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

that enhance insulin sensitivity have also been shown to produce many of these improvements among people with the metabolic syndrome. 188,190–194 No adequately powered RCTs have tested the effective- ness of weight loss, diet, or exercise for primary prevention of stroke or other vascular clinical events among patients with the metabolic syndrome. No randomized trial of secondary preventive therapy has been conducted among patients who have had a stroke with the metabolic syndrome. Metabolic Syndrome (...) activity are associated with a 10% to 30% reduction in the incidence of stroke and CHD in both men and women. 195,199–201,208,209 These observations from epidemiological work, however, have not been tested in adequately designed clinical trials. In particular, no RCTs have examined the effectiveness of exercise for secondary prevention of stroke. Two trials using multimodal approaches that include physical activity are in progress and may help clarify the role of physical activity in secondary

2014 Congress of Neurological Surgeons

242. The International Society for Heart and Lung Transplantation Guidelines for the management of pediatric heart failure

with marked dyspnea on exertion IV Unable to carry out any physical activity because they typically have symptoms of HF at rest that worsens with any exertion Symptoms at rest such as tachypnea, retractions, grunting, or diaphoresis Expansions for the abbreviations used in Table 1 are provided in Appendix 3 . Genetic testing recommendations Chairs: Richard Kirk and Jeffery Towbin Dilated cardiomyopathy x 6 Ferlini, A., Neri, M., and Gualandi, F. The medical genetics of dystrophinopathies: molecular (...) relatives and may represent early disease. J Am Coll Cardiol . 1998 ; 31 : 195–201 | | | | | , x 9 Ackerman, M.J., Priori, S.G., Willems, S. et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Heart Rhythm . 2011 ; 8 : 1308–1339 | | | | | , x 10 Mestroni, L. and Taylor, M.R.G. Genetics and genetic testing

2014 International Society for Heart and Lung Transplantation

243. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary

since 1980. The ACC/AHA Task Force on Practice Guidelines (Task Force) directs this effort by developing, updating, and revising practice guidelines for cardiovascular diseases and procedures. Experts in the subject under consideration are selected from both ACC and AHA to examine subject-speci?c data and write guidelines. Writing committees are spe- ci?cally charged with performing a literature review; weighing the strength of evidence for or against particular tests, treatments, or procedures (...) ; and including estimates of expected health outcomes where such data exist. Patient- speci?c modi?ers, comorbidities, and issues of patient preference that may in?uence the choice of tests or ther- apies are considered, as well as frequency of follow-up and cost effectiveness. When available, information from studies on cost is considered; however, a review of data on ef?cacy and outcomes constitutes the primary basis for preparing recommendations in this guideline. In analyzing the data and developing

2014 Society for Cardiovascular Angiography and Interventions

244. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

. This may be done by assessing: • L V function o Clinical, chest X-ray, echocardiogram, radionuclide studies or cardiac MRI. • Presence of myocardial ischaemia o Clinical (recurrent angina). o Exercise stress testing in asymptomatic patients. - This may be done from day 5 post-STEMI (sub-maximal stress test with a target heart rate of 70% of maximum predicted heart rate) up to 6 weeks post-STEMI (maximal with a target heart rate of 90% of maximumpredicted heart rate for age or symptom limited (...) ). - If the pre-discharge sub-maximal stress test is negative, the patient should be subjected to a maximal or symptom limited stress test within 6 weeks after discharge. - For those who cannot exercise, consider dobutamine stress echocardiogram, radionuclide perfusion studies or cardiac MRI. • Presence of malignant ventricular arrhythmias. In the presence of angina, inducible ischaemia or late ventricular arrhythmia early coronary angiography with a view to revascularisation is indicated. 80 In patients

2014 Ministry of Health, Malaysia

245. Management of Heart Failure  (3rd Edition)

and fluid intake, regular exercise and appropriate lifestyle changes such as smoking cessation and abstinence from alcohol. • Performance measures should be instituted to assess quality of care.9 Figure 1 : Algorithm for the diagnosis of Heart Failure or LV dysfunction Suspected Heart Failure because of symptoms/sign Tests abnormal Tests abnormal Treat accordingly Determine : • Underlying cause • Severity • Precipitating Factors • Type of LV Dysfunction (systolic +/- diastolic) Heart Failure or LV (...) dysfunction unlikely. Consider other diagnosis such as: • coronary artery disease (angina equivalent) • pulmonary disease • obesity Additional diagnostic tests where approprate (eg: Coronary Angiography, Nuclear Imaging & CMR) Tests normal Echocardiography Test normal but clinical suspicion high ECG Chest Radiograph Natriuretic Peptides (where available) Test normal but clinical suspicion low10 Flowchart I : Management of Acute HF NOTE: * It is important to look for tissue hypoperfusion - cool peripheries

2014 Ministry of Health, Malaysia

246. Atrial Fibrillation: Guidelines For Management of Patients With

. . e13 2.2.3.1. Atrial Tachycardia Remodeling e13 2.2.3.2. In?ammation and Oxidative Stress e13 2.2.3.3. The Renin-Angiotensin-Aldosterone System e13 2.2.3.4. Risk Factors and Associated Heart Disease e13 3.CLINICAL EVALUATION: RECOMMENDATION . ... e14 3.1. Basic Evaluation of the Patient With AF ... e14 3.1.1. Clinical History and Physical Examination . ... e14 3.1.2. Investigations ... e14 3.1.3. Rhythm Monitoring and Stress Testing ... e15 4.PREVENTION OF THROMBOEMBOLISM ... e15 4.1. Risk-Based (...) to develop, update, or revise written recommendations for clinical practice. Experts in the subject under consideration are selected from both organizations to examine subject- speci?c data and write guidelines. Writing committees are speci?cally charged to perform a literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist. Patient-speci?cmodi?ers, comorbidities, and issues

2014 American College of Cardiology

247. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

several risk factors: age >1 month for full-term infants or 48 weeks’ postconceptional age for preterm infants, and absence of any previous apneic event at presentation to the hospital. Another large multicenter study found no association between the specific viral agent and risk of apnea in bronchiolitis. The literature on viral testing for bronchiolitis has expanded in recent years with the availability of sensitive polymerase chain reaction (PCR) assays. Large studies of infants hospitalized (...) for bronchiolitis have consistently found that 60% to 75% have positive test results for RSV, and have noted coinfections in up to one-third of infants. , , In the event an infant receiving monthly prophylaxis is hospitalized with bronchiolitis, testing should be performed to determine if RSV is the etiologic agent. If a breakthrough RSV infection is determined to be present based on antigen detection or other assay, monthly palivizumab prophylaxis should be discontinued because of the very low likelihood

2014 American Academy of Pediatrics

248. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

4.4.6. Care Objectives 51 4.5. Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS: Recommendations 52 4.5.1. Noninvasive Test Selection 53 4.5.2. Selection for Coronary Angiography 53 5. Myocardial Revascularization 54 5.1. Percutaneous Coronary Intervention 54 5.1.1. PCI—General Considerations: Recommendation 54 5.1.2. PCI—Antiplatelet and Anticoagulant Therapy 55 5.1.2.1. Oral and Intravenous Antiplatelet Agents: Recommendations 55 5.1.2.2. GP IIb/IIIa (...) Antiplatelet Therapy: Recommendations 61 6.2.2. Combined Oral Anticoagulant Therapy and Antiplatelet Therapy in Patients With NSTE-ACS 62 6.2.3. Platelet Function and Genetic Phenotype Testing 64 6.3. Risk Reduction Strategies for Secondary Prevention 64 6.3.1. Cardiac Rehabilitation and Physical Activity: Recommendation 65 6.3.2. Patient Education: Recommendations 65 6.3.3. Pneumococcal Pneumonia: Recommendation 65 6.3.4. NSAIDs: Recommendations 66 6.3.5. Hormone Therapy: Recommendation 67 6.3.6

2014 Society for Cardiovascular Angiography and Interventions

249. 2014 ESC Management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting With Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary or Valve Interventions

it might be premature to abandon aspirin after stent im- plantation in AF patients requiring OAC based solely on the results of WOEST, dual therapy with OAC and clopidogrel may be considered as an alternative to triple therapy in selected AF patients at low risk of stent thrombosis/recurrent cardiac events. Ongoingrandomizedcontrolledtrials andregistries Two randomized trials and one multinational registry are currently testing different antithrombotic combinations for patients on OAC therapy who (...) in non-valvular AF patients, 59 as well as data on patient outcomes from RCTs of NOACs and antiplatelets in ACS/PCI patients 60–64 (Table 2). Where a NOAC is used in combination with clopidogrel and/or low-dose aspirin, the lower tested dose for stroke prevention in AF (that is, dabi- gatran 110 mg b.i.d., rivaroxaban 15 mg o.d. or apixaban 2.5 mg b.i.d.) should be considered, to minimize the risks of bleeding. However, dabigatran 110 b.i.d. was one intervention arm of the RE-LY trial, and thus

2014 Heart Rhythm Society

250. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

. Document Review and Approval e62 1.4. Scope of the Guideline e62 2. General Principles e63 2.1. Evaluation of the Patient With Suspected VHD e63 2.2. De?nitions of Severity of Valve Disease e64 2.3. Diagnosis and Follow-Up e64 2.3.1. Diagnostic Testing–Initial Diagnosis: Recommendation e64 2.3.2. Diagnostic TestingdChanging Signs or Symptoms: Recommendation e65 2.3.3. Diagnostic TestingdRoutine Follow-Up: Recommendation e65 2.3.4. Diagnostic TestingdCardiac Catheterization: Recommendation e65 2.3.5 (...) . Diagnostic TestingdExercise Testing: Recommendation e65 2.4. Basic Principles of Medical Therapy e66 2.4.1. Secondary Prevention of Rheumatic Fever: Recommendation e66 2.4.2. IE Prophylaxis: Recommendations e67 2.5. Evaluation of Surgical and Interventional Risk e68 2.6. TheHeartValveTeamandHeartValveCenters of Excellence: Recommendations e69 3. Aortic Stenosis e71 3.1. Stages of Valvular AS e71 3.2. Aortic Stenosis e71 3.2.1. Diagnosis and Follow-Up e71 3.2.1.1. DIAGNOSTIC TESTINGdINITIAL DIAGNOSIS

2014 Society for Cardiovascular Angiography and Interventions

251. Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations from ESPGHAN and NASPGHAN

after 2-4 weeks 6 7 9 16 17 20 22 24 25 27 26 23 18 19 21 15 14 11 13 12 8 5 4 23 10 1 Alarm signs/ symptoms? Tailor testing for differential diagnosis Continue therapy Consider hypo- allergic formula for 2-4 weeks Response? Reconsider organic diseases No No No No No No No No No No No No No No No No No No No No No No No No No No No Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes Yes Y es Yes FIGURE 1. Algorithm (...) previous treatment been sufficient? Alarm signs/ symptoms? Normal results? Tailor testing for differential diagnosis Treat accordingly Intractable constipation Constipation confirmed? Consultation with mental health care Maintenance therapy Colonic transit time study to confirm constipation Doubts about the diagnosis of constipation? Colonic manometry (Rule out colonic neuro muscular disorders) Consider:  Mental health care  Biofeedback  ACE  Botox  SNS  TENS Consider:  Surgery  SNS  TENS

2014 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

252. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation Full Text available with Trip Pro

With AF e210 3.1.1. Clinical History and Physical Examination e210 3.1.2. Investigations e210 3.1.3. Rhythm Monitoring and Stress Testing ………..e210 Prevention of Thromboembolism e211 4.1. Risk-Based Antithrombotic Therapy: Recommendations e211 4.1.1. Selecting an Antithrombotic Regimen—Balancing Risks and Benefits e212 4.1.1.1. Risk Stratification Schemes (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) e213 4.2. Antithrombotic Options e214 4.2.1. Antiplatelet Agents e214 4.2.2. Oral Anticoagulants e215 (...) of the evidence and acting as an independent group of authors to develop, update, or revise written recommendations for clinical practice. Experts in the subject under consideration are selected from both organizations to examine subject-specific data and write guidelines. Writing committees are specifically charged to perform a literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist

2014 American Heart Association

253. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary Full Text available with Trip Pro

of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that may influence the choice of tests or therapies are considered, as well as frequency of follow-up and cost-effectiveness. When available, information from studies on cost is considered; however, review of data on efficacy and outcomes constitutes the primary basis for preparing

2014 American Heart Association

254. Stable Ischemic Heart Disease: Guideline For the Diagnosis and Management of Patients With

Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain: Recommendations e58 2.1.2. History e58 2.1.3. Physical Examination e60 2.1.4. Electrocardiography e60 2.1.4.1. RESTING ELECTROCARDIOGRAPHY TO ASSESS RISK: RECOMMENDATION e60 2.1.5. Differential Diagnosis e60 2.1.6. Developing the Probability Estimate e61 2.2. Noninvasive Testing for Diagnosis of IHD e62 2.2.1. Approach to the Selection of Diagnostic Tests to Diagnose SIHD e62 2.2.1.1. ASSESSINGDIAGNOSTICTESTCHARACTERISTICS e63 (...) 2.2.1.2. SAFETY AND OTHER CONSIDERATIONS POTENTIALLY AFFECTING TEST SELECTION e64 2.2.1.3. EXERCISEVERSUSPHARMACOLOGICALTESTING e65 2.2.1.4. CONCOMITANT DIAGNOSIS OF SIHD AND ASSESSMENT OF RISK e65 2.2.1.5. COST-EFFECTIVENESS e65 2.2.2. Stress Testing and Advanced Imaging for Initial Diagnosis in Patients With Suspected SIHD Who Require Noninvasive Testing: Recommendations e66 2.2.2.1. ABLE TO EXERCISE e66 2.2.2.2. UNABLE TO EXERCISE e66 2.2.2.3. OTHER e67 2.2.3. Diagnostic Accuracy of Nonimaging

2014 American College of Cardiology

255. Valvular Heart Disease: Guidelines For the Management of Patients With

Principles e63 2.1. Evaluation of the Patient With Suspected VHD e63 2.2. De?nitions of Severity of Valve Disease e64 2.3. Diagnosis and Follow-Up e64 2.3.1. Diagnostic Testing–Initial Diagnosis: Recommendation e64 2.3.2. Diagnostic TestingdChanging Signs or Symptoms: Recommendation e65 2.3.3. Diagnostic TestingdRoutine Follow-Up: Recommendation e65 2.3.4. Diagnostic TestingdCardiac Catheterization: Recommendation e65 2.3.5. Diagnostic TestingdExercise Testing: Recommendation e65 2.4. Basic Principles (...) 3.2.1.3. DIAGNOSTICTESTINGdROUTINEFOLLOW-UP .. e73 3.2.1.4. DIAGNOSTIC TESTINGdCARDIAC CATHETERIZATION e73 3.2.1.5. DIAGNOSTIC TESTINGdEXERCISE TESTING: RECOMMENDATIONS e74 3.2.2. Medical Therapy: Recommendations e74 3.2.3. Timing of Intervention: Recommendations e75 3.2.4. ChoiceofIntervention:Recommendation ...e79 4. Aortic Regurgitation e82 4.1. Acute AR e82 4.1.1. Diagnosis e83 4.1.2. Intervention e83 4.2. Stages of Chronic AR e83 4.3. Chronic AR e83 4.3.1. Diagnosis and Follow-Up e83 4.3.1.1

2014 American College of Cardiology

256. How Much Do We Know About HDL Cholesterol?

Pfizer was forced to halt phase III trials of torcetrapib, a CETP inhibitor, after it was shown to increase mortality . [5] Pfizer spent over $800 million on their failed HDL raising attempt. [6] Some suggested that the mortality increase was due to adverse effects such as raising blood pressure. However, subsequent data analysis found that , [7] further confirming its lack of efficacy in halting or reversing atherosclerosis. Another CETP inhibitor, dalcetrapib, was tested in the dal-OUTCOMES study (...) clearance. [10] Several trials have evaluated the effect of niacin on cardiovascular outcomes. The HATS trial evaluated the effect of simvastatin plus niacin and found not only a rise in HDL levels but a regression of atherosclerotic lesions as well as reduced incidence of coronary events. [11] This trial did not compare niacin plus a statin to statin alone, however, so the marginal benefit of raising HDL could not be tested. The ARBITER 6-HALTS study looked at statin plus niacin versus statin plus

2014 Clinical Correlations

257. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults

, calcium supplements should be lim- ited to no more than 500 mg of elemental calcium per dose, since there is decreasing absorption with increasing doses (Grade A, BEL 1). A 24-hour urine calcium collection should be measured in patients with osteoporosis or patients at risk for bone loss in order to check calcium adequacy and test for hypercalciuria or malabsorption (Grade B, BEL 2). 3.Q7.2 Vitamin D • R33. Serum 25(OH)D should be measured in individuals at risk for vitamin D deficiency (e.g., elderly (...) activity. After 4 years, the cumulative incidence of DM defined by oral glucose tolerance testing (OGTT) was 11% in the intervention group and 23% in the control subjects. The Diabetes Prevention Program (DPP) randomized 3,234 adults (mean age, 51 years; mean BMI, 34 kg/m 2 ) who had impaired fasting glucose and were at high risk for the development of T2DM into placebo, metformin, or lifestyle modification groups. The intensive lifestyle intervention was intended to help subjects lose and main- tain

2013 American Association of Clinical Endocrinologists

258. Guidelines for the Management of Hiatal Hernia

hiatal hernia and symptoms of gastroesophageal reflux. pH testing has limited relevance in the diagnosis of a hiatal hernia, but is critical to identify the presence of increased esophageal acid exposure in patients with sliding hiatal hernias that might benefit from antireflux surgery. Confirmation of abnormal gastroesophageal reflux either by the identification of erosive esophagitis or Barrett’s esophagus on upper endoscopy, or by demonstration of increased esophageal acid exposure on pH

2013 Society of American Gastrointestinal and Endoscopic Surgeons

259. Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions Full Text available with Trip Pro

cardiomyopathy by testing lower cumulative doses and alternative dosing schedules and methods of administration, , as well as by adding potentially cardioprotective agents. Similarly, to reduce the risk of cardiac disease and second malignant neoplasms (eg, breast cancer), the use, dose, and volume of radiation to the heart has decreased substantially in frontline trials for children with hematological and low-stage, biologically favorable solid malignancies. Current therapy for childhood malignancies has

2013 American Heart Association

260. 2013 ACCF/AHA Guideline for the Management of Heart Failure Full Text available with Trip Pro

, Frederick A. Masoudi , Patrick E. McBride , John J.V. McMurray , Judith E. Mitchell ACCF/AHA representative. , Pamela N. Peterson ACCF/AHA representative. , Barbara Riegel ACCF/AHA representative. , Flora Sam ACCF/AHA representative. , Lynne W. Stevenson , W.H. Wilson Tang , Emily J. Tsai ACCF/AHA representative. , and Bruce L. Wilkoff and WRITING COMMITTEE MEMBERS Originally published 5 Jun 2013 Circulation. 2013;128:e240–e327 You are viewing the most recent version of this article. Previous versions (...) Patient e253 6.1. Clinical Evaluation e253 6.1.1. History and Physical Examination: Recommendations e253 6.1.2. Risk Scoring: Recommendation e253 6.2. Diagnostic Tests: Recommendations e253 6.3. Biomarkers: Recommendations e255 6.3.1. Natriuretic Peptides: BNP or NT-proBNP e256 6.3.2. Biomarkers of Myocardial Injury: Cardiac Troponin T or I e256 6.3.3. Other Emerging Biomarkers e256 6.4. Noninvasive Cardiac Imaging: Recommendations e256 6.5. Invasive Evaluation: Recommendations e258 6.5.1. Right-Heart

2013 American Heart Association

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