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McMurray Test

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21. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD Full Text available with Trip Pro

-centred care 46 12.1 General aspects 46 13 ‘What to do’ and ‘what not to do’ messages from the Guidelines 48 14 Appendix 51 15 References 52 Recommendations Recommendations for the diagnosis of disorders of glucose metabolism 12 Recommendations for the use of laboratory, electrocardiogram, and imaging testing for cardiovascular risk assessment in asymptomatic patients with diabetes 16 Recommendations for lifestyle modifications for patients with diabetes mellitus and pre-diabetes 18 Recommendations (...) peptidase-4 DYNAMIT Do You Need to Assess Myocardial Ischemia in Type 2 Diabetes EACTS European Association for Cardio-Thoracic Surgery EAS European Atherosclerosis Society EASD European Association for the Study of Diabetes ECG Electrocardiogram EDIC Epidemiology of Diabetes Interventions and Complications EET Exercise electrocardiogram test eGFR Estimated glomerular filtration rate ELIXA Evaluation of Lixisenatide in Acute Coronary Syndrome EMPA-REG OUTCOME Empagliflozin Cardiovascular Outcome Event

2019 European Society of Cardiology

22. Heart Failure - Systolic Dysfunction

, tadalafil, and vardenafil. Ivabradine Initiation: For patients with persistent symptoms and HR > 70 despite maximally tolerated or target dose beta blocker Contraindication: Atrial fibrillation Diuretics "Background" therapy. Though not specifically tested in clinical trials, diuretics should still be used as needed for volume overload. Diuretics were consistently part of background therapy in all published placebo controlled mortality trials of symptomatic patients in which ACE inhibitors, beta (...) blockers, and aldosterone antagonists were tested. Combining Drugs Starting other drugs. The therapy described in Table 2 is the desired endpoint for patients with the indicated symptoms and history. No data are available to indicate how best to introduce all of these medications. All of the major trials added beta blockers or spironolactone to background therapy of ACE inhibitors, diuretics, and sometimes digoxin. Electrolytes and renal function. Many of the medications appropriate for HF (ACE, ARB

2020 University of Michigan Health System

23. Guidance for the clinical management of children admitted to hospital with suspected COVID-19

as this may reduce the risk of ARDS. Be aware that febrile children, and those who are tachypnoeic, will have increased insensible losses. A small proportion of children may have pharyngitis, but this is not reported as a common problem with this virus so should not in most children affect oral intake. Monitor fluid balance, and measure daily weight in those children in whom fluid intake is a concern. Renal profile blood tests and urine dipstick are not required in all children but should be measured (...) Semple, Daniel Hawcutt, Rebecca Thursfield, Nayan Shetty, Sarah Mahoney, David Porter, Chris Parry, Fulya Mehta, Mark Deakin, Bimal Mehta, CK Chong, Louise Oni, Caroline B. Jones, Marcus Auth, Musa Kaleem, Gemma Saint, Kevin Southern, Rachel Harwood, Omi Narayan (From BPRS Executive Committee): Louise Fleming, Jane Davies, Jayesh Bhatt, Ann McMurray, Rebecca Thursfield Version 1 Ratified by Alder Hey CDEG 13 th March 2020 Version 2 Ratified by BPRS March 18 th 2020 Changes to Version 2: Pathology

2020 British Thoracic Society

24. Physical Activity and Exercise During Pregnancy and the Postpartum Period

with the patient and adjusted as medically indicated. Because blunted and normal heart-rate responses to exercise have been reported in pregnant women, the use of ratings of perceived exertion may be a more effective means to monitor exercise intensity during pregnancy than heart-rate parameters . For moderate-intensity exercise, ratings of perceived exertion should be 13–14 (somewhat hard) on the Borg ratings of perceived exertion scale . Using the “talk test” is another way to measure exertion: as long (...) evidence base concerning the effects of occupational physical activity on maternal–fetal health. References American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription . 10th ed. Philadelphia, PA: Wolters Kluwer; 2018. Article Locations: World Health Organization. Global recommendations on physical activity for health . Geneva: WHO; 2010. Available at: . Retrieved October 18, 2019. Article Locations: Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM

2020 American College of Obstetricians and Gynecologists

26. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association

, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second (...) , the efficacy and net clinical benefit of ticagrelor were more favorable among patients from THEMIS who had a history of percutaneous coronary intervention (PCI). Rivaroxaban The COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) examined whether rivaroxaban improved cardiovascular outcomes in 27 395 patients with stable atherosclerotic vascular disease. Three strategies were tested: rivaroxaban 2.5 mg twice daily plus aspirin, rivaroxaban 5 mg twice daily, and aspirin alone

2020 American Heart Association

27. Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association

characteristics from these reviews, approximately three-quarters of caregivers in interventions trials have been female and the spouse or partner of the patient. Between half and three-quarters of interventions delivered education face-to-face, with supplemental follow-up by phone or in person. Examples of common educational content tested in intervention trials have included HF pathophysiology, medication management, patient and caregiver self-care, principles of communication, and device management (eg (...) , for left ventricular assist devices). Skills training has also been a common therapeutic approach and has included application-based training in problem solving; goal setting; medication, symptom, and device management; and communication. Interventions have been formatted in different ways, including patient-caregiver couples receiving an intervention together, the patient and caregiver receiving a separate intervention but in parallel, and caregiver-only interventions. Just over half of tested

2020 American Heart Association

28. Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association

of physical functioning, emotional and social behavior affecting an individual’s health Frequently documented as a narrative Inconsistently transitioned into the EHR Comprehensive Geriatric Assessment ( Parker et al, 2018; Jha et al, 2015) Scale addressing psychosocial, medical, functional, and environmental needs Involves use of validated scales: Barthel Index of ADL Older Americans Resource and Services Pfeiffer cognitive test Yesavage geriatric depression Reliability in HF Multidimensional, including

2020 American Heart Association

29. EHRA/HRS/APHRS/LAHRS Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome

et al Risk Assessment in Cardiac Arrhythmias 5e.g.suddendeathprediction(orfailedablation,deviceinfec- tion,etc.),CharlsonComorbidityIndex,frailty,etc.—butus- ing the right score designed for that purpose. Ifappropriatelyused,someofthese(simpli?ed)toolshelp withclinicalmanagement.Indeed,thevalueofamedicaltest ismeasuredbyitsaccuracyaswellashowitimpactsmedical decisions and ultimately patient health. As medical tests are considered andnewonesemerge,theyshouldbeconsidered and evaluated (...) in a framework of accuracy and patient impact. 16 A test must not only beaccurate,but also feasible. Tests that are dif?cult to reproduce, subject to technical fail- ures, or dif?cult to interpret are likely to impact patient care asaconsequenceof aprimary failure to produceade?nitive and actionable result. Electrocardiographic methods including monitoring Electrocardiographic methods The ECG is the gold standard for risk assessment in patients withoratriskofdevelopingcardiacarrhythmias.The12-lead ECG

2020 Heart Rhythm Society

30. HRS White Paper on Atrial Fibrillation Centers of Excellence: Rationale, Considerations, and Goals

, or at home with wearable patient monitors or smartphone-based or direct-to-consumer applications. Appropriate triage in these settings has the potential to minimize unnecessary emergency room visits, hospitalizations, and testing and improve patient satisfaction. This triage may be enhanced by direct phone access to knowledgeable staff, such as an appropriately trained nurse or medical assistant in an AF clinic. Same-day or next-day appointments are frequently required to avoid hospitalization

2020 Heart Rhythm Society

31. Clinical Insights for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic

to protect our patients, communities, and healthcare workers. Data from Italy indicate that up to 20% of healthcare workers who are taking care of patients with COVID-19 may become infected. 7 The Centers for Disease Control and Prevention (CDC) has reported over 9200 COVID-19 cases in US healthcare workers, including some with severe outcomes including death. 8 We must continue to work to contain the spread of SARS-CoV-2 to ensure the preservation of our healthcare system’s capacity to test (...) with autoimmune hepatitis on immunosuppressive medications, and posttransplant patients on immunosuppressant therapy are potentially at increased risk for severe COVID-19 and should be prioritized for testing until further data become available. • Consider etiologies unrelated to COVID-19, including other viruses such as hepatitis A, B and C, and drug-induced liver injury when assessing patients with COVID-19 and elevated liver biochemistries. • To limit unnecessary transport of patients with COVID-19

2020 American Association for the Study of Liver Diseases

32. Cardiac arrhythmias in coronary heart disease

of ischaemic VT induced at electrophysiological study, sudden death and out-of-hospital collapse. R Revascularisation should be considered in patients who have had sustained VT or VF. 9 Patients with previous sustained VT/VF should undergo assessment for inducible ischaemia by stress testing or myocardial perfusion imaging followed, if appropriate, by coronary arteriography and revascularisation. These patients should all be considered for implantable cardioverter defibrillator therapy. 5.2.2 IMPLANTABLE

2018 SIGN

34. Meniscal tear

present. [Figure caption and citation for the preceding image starts]: Anatomical structures around the menisci Created by BMJ Publishing Group [Citation ends]. History and exam presence of risk factors knee swelling sensation of knee instability or buckling/catching knee pain tenderness at joint line and joint line crepitation positive McMurray's test positive Apley's test positive hyperextension test popliteal (Baker's) cyst in chronic cases limited range of motion acute trauma (twisting injury

2018 BMJ Best Practice

35. Management of stable angina

-cardiac chest pain Minor update 3.2 Diagnostic and prognostic tools Completely revised 3.2.2 Exercise tolerance testing Updated 3.2.3 Stress echocardiography New 3.2.4 Stress perfusion cardiac magnetic resonance imaging New 3.2.5 Myocardial perfusion scintigraphy Minor update 3.2.6 CT-coronary angiography and calcium scoring New 3.2.7 Coronary angiography Updated 3.3 Models of care Completely revised 4.1.5 Selective If inhibitors Completely revised 4.1.6 Ranolazine New 4.2.1 Adding calcium channel (...) the diagnosis of stable angina is suspected but not clear from history alone. R In patients with suspected stable angina, the exercise tolerance test should not be used routinely as a first-line diagnostic tool. 2.2 STABLE ANGINA AND NON-CARDIAC SURGERY R The routine use of aspirin to reduce perioperative cardiac events in patients undergoing non-cardiac surgery, including those with known stable coronary artery disease, is not recommended. Management of stable angina| 7 3 Diagnosis and assessment Angina

2018 SIGN

37. Fourth Universal Definition of Myocardial Infarction Full Text available with Trip Pro

.) should prompt clinical review of the procedure and/or consideration of additional diagnostic testing for possible type 5 MI. 13 Other definitions of myocardial infarction related to percutaneous coronary intervention or coronary artery bypass grafting There is no universal consensus on the cTn or hs-cTn cut-off points that clearly distinguish cardiac procedural myocardial injury from MI. The distinction is made on the basis of an injury created by a flow-limiting complication during the procedure

2018 European Society of Cardiology

38. Management of Cardiovascular Diseases during Pregnancy Full Text available with Trip Pro

and offspring complications 3174 3.3.3 Pregnancy heart team 3176 3.4 Cardiovascular diagnosis in pregnancy 3176 3.4.1 Electrocardiography 3176 3.4.2 Echocardiography 3176 3.4.3 Exercise testing 3177 3.4.4 Ionizing radiation exposure 3177 3.4.5 Chest radiography and computed tomography 3177 3.4.6 Cardiac catheterization 3177 3.4.7 Magnetic resonance imaging 3177 3.5 Genetic testing and counselling 3177 3.5.1 Pre-natal diagnosis 3178 3.6 Foetal assessment 3178 3.6.1 Screening for congenital heart disease 3178 (...) Ventricular tachycardia 3203 9.7 Bradyarrhythmias 3204 9.7.1 Sinus node dysfunction 3204 9.7.2 Atrioventricular block 3204 9.8 Interventions 3204 9.8.1 Electrical cardioversion 3204 9.8.2 Catheter ablation 3204 9.8.3 Implantable cardioverter-defibrillator and pacing 3204 9.9 Recommendations 3206 10. Hypertensive disorders 3207 10.1 Diagnosis and risk assessment 3207 10.1.1 Blood pressure measurement 3207 10.1.2 Laboratory tests 3207 10.2 Definition and classification of hypertension in pregnancy 3207 10.3

2018 European Society of Cardiology

39. Cardiovascular Disease: Secondary Prevention

with atorvastatin, for secondary prevention. Previously, rosuvastatin was non-formulary and was a second-line option for secondary prevention. Annual LDL monitoring is no longer required. Annual LDL monitoring was recommended for all patients on a statin. Non-fasting lipid panel is now the preferred cholesterol test. Fasting lipoprotein panel or direct LDL cholesterol were the preferred cholesterol tests. Updated blood pressure targets: • 50%. • Cerebrovascular disease, such as transient ischemic attack (...) 1,000 mg/dL would also be reasonable. Use shared decision making.) If a patient has elevated triglycerides, consider the following workup: • HbA1c, TSH, protein/creatinine ratio, and pregnancy test (if applicable). • Review other items that can cause triglyceride elevations: o Obesity (review diet). o Alcohol intake. o Medications—estrogen replacement, oral contraceptives, tamoxifen, HIV antiretroviral regimens, beta-blockers (excluding carvedilol), retinoids, and immunosuppressive agents

2018 Kaiser Permanente Clinical Guidelines

40. Cardiovascular Disease: Primary Prevention

ASCVD shared decision making tool in Epic. No shared decision making tool. Atorvastatin and rosuvastatin are now the preferred statins for primary prevention. Simvastatin was the preferred statin for primary prevention. Annual LDL monitoring is no longer required for people on a statin or with diabetes. Annual LDL monitoring was recommended for all patients on a statin. Non-fasting lipid panel is now the preferred cholesterol test. Fasting lipoprotein panel or direct LDL cholesterol were (...) the preferred cholesterol tests. Updated blood pressure targets: • 190 mg/dL, or diabetes. • Aspirin not recommended for patients with 190 mg/dL. • Statins not recommended for patients with 50%. • Cerebrovascular disease, such as transient ischemic attack, ischemic stroke, and carotid artery stenosis > 50%. • Peripheral artery disease, such as claudication. • Aortic atherosclerotic disease, such as abdominal aortic aneurysm and descending thoracic aneurysm. Primary prevention refers to the effort to prevent

2018 Kaiser Permanente Clinical Guidelines

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