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McMurray Test

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82. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

syndrome (ACS). Thus, among patients with CS within the appropriate demographic or with risk factors for coronary artery disease, ACS should be the focus of initial diagnostic testing, and this testing should include an ECG within 10 minutes of presentation. Although 5% to 12% of ACS cases are complicated by CS, this presentation is often associated with a large degree of at-risk myocardium. , In patients with a recent ACS, mechanical complications (including papillary muscle rupture, ventricular (...) . Thyroid disorders, both hyperthyroidism and hypothyroidism, can also cause circulatory collapse. , Pregnancy-associated cardiac conditions, including both peripartum cardiomyopathy and acute coronary dissection, may present as CS. Numerous additional causes of CS have been reported, but they typically occur in <1% of patients. , Laboratory Evaluation, Noninvasive Testing, and Hemodynamic Monitoring Laboratory Evaluation Biomarkers of cardiac myonecrosis are useful to gauge the severity of acute

2017 American Heart Association

83. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non?ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

Short Title: PM-15: Stress Test in Conservatively Treated Patients 27 Short Title: PM-16: Early Troponin Measurement After NSTEMI 28 Short Title: PM-17: AMI Registry Participation 28 Quality Improvement Measures for Inpatient STEMI and NSTEMI Patients 29 Inpatient Measures 29 Short Title: QM-1: Risk Score Stratification for NSTEMI 29 Short Title: QM-2: Early Invasive Strategy for High-Risk NSTEMI 30 Short Title: QM-3: Therapeutic Hypothermia for STEMI Patients 31 Short Title: QM-4: Aldosterone (...) to have the measure tested to identify the consequences of measure implementation. Quality measures may then be promoted to the status of performance measures as supporting evidence becomes available. Gregg C. Fonarow, MD, FACC, FAHA Chair, ACC/AHA Task Force on Performance Measures 1. Introduction In the summer of 2015, the Task Force convened the writing committee to begin the process of revising the existing set of performance measures for adult patients hospitalized with ST-Elevation and Non–ST

2017 American Heart Association

84. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association (PubMed)

, the adjusted odds for incident peripheral arterial disease were 1.67 times higher in African Americans compared with whites. The San Diego Population Study included markers of inflammation in multivariable models to test whether they explained the residual excess risk in African Americans compared with whites but found that, although the RRs for peripheral artery disease between African Americans and whites were further attenuated, they remained statistically significantly higher, ranging from 1.5 to 2.0 (...) duration appears to be a consistent risk factor for stroke, early indications suggest that among diabetic adults, short sleep duration (≤6 hours) is associated with increased stroke risk in whites (OR, 1.38; 95% CI, 1.06–1.80) but not in African Americans (OR, 0.86; 95% CI, 0.58–1.26). Additional research is needed to test the association of objectively determined sleep duration with incident CHD risk in African Americans compared with whites. Summary There are significant disparities in the age

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2017 American Heart Association

85. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. Results: A number of biomarkers associated with HF are well recognized, and measuring (...) peptide testing for the evaluation of patients with suspected or proven heart failure (HF) in the year 2000, interest in biomarkers has grown exponentially. Accordingly, a large number of preclinical and clinical analyses of biomarkers in HF have been completed, and the volume of publications in peer-reviewed literature focused on HF biomarkers has risen dramatically. In addition, after the regulatory approval of the natriuretic peptides for clinical use, a number of newer biomarkers have received

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2017 American Heart Association

86. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

involvement are dissociated from or occur late after the development of skeletal myopathy, and poor correlation exists between genotype and phenotypes at the cardiac and skeletal muscle levels. The importance of genetic testing in the diagnosis of NMDs must be noted. Because there can be significant phenotypic overlap among NMDs at initial presentation, genetic testing is crucial to the diagnostic workup of NMDs, commonly allowing for a definitive diagnosis. , Although typical disease inheritance patterns (...) is confirmed by genetic testing, with affected individuals having >35 trinucleotide repeats. In general, longer repeat expansion correlates with higher penetrance, earlier onset, and increased severity of disease. Clinically, DM1 is characterized by progressive development of facial, neck, and distal limb muscle weakness and myotonia. Other degenerative symptoms include cataracts, neurological/neuropsychiatric deficits, and endocrine/metabolic abnormalities. There is a tendency for successive generations

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2017 American Heart Association

87. Chronic Heart Failure - Diagnosis and Management

years with chronic heart failure (HF) in the primary care setting. Key Recommendations B-Type natriuretic peptide (BNP) OR N-terminal prohormone of BNP (NT-proBNP) is the biochemical test of choice for ruling-in or ruling-out the diagnosis of HF and should be considered as part of the initial evaluation of patients with dyspnea suspected of having HF. [Amended, 2015] BNP (or NT-proBNP) testing should not be used routinely for monitoring disease severity. [New, 2015] Educate the patient and family (...) in heart failure. 2012. The Criteria Committee of the New York Heart Association. (1994). Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. (9th ed.). Boston: Little, Brown & Co. pp. 253–256. McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014;371:993-1004. Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heart failure (SHIFT

2016 Clinical Practice Guidelines and Protocols in British Columbia

88. Acute and Chronic Heart Failure

outcomes. Detailed summaries of the key evidence supporting generally recommended treatments have been provided. For diagnostic recommendations a level of evidence C has been typically decided upon, because for the majority of diagnostic tests there are no data from randomized controlled trials (RCTs) showing that they will lead to reductions in morbidity and/or mortality. Practical guidance is provided for the use of the important disease-modifying drugs and diuretics. When possible, other relevant (...) microcirculation as alternative evidence for IHD. In clinical practice, a clear distinction between acquired and inherited cardiomyopathies remains challenging. In most patients with a definite clinical diagnosis of HF, there is no confirmatory role for routine genetic testing, but genetic counselling is recommended in patients with hypertrophic cardiomyopathy (HCM), ‘idiopathic’ DCM or arrhythmogenic right ventricular cardiomyopathy (ARVC) (see Section 5.10.1), since the outcomes of these tests may have

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2016 European Society of Cardiology

89. Dyslipidaemias

kidney disease, familial hypercholesterolaemia, or very high levels of individual risk factors because such people are already at high-risk and need intensive risk factor advice. The reasons for retaining a system that estimates fatal as opposed to total fatal + non-fatal events are that non-fatal events are dependent on definition, developments in diagnostic tests and methods of ascertainment, all of which can vary, resulting in very variable multipliers to convert fatal to total events. In addition (...) of apoB. The analysis of apoB is accurate, with small variations, and is recommended as an alternative when available. Near patient testing is also available using dry chemistry methods. These methods may give a crude estimate, but should be verified by analysis in an established certified laboratory. 3.1 Fasting or non-fasting? Traditionally blood samples for lipid analysis have been drawn in the fasting state. As recently shown, fasting and non-fasting sampling give similar results for TC, LDL-C

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2016 European Society of Cardiology

90. Atrial Fibrillation

non-vitamin K antagonist oral anticoagulant dosing 47 9.5.4 Alcohol abuse 47 9.5.5 Falls and dementia 47 9.5.6 Genetic testing 47 9.5.7 Bridging periods off oral anticoagulation 48 9.6 Management of bleeding events in anticoagulated patients with atrial fibrillation 48 9.6.1 Management of minor, moderate, and severe bleeding 48 9.6.2 Oral anticoagulation in atrial fibrillation patients at risk of or having a bleeding event 49 9.7 Combination therapy with oral anticoagulants and antiplatelets 50 (...) penetration of rare gene defects have been suggested as potential mechanisms mediating increased AF risk in carriers of common gene variants. Genetic variants could, in the future, become useful for patient selection of rhythm or rate control. – While genomic analysis may provide an opportunity to improve the diagnosis and management of AF in the future, , routine genetic testing for common gene variants associated with AF cannot be recommended at present. 4.2 Mechanisms leading to atrial fibrillation

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2016 European Society of Cardiology

92. Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease

more significantly in older age. Oxygen use is ideally measured by cardiopulmonary exercise testing (CPET). Peak V o 2 is an assessment of maximal aerobic performance that implies that activity has intensified to a point of maximal volition; hence, peak V o 2 is usually assessed as part of a symptom-limited or maximum exercise test. Metabolic equivalents (METs) achieved are a surrogate indicator of exercise performance that are calculated from workload (ie, treadmill speed/grade or Watts) and often (...) et al used the METs calculated from standard ETT and showed that even this relatively less intricate measure of CRF was a powerful predictor of mortality in adults with coronary heart disease and in adults without CVD. In multiple studies, CRF metrics, whether measured by CPET, ETT, or 6-minute walking testing (6MWT), have shown significant prognostic bearing for patients with coronary artery disease (CAD), valvular heart disease, arrhythmia, peripheral arterial diseases, pulmonary hypertension

2017 American Heart Association

93. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke

be addressed early. For example, pregnancy is considered a “natural stress test” that uncovers risk for future CVD among mothers. Women with hypertension or preeclampsia during pregnancy have more than double the risk for a future CVD or cerebrovascular disease death or diagnosis than women who do not have these conditions during pregnancy. LBW among offspring or delivery of a preterm baby place the mother at increased risk for CVD. Early self‐care during this window of opportunity could stave off (...) these recommendations are the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean‐style diets. The recommendations can also easily be achieved with vegan or vegetarian diets as long as attention is paid to obtaining all essential amino acids and minerals. , Although adherence to dietary recommendations has improved over the past 10 years, it still remains low at ≤60% of the population. Although considerable research has been conducted testing the effect of various diets on cardiovascular health

2017 American Heart Association

95. Clinical Practice Guidelines on Hypertension

. Grade D, Level 4 22 3 Evaluating high blood pressure No. Recommendation Grade, Level of Evidence CPG page no. 10 Routine clinical evaluation of a patient with elevated BP includes the following: 1. Clinical and family history 2. Full standard physical examination 3. Laboratory investigations, including: a) Urine analysis: Dipstick for hematuria/albumin, microscopic examination, and test for albuminuria b) Measurement of serum concentrations of electrolytes, creatinine, urea, fasting glucose (...) damage in hypertension. Journal of Hypertension. 1987; 5:93-8. 52 Investigators TS. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New England Journal of Medicine. 1991; 325:293-302. 53 de Vries RJ, van Veldhuisen DJ, Dunselman PH. Efficacy and safety of calcium channel blockers in heart failure: focus on recent trials with second-generation dihydropyridines. American Heart Journal. 2000; 139:185-94. 54 Granger CB, McMurray

2017 Ministry of Health, Singapore

96. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation

: a systematic review and meta-analysis of the literature. Circulation . 2012 ; 126 : 2381–2391 | | | There has been no suggestion of excess MI with apixaban, x 23 Granger, C.B., Alexander, J.H., McMurray, J.J. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med . 2011 ; 365 : 981–992 | | | rivaroxaban, x 24 Patel, M.R., Mahaffey, K.W., Garg, J. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med . 2011 ; 365 : 883–891 | | | or edoxaban x 25

2016 Canadian Cardiovascular Society

97. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position Statement on the Optimal Care of the Post Arrest Patient

“comatose” or “unresponsiveness” in postarrest patients as an absence of purposeful response to verbal commands. Which Patient Populations Benefit From TTM? OHCA patients with an initial shockable rhythm Two landmark randomized controlled trials were published in 2002 that tested TTM for 12-24 hours in comatose survivors of OHCA. x 17 Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest [erratum in 2002;346:1756]. N Engl J Med

2016 Canadian Cardiovascular Society

98. U.S. Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of nontuberculous mycobacteria in individuals with cystic fibrosis

in rates of skin test reactivity to NTM antigens in US population-based testing studies, potentially indicating increasing exposure to NTM (see below). Furthermore, the relative frequency of M. abscessus detection in NTM-positive samples from individuals with CF has increased remarkably over time both in the USA and in Europe, , , , , , suggesting real changes in NTM acquisition rates (rather than increased sampling). Possible reasons for the potential increased frequency of NTM-positive cultures (...) in the same household for more than 10 years, have unique strains, , suggesting a lack of person-to-person transmission. However, a case report from the University of Washington described a possible outbreak of M. a. massiliense in five patients with potential transmission occurring during synchronous clinic visits. Recently, whole genome sequencing and antimicrobial susceptibility testing performed on 168 consecutive isolates of M. abscessus from 31 patients attending an adult CF centre in the UK

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2016 Cystic Fibrosis Foundation

99. Drugs That May Cause or Exacerbate Heart Failure

was caused mostly by HF. Another study, PALLAS (Permanent Atrial Fibrillation Outcome Study), tested whether dronedarone reduced cardiovascular events in patients with permanent atrial fibrillation. PALLAS was terminated prematurely after enrolling 3236 patients because dronedarone was associated with an increase in cardiovascular death, stroke, and hospitalization for HF (HR, 1.81; 95% CI, 1.10–2.99; P =0.02). Thus, the prescribing information for dronedarone carries a black box warning that the drug

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2016 American Heart Association

100. Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

of recommendations and Level of Evidence A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age (...) Study. J Am Coll Cardiol. 2004;43:2236–2241. doi: 10.1016/j.jacc.2003.10.074. 122. Castagno D, Baird-Gunning J, Jhund PS, Biondi-Zoccai G, MacDonald MR, Petrie MC, Gaita F , McMurray JJ. Intensive glycemic control has no impact on the risk of heart failure in type 2 diabetic patients: evidence from a 37,229 patient meta-analysis. Am Heart J. 2011;162:938–948.e2. doi: 10.1016/j.ahj.2011.07.030. 123. Aguilar D, Bozkurt B, Ramasubbu K, Deswal A. Relationship of hemoglobin A1C and mortality in heart

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2016 American Heart Association

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