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MRI with MRA in abdominal aortic aneurysm

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41. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary

with a doubling in the risk of death from stroke, heart disease, or other vascular disease. In a separate observational study including >1 million adult patients ≥30 years of age, higher SBP and DBP were associated with increased risk of CVD incidence and angina, myocardial infarction (MI), HF, stroke, peripheral artery disease (PAD), and abdominal aortic aneurysm, each evaluated separately. An increased risk of CVD associated with higher SBP and DBP has been reported across a broad age spectrum, from 30 (...) 9.8. Atrial Fibrillation 1296 9.9. Valvular Heart Disease 1296 9.10. Aortic Disease 1296 10. Special Patient Groups 1296 10.1.1. Racial and Ethnic Differences in Treatment 1296 10.2. Sex-Related Issues 1296 10.2.1. Women 1297 10.2.2. Pregnancy 1297 10.3. Age-Related Issues 1297 10.3.1. Older Persons 1297 11. Other Considerations 1298 11.1. Resistant Hypertension 1298 11.2. Hypertensive Crises—Emergencies and Urgencies 1298 11.3. Cognitive Decline and Dementia 1301 11.4. Patients Undergoing

2017 American Heart Association

42. Prevention, Diagnosis & Management of infective endocarditis

Prosthetic valve endocarditis 106 5.4 Principles of surgery 107 5.4.1 Aortic valve 109 5.4.2 Mitral valve 109 5.4.3 Tricuspid valve 109 5.4.4 Periannular extension 109 5.5 Surgery for infective endocarditis in congenital heart disease 110 5.5.1 Indications for surgery 110 5.5.2 Timing of surgery 111 5.5.3 Surgical techniques 113 6.0 OUTCOME AND FOLLOW-UP 114 7.0 SPECIFIC SITUATIONS 117 7.1 Infective endocarditis in congenital heart disease 117 7.1.1 Epidemiology 117 7.1.2 Mortality 118 7.1.3 Lesion (...) Transcatheter aortic valve implantation/ transcatheter aortic valve replacement 126 7.4 Infective endocarditis in cardiac implantable electronic devices 127 7.5 Infective endocarditis in pregnancy 129 8.0 ANTIMICROBIAL PROPHYLAXIS FOR INFECTIVE ENDOCARDITIS 130 8.1 Introduction 130 8.2 Cardiac conditions associated with the highest risk of infective endocarditis 130 8.3 Antimicr obial pr ophylaxis for specific pr ocedur es 131 8.3.1 Dental procedures 131 8.3.2 Non-dental procedures 132 8.4 Antimicrobial

2017 Ministry of Health, Malaysia

43. Vascular Claudication?Assessment for Revascularization

in a defined population. Circulation. 1985;71(3):510-515. 5. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology (...) Criteria ® Vascular Claudication–Assessment for Revascularization Variant 1: Vascular claudication–assessment for revascularization. Radiologic Procedure Rating Comments RRL* MRA lower extremity without and with IV contrast 8 O CTA lower extremity with IV contrast 8 This procedure is the test of choice in patients who cannot have MRA. ??? US duplex Doppler lower extremity 7 This procedure is useful in patients with contrast allergy or renal dysfunction. O Arteriography lower extremity 7 This procedure

2016 American College of Radiology

44. Chronic Chest Pain - High Probability of Coronary Artery Disease

aortic pathology (eg, dissection, aneurysm, and penetrating ulcer) in patients with chronic chest pain, although CT and MRI are less invasive and simpler to perform. Magnetic resonance imaging Use of MRI for evaluating general cardiac anatomy and function and specific aspects of valvular disease, cardiomyopathies, and myocardial viability is well established. MRI myocardial perfusion techniques can be used to assess for significant CAD. The diagnostic accuracy of stress perfusion MRI has been (...) and inotropic stress without and with IV contrast 7 O MRI heart with function and inotropic stress without IV contrast 7 O MRI heart function and morphology without and with IV contrast 7 O MRA coronary arteries without and with IV contrast 5 O US echocardiography transthoracic resting 4 O MRI heart function and morphology without IV contrast 4 O MRA coronary arteries without IV contrast 4 O CT chest with IV contrast 4 ??? CT chest without IV contrast 4 ??? CT chest without and with IV contrast 4 ??? US

2016 American College of Radiology

45. Hypertrophic Cardiomyopathy

. . . . . . . . . . . . . . . . . . . . . . . . . . .2756 9.1.3.2 Septal alcohol ablation . . . . . . . . . . . . . . . . .2756 9.1.3.3 Surgery vs. alcohol ablation . . . . . . . . . . . . . .2757 9.1.3.4 Minimum activity requirements . . . . . . . . . . . .2757 9.1.3.5 Dual chamber pacing . . . . . . . . . . . . . . . . . .2758 9.2 Left ventricular mid-cavity obstruction and apical aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2759 9.3 Management of symptoms in patients without left ventricular outlow tract obstruction (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . .2771 12.2.1 Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2771 12.2.2 Electrocardiogram . . . . . . . . . . . . . . . . . . . . . .2771 12.3 Isolated basal septal hypertrophy (sigmoid septum) in elderly people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2771 12.4 Diagnosis and management of valve disease in patients with hypertrophic cardiomyopathy . . . . . . . . . . . . . . . . . .2772 12.4.1 Aortic valve disease . . . . . . . . . . . . . . . . . . . . .2772

2014 European Society of Cardiology

46. Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

with CI and all patients with recurrent CI ( 26–28 ) 6. Surgical procedures in which the inferior mesenteric artery (IMA) has been sacri? ced, such as abdominal aortic aneurysm repair and other abdominal operations, should increase consideration of CI in patients with typical clinical features ( 14,29,30 ) 7. In patients suspected of having CI, a history of medication and drug use is important, especially constipation-inducing medications, immunomodulators, and illicit drugs ( 9,15,31 ) Clinical (...) right-colon ischemia; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; WBC, white blood cell count. Typical symptoms of CI with none of the commonly associated risk factors for poorer outcome that are seen in moderate disease* Any patient suspected of CI with up to three of the risk factors associated with poor outcome (listed below).* CT of the abdomen and pelvis Non-IRCI IRCI on CT (or colonoscopy) Consider colonoscopy and biopsy Consider CTA or MRA Vascular occlusion Surgical

2015 American College of Gastroenterology

47. Acute Nonspecific Chest Pain ? Low Probability of Coronary Artery Disease

and Transesophageal Echocardiography Transthoracic and transesophageal echocardiography, with or without pharmacologic stress, are frequently used to define abnormalities of ventricular wall motion as indicators of cardiac disease [39]. In addition, echocardiography can readily demonstrate pericardial effusion, valve dysfunction, and cardiac thrombus. Aortic pathology can be identified [40,41], but the findings of intramural hematoma, dissection, pulmonary embolus, and aneurysm are better seen with MDCT or MRI (...) sequentially. ??? US echocardiography transthoracic resting 7 X-ray, CTA, and US are generally nonoverlapping and can be used sequentially. O Tc-99m SPECT MPI rest and stress 6 ???? Tc-99m V/Q scan lung 5 ??? X-ray rib views 5 ??? MRA chest without and with IV contrast 5 O MRI heart stress perfusion without and with IV contrast 5 This procedure may be appropriate but there was disagreement among panel members on the appropriateness rating as defined by the panel’s median rating. O MRI heart function

2015 American College of Radiology

48. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid (...) were published, the pace of discovery has accelerated. New approaches and improvements in existing approaches are constantly emerging. To help clinicians safeguard past success and drive the rate of secondary stroke even lower, this guideline is updated every 2 to 3 years. Important revisions since the last statement are displayed in . New sections were added for sleep apnea and aortic arch atherosclerosis, in recognition of maturing literature to confirm these as prevalent risk factors

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2014 American Heart Association

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

, including sickle cell disease and patent foramen ovale. (Stroke. 2014;45:3754-3832.) Key Words: AHA Scientific Statements ? atrial fibrillation ? diabetes mellitus ? hyperlipidemias ? hypertension ? intracranial aneurysm ? ischemia ? prevention and control ? smoking ? stroke Guidelines for the Primary Prevention of Stroke A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association The American Academy of Neurology affirms the value of these guidelines (...) %) and then all Hispanics (39.1%), with the lowest rate being among non- Hispanic whites (34.3%). 263–265 A patient’s body mass index (BMI), defined as weight in kilograms divided by the square of the height in meters, is used to distinguish overweight (BMI, 25 to 29 kg/m 2 ) from obesity (BMI >30 kg/m 2 ) and morbid obesity (BMI >40 kg/m 2 ). 266 Men presenting with a waist circumference of >102 cm (40 in) and women with a waist circumference >88 cm (35 in) are catego- rized as having abdominal obesity. 267

2014 American Heart Association

50. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (Secondary Stroke Prevention)

, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use

2014 Congress of Neurological Surgeons

51. Diagnosis and Treatment of Peripheral Artery Diseases

of Trends and Determinants in Cardio- vascular Disease MRA magnetic resonance angiography MRI magnetic resonance imaging NASCET North American Symptomatic Carotid Endarter- ectomy Trial ONTARGET Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial OR odds ratio PAD peripheral artery diseases PARTNERS Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival PCI percutaneous coronary intervention PET positron emission tomography PRO-CAS Predictors (...) of renal artery disease, de?ned as stenosis reducing arterial diameter by=60% or occlu- sion, was 9.1% in men and 5.5% in women. 12 However, much infor- mation on the prevalence of renal artery disease has been derived from studies of patients undergoing coronary angiography or abdominal aortography in which the renal arteries have been imaged. A systematic review of such studies found that between 10% and 50% of patients had renal artery stenosis (RAS) depending on the risk group being examined. 13

2011 European Society of Cardiology

52. Peripheral arterial disease. Diagnosis and management in general practice

km/h, and a 10–12% grade). If a treadmill is not available, then the walking exercise may be performed by climbing stairs or by walking up and down the hallway. 12 Active pedal plantar flexion compares favourably with treadmill exercise and should be considered an appropriate alternative. 12 More detailed anatomical information about PAD may be required to exclude abdominal aortic aneurysm (which can occur in up to 10% of patients with PAD 13 ), or popliteal aneurysm, which might be suggested (...) considered, or if abdominal aortic aneurysm or popliteal aneurysm need to be excluded. Management is focused on lifestyle modification, including smoking cessation and exercise; medical management of atherosclerotic risk factors, including antiplatelet agents, statins, antihypertensive therapy; and agents to improve walking distance, such as cilostazol and ramipril. Endovascular or surgical interventions are usually considered for lifestyle limiting intermittent claudication not responding

2013 Clinical Practice Guidelines Portal

53. Assessment and Management of Foot Ulcers for People with Diabetes, Second Edition

) recommend that persons with new diabetic foot infections have plain radiographs to identify bony abnormalities such as bone deformity or destruction, foreign bodies or soft tissue gas. An abnormal plain radiograph finding can be helpful in the diagnosis of osteomyelitis (Butalia et al., 2008). Magnetic resonance imaging (MRI) is recommended for clients who require additional imaging, especially if soft tissue abscess G or osteomyelitis is suspected (Lipsky et al., 2012). In a meta-analysis conducted (...) by Dinh, Abad and Safdar (2008), MRI was determined to be the most accurate imaging test for diagnosis of osteomyelitis. Furthermore, osteomyelitis was found to be highly unlikely in a client with a normal MRI result (Butalia et al., 2008). If MRI is unavailable or contraindicated, a labeled white blood cell scan is the best alternative (Lipsky et al., 2012). It is important to note that accessibility to and interpretation of these tests may be limited to specific geographic locations and medical

2013 Registered Nurses' Association of Ontario

55. Ataxia

without IV contrast May Be Appropriate O MRI head without IV contrast May Be Appropriate O MRV head without IV contrast May Be Appropriate O MRA head and neck without and with IV contrast May Be Appropriate O MRI head without and with IV contrast May Be Appropriate O CT head with IV contrast Usually Not Appropriate ??? MRV head with IV contrast Usually Not Appropriate O CT temporal bone with IV contrast Usually Not Appropriate ??? CT head without and with IV contrast Usually Not Appropriate ??? CT (...) temporal bone without and with IV contrast Usually Not Appropriate ??? Radiography skull Usually Not Appropriate ? Variant 2: Acute ataxia following recent spine trauma. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT spine area of interest without IV contrast Usually Appropriate Varies CTA neck with IV contrast Usually Appropriate ??? MRI spine area of interest without IV contrast Usually Appropriate O MRA neck with IV contrast May Be Appropriate O MRA neck without IV

2012 American College of Radiology

56. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

),includinglowerextremityperipheralarterydisease (PAD), abdominal aortic aneurysm (AAA), renal and mesen- teric artery disease, and extracranial carotid artery disease. It may serve as a companion to the “2005 ACC/AHA Guide- linesfortheManagementofPatientsWithPeripheralArterial Disease,” 3 the “2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease,” 4 and the “2010 ACCF/AHA Performance Measures for Adults With Peripheral Artery Disease.” 5 Cor- onary artery disease is outside the scope (...) if the patient has a history of aortic aneurysm. This can include ? Thoracic aneurysm ? Thoracoabdominal aneurysm ? AAA Confirmed by ultrasound, CT, and/or MR imaging. History of renal or mesenteric artery disease Indicate if the patient has a history of renal or mesenteric artery disease. This can include an abnormal imaging study such as duplex ultrasonography, MRA, CTA, or catheter-based contrast angiography demonstrating50% diameter stenosis in the renal artery, celiac trunk, SMA, or IMA. TIA 25 Indicate

2012 Society for Cardiovascular Angiography and Interventions

57. Extracranial Carotid and Vertebral Artery Disease: Guideline on the Management of Patients With

Lesions in the Extracranial Carotid Arteries e27 3.3. Symptoms and Signs of Transient Ischemic Attack and Ischemic Stroke e29 3.3.1. Public Awareness of Stroke Risk Factors and Warning Indicators e29 4. Clinical Assessment of Patients With Focal Cerebral Ischemic Symptoms e29 4.1. Acute Ischemic Stroke e29 4.2. Transient Ischemic Attack e29 4.3. Amaurosis Fugax e29 4.4. Cerebral Ischemia Due to Intracranial Arterial Stenosis and Occlusion e30 4.5. Atherosclerotic Disease of the Aortic Arch as a Cause (...) , SVM, and SVS. The AAN af?rms the value of this guideline. 1.4. Anatomy and De?nitions The normal anatomy of the aortic arch and cervical arteries that supply the brain is subject to considerable variation (3). Three aortic arch morphologies are distinguished on the basis of the relationship of the brachiocephalic (innominate) arterial trunk to the aortic arch (Figure 1). The Type I aortic arch is characterized by the origin of all 3 major vessels in the horizontal plane de?ned by the outer

2011 American College of Cardiology

58. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

, the prevalence of ≥60% carotid artery stenosis among patients with abdominal aortic aneurysms (AAA) is <20%. x 52 Deville, C., Kerdi, S., Madonna, F., de la Renaudière, D.F., and Labrousse, L. Infrarenal abdominal aortic aneurysm repair: detection and treatment of associated carotid and coronary lesions. Ann Vasc Surg . 1997 ; 11 : 467–472 | | | | , x 53 Cahan, M.A., Killewich, L.A., Kolodner, L., Powell, C.C., Metz, M., Sawyer, R. et al. The prevalence of carotid artery stenosis in patients undergoing (...) aortic reconstruction. Am J Surg . 1999 ; 178 : 194–196 | | | | | , x 54 Axelrod, D.A., Diwan, A., Stanley, J.C., Jacobs, L.A., Henke, P.K., Greenfield, L.J. et al. Cost of routine screening for carotid and lower extremity occlusive disease in patients with abdominal aortic aneurysms. J Vasc Surg . 2002 ; 35 : 754–758 | | | | | This suggests that screening patients with AAA would have only a modest benefit and only if intervention could be performed with low morbidity and mortality. x 23 Perry, J.R

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2011 Society for Vascular Surgery

59. Guideline on the management of patients with extracranial carotid and vertebral artery disease

significant carotid stenosis may be considered in asymptomatic patients with symptomatic PAD, coro- nary artery disease (CAD), or atherosclerotic aortic aneurysm, but because such patients already have an indication for medical therapy to prevent ischemic symptoms, it is unclear whether establishing the addi- tionaldiagnosisofECVDinthosewithoutcarotidbruit would justify actions that affect clinical outcomes. (Level of Evidence: C) 2. Duplex ultrasonography might be considered to detect carotid stenosis (...) .e67 4.4. Cerebral Ischemia Due to Intracranial Arterial Stenosis and Occlusion .e67 4.5. Atherosclerotic Disease of the Aortic Arch as a Cause of Cerebral Ischemia .e68 4.6. Atypical Clinical Presentations and Neurological Symptoms Bearing an Uncertain Relationship to Extracranial Carotid and Vertebral Artery Disease .e68 5. Diagnosis and Testing .e68 5.1. Recommendations for Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease .e68 5.2. Carotid Duplex

2011 American Academy of Neurology

60. Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease

significant carotid stenosis may be considered in asymptomatic patients with symptomatic PAD, coro- nary artery disease (CAD), or atherosclerotic aortic aneurysm, but because such patients already have an indication for medical therapy to prevent ischemic symptoms, it is unclear whether establishing the addi- tionaldiagnosisofECVDinthosewithoutcarotidbruit would justify actions that affect clinical outcomes. (Level of Evidence: C) 2. Duplex ultrasonography might be considered to detect carotid stenosis (...) .e67 4.4. Cerebral Ischemia Due to Intracranial Arterial Stenosis and Occlusion .e67 4.5. Atherosclerotic Disease of the Aortic Arch as a Cause of Cerebral Ischemia .e68 4.6. Atypical Clinical Presentations and Neurological Symptoms Bearing an Uncertain Relationship to Extracranial Carotid and Vertebral Artery Disease .e68 5. Diagnosis and Testing .e68 5.1. Recommendations for Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease .e68 5.2. Carotid Duplex

2011 Congress of Neurological Surgeons

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