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McMurray Test

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22. 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

23. 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

24. 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

27. AIM Clinical Appropriateness Guidelines for Joint Surgery

osteophytes, joint subluxation, avascular necrosis or bone on bone articulations. The degree of joint space narrowing should also be noted. Tobacco Cessation – Adherence to a tobacco-cessation program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample time afforded (...) , adherence to a tobacco-cessation program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample time afforded to submit this confirmation and complete the prior authorization process. Acute Full Thickness Tear All of the following are required: ? Traumatic injury

2019 AIM Specialty Health

28. Extremity imaging

Administrative Guidelines 6 Ordering of Multiple Studies 6 Simultaneous Ordering of Multiple Studies 6 Repeated Imaging 6 Pre-Test Requirements 7 History 7 Imaging of the Extremities 8 General Information/Overview 8 Scope 8 Technology Considerations 8 Definitions 8 Clinical Indications 10 Congenital and Developmental Conditions 10 Blount disease (Pediatric only) 10 Congenital anomalies of the lower extremity (Pediatric only) 10 Congenital anomalies of the upper extremity (Pediatric only) 11 Coxa vara (...) on persistent symptoms with no clinical change, treatment, or intervention since the previous study ? Repeated imaging of the same anatomical area by different providers for the same member over a short period of time Imaging of the Extremities Copyright © 2019. AIM Specialty Health. All Rights Reserved. 7 Pre-Test Requirements Critical to any finding of clinical appropriateness under the guidelines for specific imaging exams is a determination that the following are true with respect to the imaging request

2019 AIM Specialty Health

29. 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

30. 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

32. Fourth Universal Definition of Myocardial Infarction

.) 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

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2018 European Society of Cardiology

33. Management of Cardiovascular Diseases during Pregnancy

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

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2018 European Society of Cardiology

34. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

to the pharmacological properties of the drug. Most clinical trials report the numbers of patients stopping the study medication because of any adverse event. The difference between the test agent and placebo is a good measure of the overall tolerability of the agent, provided that the blind remains secure throughout the trial. 1.2. Randomized Controlled Trials In the evaluation of the safety of a drug used long term, the most reliable data are derived from properly designed and conducted large, long-term, double (...) -blind, placebo-controlled randomized trials. The great advantage of this form of investigation is that bias is controlled by random allocation to treatment. There can still be random error, and sometimes other issues within the control of the investigator such as inadequate follow-up or ineffective blinding, but in a well-planned and executed RCT, the results are determined solely by allocation to the test treatment or the control. Most statin RCTs, especially the largest of such trials, were

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2019 American Gastroenterological Association Institute

35. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

dyslipidemia (triglycerides >200 mg/dL and HDL-C <40 mg/dL) ( ). Niacin lowers apo B, LDL-C, and triglycerides in a dose-dependent fashion and is the most powerful lipid-modifying agent for raising HDL-C currently available ( ), although it may reduce cardiovascular events through a mechanism other than an increase in HDL-C ( ). Two trials designed to test the HDL-C–raising hypothesis (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes [AIM (...) , and/or niacin to reduce triglyceride levels and to prevent pancreatitis. Blood glucose control is also essential for triglyceride reduction. While no large clinical trials have been designed to test this objective, observational data and retrospective analyses support long-term dietary and lipid management of hypertriglyceridemia for prophylaxis against or treatment of acute pancreatitis ( , ). T2D Pharmacotherapy In patients with T2D, achieving the glucose and A1C targets requires a nuanced approach

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2019 American Association of Clinical Endocrinologists

36. Is there a role for DOAC level monitoring in clinical practice?

to have the clear advantage in terms of rapid, reliable, widely-available laboratory testing and drug reversal agents. For an anticoagulated patient presenting with an acute bleed, thromboembolic event, and/or a need for an urgent invasive procedure, the evidence and tools available to reliably assess levels of anticoagulation and reverse continue to buoy warfarin’s modern clinical relevance. A DOAC lab measurement analogous to prothrombin time (PT)/international normal ratio (INR) would be a valuable (...) -22 . Additionally, there are other scenarios where DOAC levels would be potentially useful such as with patients at extreme body weight, presence of interacting medications, and confirmation of chronic anticoagulation following initial loading period 10,13,18 . There are two types of tests in the situations outlined above that can help guide management for patients on DOACs: 1) a screening assay for when a clinician needs to determine quickly the presence or absence of the drug (e.g. prior

2019 Clinical Correlations

37. Atrial Fibrillation (Focused Update)

by the writing committee on the basis of the systematic review are marked “ SR ”. Guideline-Directed Management and Therapy The term guideline-directed management and therapy encompasses clinical evaluation, diagnostic testing, and both pharmacological and procedural treatments. For these and all recommended drug treatment regimens, the reader should confirm dosage with product insert material and evaluate for MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al. 2019 Focused Update on Atrial (...) , and consistency of data from clinical trials and other sources (Table 1) (P-5). Glenn N. Levine, MD, FACC, FAHA Chair, ACC/AHA Task Force on Clinical Practice Guidelines MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al. 2019 Focused Update on Atrial Fibrillation Page 7 Table 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015) MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al

2019 American College of Cardiology

39. Treatment of Diabetes in Older Adults

|⊕⊕⊕⊕) Technical remark: The measurement of HbA1c may be inaccurate in some people in this age group because of comorbidities that can affect the lifespan of red blood cells in the circulation. Although the optimal screening frequency for patients whose initial screening test is normal remains unclear, the writing committee advocates repeat screening every 2 years thereafter. As with any health screening, the decision about diabetes and prediabetes screening for an individual patient depends on whether some (...) action will be taken as a result and the likelihood of benefit. For example, such screening may not be appropriate for an older patient with end-stage cancer or organ system failure. In these situations, shared decision-making with the patient is recommended. 2.2 In patients aged 65 years and older without known diabetes who meet the criteria for prediabetes by fasting plasma glucose or HbA1c, we suggest obtaining a 2-hour glucose post–oral glucose tolerance test measurement. (2|⊕⊕⊕O) Technical

2019 The Endocrine Society

40. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk

of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B–containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical (...) glucose, or 2-hour glucose with a second test for confirmation using a new blood sample. Testing for additional biological markers ( e.g., high-sensitivity C-reactive protein) associated with metabolic risk should be limited to subpopulations. This recommendation is specifically for adults aged 40 to 75 years, those for whom the interventions have the greatest impact and evidence for efficacy. This does not restrict screening for appropriate individuals outside of this age range, especially those who

2019 The Endocrine Society

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