Stable Coronary Artery Disease

assigned is indicative of the maximum limitation and that the patient may do better on other days. Patientswith chest pain are often seenin generalpractice. Applying a well-validated prediction rule containing the ?ve determinants [viz. age/sex (male= 55 years, female= 65 years); known vascular disease; patient assumes pain is of cardiac origin; pain is worse during exercise and pain is not reproducible by palpation: one point for each determinant] leads to accurate ruling-out of CAD at a speci?city (...) of stable coronary artery disease. 2956 Table 4 Traditional clinical classi?cation of chest pain 2957 Table 5 Classi?cation of angina severity according to the Canadian Cardiovascular Society 2958 Table 6 Traditional clinical classi?cation of chest pain 2959 Table 7 Blood tests for routine re-assessment in patients with chronic stable coronary artery disease 2959 Table 8 Resting electrocardiogram for initial diagnostic assessment of stable coronary artery disease 2960 Table 9 Echocardiography 2960 Table

2013 European Society of Cardiology

10. Using clinical risk scores wisely

, a negative D-dimer test in a patient with a low pre-test probability score usually negates the need for further testing. Similarly, " " discusses the use of the Diamond and Forrester score to calculate the pre-test probability of coronary artery disease (CAD) in patients with chest pain. Exercise stress testing provides the highest diagnostic utility in patients with an intermediate pre-test probability for CAD; low risk patients with negative cardiac enzymes typically require no further testing (...) risk scores for patients on anticoagulation. " " discusses the importance of ruling out pulmonary embolism (PE), the most common life-threatening cause of pleuritic chest pain. The authors advocate for using a validated risk score in patients presenting with pleuritic chest pain to guide decisions about testing for PE; one of the reference articles describes several available validated risk scores but lists the Wells rule as "widely validated and commonly used;" regardless of the score used

2017 The AFP Community Blog

11. Exercise Standards for Testing and Training

, and during this time additional purposes for testing have evolved. Exercise testing now is used widely for the following: Detection of coronary artery disease (CAD) in patients with chest pain (chest discomfort) syndromes or potential symptom equivalents Evaluation of the anatomic and functional severity of CAD Prediction of cardiovascular events and all-cause death Evaluation of physical capacity and effort tolerance Evaluation of exercise-related symptoms Assessment of chronotropic competence (...) , or exercise physiologist or specialist) for testing apparently healthy younger people (<40 years of age) and those with stable chest pain syndromes. Recent recommendations permit additional flexibility with regard to supervision personnel. Possibly with the exception of young, apparently healthy individuals (eg, exercise testing of athletes), a physician should be immediately available during all exercise tests. For additional details about supervision and interpretation of exercise tests, reference

2013 American Heart Association

12. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization

(10,11): • Low-risk stress test ?ndings: associated with a car- diac mortality of1% per year • Intermediate-risk stress test ?ndings: associated with a 1% to 3% per year cardiac mortality • High-risk stress test ?ndings: associated with a3% per year cardiac mortality Symptomatic/Ischemic Equivalent: Chest Pain Syn- drome, Anginal Equivalent, or Ischemic Electrocardio- gram (ECG) Abnormalities: Any constellation of clinical ?ndings that the physician believes is consistent with CAD manifestations (...) . Examples of such ?ndings include, but are not limited to, chest pain, chest tightness, chest burning, shoulder pain, left arm pain, jaw pain, new ECG abnor- malities, or other symptoms/?ndings suggestive of CAD. Clinical presentations in the absence of chest pain (e.g., dyspnea with exertion or reduced/worsening effort toler- ance) that are thought to be consistent with CAD may also be considered to be an ischemic equivalent. Clinical Classi?cation of Chest Pain: • Typical Angina (De?nite): de?ned as 1

2012 Society for Cardiovascular Angiography and Interventions

13. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

status. (1B) Troponins 4.2.2: In people with GFRo60ml/min/1.73 m 2 (GFR categories G3a-G5), we recommend that serum concentrations of troponin be interpreted with caution with respect to diagnosis of acute coronary syndrome. (1B) Kidney International Supplements (2013) 3, 5–14 11 summary of recommendation statementsNon-invasive testing 4.2.3: We recommend that people with CKD presenting with chest pain should be investigated for underlying cardiac disease and other disorders according to the same (...) and context 15 Chapter 1: Definition, and classification of CKD 19 Chapter 2: Definition, identification, and prediction of CKD progression 63 Chapter 3: Management of progression and complications of CKD 73 Chapter 4: Other complications of CKD: CVD, medication dosage, patient safety, infections, hospitalizations, and caveats for investigating complications of CKD 91 Chapter 5: Referral to specialists and models of care 112 Methods for Guideline Development 120 Biographic and Disclosure Information 128

2012 National Kidney Foundation

14. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

. . . . . . . . . . . . . . . . .e362 1.6. Magnitude of the Problem. . . . . . . . . . . . . . . .e363 1.7. Organization of the Guideline. . . . . . . . . . . . . .e364 1.8. Vital Importance of Involvement by an Informed Patient: Recommendation. . . . . . . . .e364 2. Diagnosis of SIHD. . . . . . . . . . . . . . . . . . . . . . . . . .e367 2.1. Clinical Evaluation of Patients With Chest Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . .e367 2.1.1. Clinical Evaluation in the Initial Diagnosis of SIHD in Patients (...) With Chest Pain: Recommendations. . . . . . . .e367 2.1.2. History. . . . . . . . . . . . . . . . . . . . . . . . . .e367 2.1.3. Physical Examination. . . . . . . . . . . . . . .e368 2.1.4. Electrocardiography. . . . . . . . . . . . . . . .e368 2.1.4.1. Resting Electrocardiography to Assess Risk: Recommendation. . . . . . . . . . .e369 2.1.5. Differential Diagnosis. . . . . . . . . . . . . .e370 2.1.6. Developing the Probability Estimate. . .e370 2.2. Noninvasive Testing for Diagnosis of IHD. . . .e371

2011 American Heart Association

15. Treatment of Fungal Infections in Adult Pulmonary, Critical Care, and Sleep Medicine: An Official ATS Statement

to Histoplasma capsulatum depends on the intensity of exposure, as well as the immunestatusandunderlyinglungarchitectureofthehost,and playsamajorroleintreatmentdecisions(Table3).Thechronic manifestations of healed histoplasmosis will be brie?y men- tioned and, as a rule, do not require speci?c antifungal therapy. Inallinstances,severeprogressivedisseminateddisease,aswell as CNS involvement, require initial treatment with amphoter- icin B, while mild to moderate disease can usually be treated (...) ) and associated chest adenopathy, recent infection is presumed and treatment with antifungal agents may be warranted depending on disease severity, as discussed below for the immunocompetent host. Broncholithiasis Broncholithiasis occurs when calci?ed lymph nodes erode into the airway, causing symptoms of dyspnea, wheezing, or hemop- tysis. Many times these are managed conservatively and the patient may spontaneously cough the broncholith out of the airway. In instances in which the patient requires

2011 American Thoracic Society

17. Coronary Artery Atherosclerosis (Follow-up)

and Forrester Chest Pain Prediction Rule: For example, in patients with suspected CAD using the new criteria, if the PTP is < 15%, investigate other possible causes and consider a diagnosis of functional coronary disease; if the PTP is intermediate (eg, 15%-85%), send the patient for noninvasive testing; if the PTP is high (eg, >85%), a diagnosis of CAD is established, and patient risk stratification should follow In stable CAD, the functional impact of coronary lesions relative to their angiographic (...) prevention in women with heart disease: the Heart and Estrogen/progestin Replacement Study. Ann Intern Med . 2003 Jan 21. 138(2):81-9. . Pullen LC. Coronary CT Angiography Predicts Cardiovascular Risk. Medscape Medical News . Dec 6 2013. . Conti A, Poggioni C, Viviani G, Luzzi M, Vicidomini S, Zanobetti M, et al. Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram. Am J Emerg Med . 2012 Mar 16. . Paynter NP

2014 eMedicine.com

18. Coronary Artery Atherosclerosis (Treatment)

and Forrester Chest Pain Prediction Rule: For example, in patients with suspected CAD using the new criteria, if the PTP is < 15%, investigate other possible causes and consider a diagnosis of functional coronary disease; if the PTP is intermediate (eg, 15%-85%), send the patient for noninvasive testing; if the PTP is high (eg, >85%), a diagnosis of CAD is established, and patient risk stratification should follow In stable CAD, the functional impact of coronary lesions relative to their angiographic (...) prevention in women with heart disease: the Heart and Estrogen/progestin Replacement Study. Ann Intern Med . 2003 Jan 21. 138(2):81-9. . Pullen LC. Coronary CT Angiography Predicts Cardiovascular Risk. Medscape Medical News . Dec 6 2013. . Conti A, Poggioni C, Viviani G, Luzzi M, Vicidomini S, Zanobetti M, et al. Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram. Am J Emerg Med . 2012 Mar 16. . Paynter NP

2014 eMedicine.com

19. Myocardial Ischemia - Nuclear Medicine and Risk Stratification

, 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 (...) with these questions: (1) Is the pain retrosternal? (2) Is the pain precipitated by stress? (3) Is the pain relieved by rest or nitroglycerin? Patients who answer yes to all 3 questions are determined to have typical chest pain. Patients who answer yes to 2 of the questions have atypical chest pain, and patients who answer yes to only 1 question have nonanginal chest pain. Diamond and Forrester’s findings showed a large difference in the rates of angiographically significant CAD according to chest pain category

2014 eMedicine Radiology

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