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McMurray Test

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121. The Canadian Cardiovascular Society heart failure companion: bridging guidelines to your practice

should includenumericEF or smallrange of EF and diastolic function evaluation Following titration of triple therapy for HFrEF, or consideration of ICD/CRT implantation 3 Months after completion of titration ECHO or MUGA or CMRI (preferably the same modality and laboratory test as initial test) LVEF after medical therapy might increase, obviating device therapy Stable HF Approximately every 2-3 years, especially if EF is> 40% ECHO or MUGA or CMRI Rationale is to identify improving (better prognosis (...) . 25. Zannad F, McMurray JJ, Drexler H, et al. Rationale and design of the EplerenoneinMildPatientsHospitalizationAndSurvIvalStudyinHeart Failure (EMPHASIS-HF). Eur J Heart Fail 2010;12:617-22. 26. Young JB, Dunlap ME, Pfeffer MA, et al. Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials. Circulation 2004;110: 2618-26. 308 Canadian Journal

2016 CPG Infobase

122. Management of chronic heart failure

pressure Peripheral oedema (ankle, sacral, scrotal) Hepatojugular reflux Pulmonary crepitations Third heart sound (gallop rhythm) Reduced air entry and dullness to percussion at lung bases (pleural effusion) Laterally displaced apical impulse Tachycardia Cardiac murmur Irregular pulse Tachypnoea (>16 breaths/min) Hepatomegaly Ascites Tissue wasting (cachexia) Reproduced from McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment (...) are most useful rather than any of these in isolation. Basic early investigations are necessary to differentiate heart failure from other conditions and to provide prognostic information. Urinalysis, serum urea and creatinine tests may help to determine if there is kidney failure, since symptoms of kidney disease are similar to those of HF . Chest X-ray may indicate signs of HF such as cardiomegaly, pulmonary congestion or pleural effusion and also non-cardiac indications such as lung tumours which

2016 SIGN

123. Acute coronary syndrome

coronary intervention 20 6 Risk stratification and non-invasive testing 22 6.1 Risk stratification 22 6.2 Assessment of cardiac function 22 6.3 Stress testing 23 7 Invasive investigation and revascularisation 24 7.1 Invasive investigation 24 7.2 Access routes for percutaneous coronary intervention 25 7.3 Glycoprotein IIb/IIIa receptor antagonists 26 7.4 Coronary artery bypass grafting surgery 26 8 Early pharmacological intervention 28 8.1 Antiplatelet therapy 28 8.2 Anticoagulant therapy 29 8.3 Statin (...) to be admitted to hospital for serial testing. Use of a high-sensitivity cardiac troponin assay permits the use of lower diagnostic thresholds than standard troponin assays, and allows earlier testing that may reduce unnecessary hospital admissions, waiting times for test results and associated anxiety in patients and carers. 37 Early rule-out protocols typically involve serial cardiac troponin measurements on presentation and three hours later. 38 High-sensitivity cardiac troponin assays appear to improve

2016 SIGN

124. 2016 Focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation

), or in the situation in which it has not stabilized the patient, idarucizumab should be administered as soon as possible. Although dilute thrombin time and ecarin clotting time were used to identify the presence of dabigatran in REVERSE-AD, these tests are not widely available. Thrombin time and activated partial thromboplastin time are widely available and can qualitatively identify the presence of active dabigatran in a patient, 65 however, obtaining these tests (...) Open 2012;2. 22. Dentali F, Riva N, Crowther M, et al. Ef?cacy and safety of the novel oral anticoagulants in atrial ?brillation: a systematic review and meta- analysis of the literature. Circulation 2012;126:2381-91. 23. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial ?brillation. N Engl J Med 2011;365: 981-92. 24. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial ?brillation. N Engl J Med 2011;365:883-91. 25

2016 CPG Infobase

125. The 2014 Canadian Cardiovascular Society heart failure management guidelines focus update: anemia, biomarkers, and recent therapeutic trial implications

with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved sys- tolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes (...) Furthermore, RCTs in patients with acute dyspnea have demonstrated that NP testing when used with conventional managementissuperiortoconventionalmanagement alonein improving clinical outcomes and reducing cost. 47,48 However, the role of biomarkers including NP in the management of patientswithacutecardiovascularsymptomsintheambulance before arrival at the hospital is still unclear. 49 Importantly, the optimal strategy to fully incorporate these research data

2015 CPG Infobase

126. 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

127. Acute and Chronic Heart Failure (Full text)

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

2016 European Society of Cardiology PubMed abstract

128. Dyslipidaemias (Full text)

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

2016 European Society of Cardiology PubMed abstract

130. Entresto - sacubitril / valsartan

Marketing Authorisation holder MEB Medicines Evaluation Board MedDRA Medical Dictionary for Regulatory Activities MHRA Medicines and Healthcare Products Regulatory Agency MI Myocardial infarction MPA Medical Products Agency MME Membrane metallo-endopeptidase (neprilysin) MMP-2 Matrix metalloprotease-2 MPA Medical Products Agency MRA mineralocorticoid antagonist MRP Multi-drug resistance protein MS Mass spectrometry MTD Maximal tolerated dose MTP Multiple testing procedure NCO Nonclinical Overview NEP (...) of administrative information, complete quality data, non-clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain tests or studies. Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC) No 1901/2006, the application included an EMA Decision P/0106/2014 on the agreement of a paediatric investigation plan (PIP). At the time of submission of the application, the PIP P/0106/2014 was not yet completed as some

2015 European Medicines Agency - EPARs

131. Use of Non-Vitamin K Antagonist Oral Anticoagulants (NOAC) in Non-Valvular Atrial Fibrillation

Drug Interactions ). In patients weighing less than 60 kg or greater than 100 kg, calculate the creatinine clearance (CrCl) and do not depend on the estimated glomerular filtration rate (eGFR) provided by laboratory reports (because weight has not be adjusted). CrCl can be calculated using the (link to calculator: ) according to the patient’s age, weight, and serum creatinine: Coagulation Testing The INR and the activated partial thromboplastin time (aPTT) are used to monitor the anticoagulant (...) effects of warfarin and heparin, respectively. They should NOT be used to measure the anticoagulant effects of NOACs. , Depending on the laboratory reagent used and the timing of the blood draw after a dose of NOAC, the INR and aPTT may or may not be prolonged. Consequently, these tests should not be used to estimate the anticoagulant activity. It is reasonable to assume that some anticoagulant activity is present if either the INR and/or aPTT is elevated, but it is not appropriate to assume

2015 Clinical Practice Guidelines and Protocols in British Columbia

132. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (Full text)

explain 15–25% of sudden arrhythmic death syndrome (SADS) cases. 17 The value of the post-mortem diagnosis in a victim of SCD lies in extending genetic screening to the family members of SADS or SIDS victims. Recent expert consensus documents for the diagnosis and management of inheritable arrhythmias state that the use of a focused molecular autopsy/post-mortem genetic testing should be considered for SCD victims when the presence of channelopathies is suspected. We endorse this recommendation (...) and the effects of various drugs may result in repolarization abnormalities and/or prolongation of the QRS duration. Exercise ECG is most commonly applied to detect silent ischaemia in adult patients with ventricular VAs. Exercise-induced non-sustained VT was reported in nearly 4% of asymptomatic middle-age adults and was not associated with an increased risk of total mortality. 108 Exercise testing in adrenergic-dependent rhythm disturbances, including monomorphic VT and polymorphic VT such as CPVT

2015 European Society of Cardiology PubMed abstract

133. Heart failure - chronic

and transthoracic echocardiography within 2 weeks. Refer people with suspected heart failure and an NT‑proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. In all people: A 12-lead ECG should be arranged in addition to considering other tests to exclude possible aggravating factors or other conditions. A loop diuretic may be prescribed for symptom relief while awaiting specialist assessment. For people with confirmed (...) is less than 400 pg/mL (47 pmol/L), be aware that a diagnosis of heart failure is less likely. Consider discussion with a physician with subspeciality training in heart failure if a clinical suspicion of heart failure persists. Be aware that the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. Arrange a 12-lead ECG in all people. Consider other tests to evaluate for possible aggravating

2019 NICE Clinical Knowledge Summaries

134. Atrial fibrillation

peptide during episodes of AF [ ]. Differential diagnosis The information on the differential diagnoses an irregular pulse is based on expert opinion in the BMJ Best Practice guidelines Chronic Atrial Fibrillation [ ] and New Onset Atrial Fibrillation [ ], the American College of Cardiology Foundation/American Heart Association/European Society of Cardiology Guidelines for the management of patients with atrial fibrillation [ ] and a medical textbook on AF [ ]. Diagnostic tests (ECG (...) ) The recommendations on diagnostic tests for atrial fibrillation are based largely on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline: Atrial fibrillation: the management of atrial fibrillation [ ]. NICE makes no specific recommendations on ECG interpretation. The information on the features of an ECG that are confirmatory for atrial fibrillation is therefore based on expert opinion in a medical textbook [ ] and in the BMJ Best Practice guideline Chronic Atrial Fibrillation

2019 NICE Clinical Knowledge Summaries

135. Anticoagulation - oral

the management of people receiving apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin treatment in primary care, including brief advice about the place of self-testing and self-management of warfarin. This CKS topic does not cover the management of acenocoumarol or phenindione and does not cover secondary care management. There are separate CKS topics on , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact (...) products Regulatory Agency (MHRA) Public assessment report. Warfarin: changes to product safety information. December 2009 — minor update. Advice about taking antidepressants in people receiving warfarin has been amended in the section on Drug interactions. Issued in December 2009. August to September 2009 — updated to include recommendations and supporting evidence on the place of self-testing and self-management of warfarin. Advice on the management of the drug interaction between selective serotonin

2019 NICE Clinical Knowledge Summaries

136. Do Intravenous Nitrates Improve Dyspnea in Acute Heart Failure Syndromes More Than Alternative Pharmacologic Interventions?

. McMurray JJ, Adamopoulos S, Anker SD, et al; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787-1847. 5. YancyCW,JessupM,BozkurtB,etal;American CollegeofCardiology Foundation;American (...) and diagnosis, in 18 categories. Go to the Images pull-down menu and test your diagnostic skill today. Below is a selection from the Dermatology Images. “Woman With Painful Swellingin Fingers” by Habboushe and Newman,May 2011,Volume57,#5,pp.434,441. Systematic Review Snapshot Volume 66, no. 1 : July 2015 Annals of Emergency Medicine 29

2015 Annals of Emergency Medicine Systematic Review Snapshots

137. Colorectal Cancer Prevention (PDQ®): Health Professional Version

or surveillance could counterbalance long-term risks such as gastrointestinal ulceration and hemorrhagic stroke for the average-risk individual.[ ] Calcium supplements A randomized placebo-controlled trial tested the effect of calcium supplementation (3 g calcium carbonate daily [1,200 mg elemental calcium]) on the risk of recurrent adenoma.[ ] The primary endpoint was the proportion of patients (72% of whom were male) in whom at least one adenoma was detected following a first and/or second follow-up

2018 PDQ - NCI's Comprehensive Cancer Database

138. Genetics of Colorectal Cancer (PDQ®): Health Professional Version

% or greater on MMRpro and MMRpredict are recommended for genetic evaluation referral and testing. Associated Genes and Syndromes Hereditary CRC has two well-described forms: (1) polyposis (including and (AFAP), which are caused by pathogenic variants in the gene; and , which is caused by pathogenic variants in the MUTYH gene); and (2) (often referred to as hereditary nonpolyposis colorectal cancer), which is caused by germline pathogenic variants in DNA MMR genes ( , , , and ) and . Other CRC syndromes (...) that all individuals with newly diagnosed CRC are evaluated for Lynch syndrome through molecular diagnostic tumor testing assessing MMR deficiency. A is supported, in which all CRC cases are evaluated regardless of age at diagnosis or fulfillment of existing clinical criteria for Lynch syndrome. A more cost-effective approach has been reported whereby all patients aged 70 years or younger with CRC and older patients who meet the revised Bethesda guidelines are tested for Lynch syndrome. Tumor

2018 PDQ - NCI's Comprehensive Cancer Database

139. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position Statement on the Optimal Care of the Post Arrest Patient (Full text)

“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 PubMed abstract

140. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation (Full text)

: 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 PubMed abstract

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