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MRI with MRA in abdominal aortic aneurysm

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41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

51. 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

52. 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

53. 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

54. 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

55. 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

56. 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

57. Autosomal Dominant Polycystic Kidney Disease

of regional structures symptoms VI. Signs With advanced renal or hepatic disease, cyst-related mass effect may be palpable VII. Labs test monitoring tic screening indications Not routinely indicated Young, at risk asymptomatic patients with normal screening Large s with s and no known of ADPKD transplant potential donor who is at risk of ADPKD VIII. Imaging First-Line Renal (effective, lower cost, no radiation) Alternative screening (if non-diagnostic or large body habitus) Abdominal MRI IX. Diagnosis (...) criteria for those at risk of ADPKD Type 1 Age <30 years: 2 or more cysts in one or both s Age 30 to 59 years: 2 or more cysts in each s Age >60 years: 4 or more cysts in each s criteria for those at risk of ADPKD with unknown Age 15 to 39 years: 2 or more cysts in one or both s Age 40 to 59 years: 2 or more cysts in each s Age >60 years: 4 or more cysts in each s MRI criteria for those at risk of ADPKD Age <30 years: 5 or more cysts in each s Age 30 to 44 years: 6 or more cysts in each s Age 45 to 59

2018 FP Notebook

58. Fibromuscular Dysplasia (Overview)

followed later by neck stiffness): May indicate an aneurysm that may be associated with FMD Symptoms suggestive of noncraniocervical FMD, such as hypertension (renal involvement), abdominal pains or a history of ischemic bowel (mesenteric or visceral artery involvement), or intermittent leg claudication (extremity artery involvement) Physical examination should include the following: Thorough neurologic examination Neurovascular examination, including auscultation for carotid and vertebral artery (...) individual known to have FMD Conventional angiography is standard for detecting FMD and its associated vascular lesions Conventional cerebrovascular ultrasonography is unlikely to depict the carotid lesions of FMD The sensitivity and specificity of computed tomography (angiography (CTA), time-of-flight (TOF) magnetic resonance angiography (MRA), or contrast-enhanced MRA (CE MRA) in this setting remain to be established Conventional CT and MRI may be useful in finding ischemic strokes caused by arterial

2014 eMedicine.com

59. Renovascular Hypertension: Surgical Perspective (Follow-up)

, the bypass is connected to the low thoracic aorta and the bifurcation of the iliac arteries. Grafts can also extend from the upper abdominal aorta behind the esophagus to the aortic bifurcation. The appropriate length of graft material must be used so as to allow for growth while avoiding kinking. Placing the graft behind the kidney may help protect the graft. Renal artery bypass grafts may be attached to the aortoaortic bypass graft or to the low aorta. Theoretically, attachment of the renal artery (...) are important in evaluating the patient’s cardiovascular stability under the stress of hypertension. Abdominal aortography and arteriography are necessary, not only to help establish a diagnosis but also to determine the extent of disease and the approach to surgical intervention. Operative approach For unilateral renal artery stenosis, a transverse transperitoneal incision may be used. This allows direct approach to the renal artery. Dissection of the kidney is minimized to limit disruption

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2014 eMedicine Pediatrics

60. Syncope and Related Paroxysmal Spells (Diagnosis)

, congestive heart failure (CHF), lung mass, effusion, or widened mediastinum Computed tomography (CT) of the head (noncontrast) - Has a low diagnostic yield in syncope but may be clinically indicated in patients with new neurologic deficits or in patients with head trauma secondary to syncope CT of the chest and abdomen - Indicated only in select cases (eg, suspected aortic dissection, ruptured abdominal aortic aneurysm, or pulmonary embolism [PE]) Magnetic resonance imaging (MRI) of the brain (...) and magnetic resonance arteriography (MRA) - May be required in select cases to evaluate vertebrobasilar vasculature Ventilation-perfusion (V/Q) scanning - Appropriate for suspected PE Echocardiography - The test of choice for evaluating suspected mechanical cardiac causes of syncope A standard 12-lead ECG is a level A recommendation in the 2007 ACEP consensus guidelines for syncope. [ ] The following considerations are relevant: Normal ECG findings are a good prognostic sign ECG can be diagnostic

2014 eMedicine.com

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