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Myocardial Infarction Stabilization

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441. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Full Text available with Trip Pro

randomized trials of fibrinolytic therapy in acute myocardial infarction required dose reduction of concurrent intravenous heparin because of excessive risk of sICH (pooled rate, 1.56%; range, 0.92%–2.80%). Rates of sICH in the 7 major published randomized trials of patients with acute myocardial infarction treated with alteplase and low-dose heparin ranged from 0.64% to 0.94%. Because of this feared complication, acute stroke clinical trials were designed to minimize this risk on the basis of previous (...) acute myocardial infarction experience. The incidence of sICH after alteplase in the modern era at the standard dose of 0.9 mg/kg administered over 1 hour with a 10% bolus varies from 2% to 7% in clinical trials and prospective stroke registries. This variation is likely the result of differences in study design, the populations treated, and the definitions of sICH. Site of image adjudication, timing and type of required follow-up imaging, method of assessing and categorizing clinical worsening

2017 American Heart Association

442. Syncope: Guideline For Evaluation and Management of Patients With

in contemporary troponin measurement unless acute myocardial infarction is suspected, and there is modest predictive value for high-sensitivity troponin and natriuretic peptides for major adverse cardiovascular events. The ability of troponin and natriureticpeptidemeasurementtoin?uenceclinicaldecisionmakingorpatientoutcomeisunknown(129). III: No Bene?t B-NR Routine and comprehensive laboratory testing is not useful in the evaluation of patients with syncope (126,131). See Online Data Supplements 7 and 8

2017 American College of Cardiology

443. Management of Patients on Non?Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

setting include the occurrence of a new clinical event (eg, myocardial infarction) in patients on established oral anticoagulant regimens, the development of a new or worsening co- morbid medical condition (eg, renal failure) that neces- sitates an anticoagulant transition and the need for an invasive procedure. In the United States, the current la- beled prescribing information for each NOAC provides guidance for the transition to and from NOAC agents to other anticoagulants; however (...) -51 trial tested rivaroxaban to lower cardiovascular events in patients with ACS and reported 10 patients undergoing coronary artery bypass grafting after ST-segment eleva- tion myocardial infarction. 129,166 Per the trial protocol, the drug was stopped 12 hours before the procedure and resumed 12 hours after the postprocedural drains were removed or after the last dose of parenteral anticoagu- lant therapy had been administered. The results specific to this group were not reported; therefore

2017 American Heart Association

444. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Guideline For the Management of Patients With

to ensure they do not have underlying conditions (e.g., ischemic heart disease, left ventricular [LV] dysfunction) that warrant further treatment to reduce risk. PVC and NSVTinpatientswithcardiovasculardiseasearecommon and have been associated with adverse outcomes (S2.2.2- 12,S2.2.2-13). In CAST (Cardiac Arrhythmia Suppression Trials), treatment of patients with post-myocardial infarction (MI) who took antiarrhythmic medications (e.g., ?ecainide, encainide, moricizine) increased the risk of death (...) acute coronary syndromes AED automated external de?brillator AMI acute myocardial infarction BNP B-type natriuretic peptide CABG coronary artery bypass graft CKD chronic kidney disease CPR cardiopulmonary resuscitation CRT cardiac resynchronization therapy CT computed tomography ECG electrocardiogram ERC evidence review committee ESRD end-stage renal disease GDMT guideline-directed management and therapy HCM hypertrophic cardiomyopathy HF heart failure HFpEF heart failure with preserved ejection

2017 American College of Cardiology

445. Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease Full Text available with Trip Pro

, myocardial infarction; ORIGIN, Outcome Reduction With Initial Glargine Intervention Trial; PVD, peripheral vascular disease; and RR, relative risk. Downloaded from http://ahajournals.org by on March 27, 2019Fish Oil and Prevention of CVD Circulation. 2017;135:e867–e884. DOI: 10.1161/CIR.0000000000000482 April 11, 2017 e869 CLINICAL STATEMENTS AND GUIDELINES OMEGA-3 PUFA (FISH OIL) SUPPLEMENTS Nonprescription Omega-3 PUFA Supplements In 2012, 7.8% of adults in the United States (18.8 million) reported (...) ; CHD, coronary heart disease; CHF, congestive heart failure; CI, confidence interval; CVD, cardiovascular disease; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; JELIS, Japan EPA Lipid Intervention Study; MI, myocardial infarction; RCT, randomized controlled trial; RR, relative risk; and SCD, sudden cardiac death. Downloaded from http://ahajournals.org by on March 27, 2019Fish Oil and Prevention of CVD Circulation. 2017;135:e867–e884. DOI: 10.1161/CIR.0000000000000482 April 11, 2017 e871

2017 American Heart Association

446. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

for physicians. Examples in cardiology include texting programs for teenagers living with congenital heart disease and several examples to improve lifestyle and to decrease risk in adults with cardiovascular disease. , Mobile health applications for personal monitoring of cardiac electrical activity exist for the detection of arrhythmias and myocardial infarction. In a prospectively recruited cohort of 76 participants undergoing cardioversion for atrial fibrillation, a novel algorithm analyzing signals (...) Australia evaluating nearly 1000 patients with a single-lead electrocardiographic device built into a smartphone case. The technology was accurate and cost-effective and has the potential to prevent stroke. , A modification of the existing smartphone case single-lead device was used in a recent study for the assessment of ST-segment–elevation myocardial infarction. Six patients for whom the hospital ST-segment–elevation myocardial infarction protocol was activated were evaluated with traditional 12-lead

2017 American Heart Association

447. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association Full Text available with Trip Pro

from its cardiac sequelae. The peak mortality occurs 15 to 45 days after onset of fever, during which time well-established coronary artery vasculitis occurs concomitantly with marked elevation of the platelet count and a hypercoagulable state. However, sudden death of myocardial infarction (MI) can occur many years later in children and adults with coronary artery aneurysms and stenoses. Many cases of fatal and nonfatal MI in young adults have now been attributed to “missed” KD in childhood (...) luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascularization procedures

2017 American Heart Association

448. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Hea Full Text available with Trip Pro

arrhythmias and the prevention of sudden cardiac death ESC 2015 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care AHA 2015 Atrial fibrillation AHA/ACC/HRS 2014 Non–ST-elevation acute coronary syndromes AHA/ACC 2014 Assessment of cardiovascular risk ACC/AHA 2013 ST-elevation myocardial infarction ACCF/AHA 2013 Acute myocardial infarction in patients presenting with ST-segment elevation ESC 2012 Device-based therapies for cardiac rhythm abnormalities ACCF/AHA/HRS 2012 Coronary (...) ., recommendation 6 Readers should refer to these sections for the updated text. 1.5. Abbreviations Abbreviation Meaning/Phrase ACS acute coronary syndromes AED automated external defibrillator AMI acute myocardial infarction BNP B-type natriuretic peptide CABG coronary artery bypass graft CKD chronic kidney disease CPR cardiopulmonary resuscitation CRT cardiac resynchronization therapy CT computed tomography ECG electrocardiogram ERC evidence review committee ESRD end-stage renal disease GDMT guideline

2017 American Heart Association

449. Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease Full Text available with Trip Pro

additional hemodynamic perturbations, fatigue, somnolence, and falls, especially in the common context of multimorbidity and polypharmacy and age-related shifts in pharmacokinetics and pharmacodynamics. An 86-year-old woman with a non–ST-segment–elevation myocardial infarction, HF, Parkinson disease, and insomnia, for example, may be prescribed β-blockers, angiotensin-converting enzyme inhibitors, diuretics, statins, selegiline, and trazodone with evidence-based rationales but with the potential effect (...) opening that in turn leads to cellular energetic failure and necrotic or programmed cell death in cardiomyocytes or other tissue. In addition, cellular mitochondrial quality control mechanisms such as autophagy and ubiquitin-protease system, which removes damaged mitochondria or protein to maintain a functional mitochondrial network, become impaired with aging, resulting in an accumulation of dysfunctional mitochondria, which further contribute to myocardial functional impairment and CVD. Age-related

2017 American Heart Association

450. The Expressed Genome in Cardiovascular Diseases and Stroke: Refinement, Diagnosis, and Prediction: A Scientific Statement From the American Heart Association

of a phenotype because it is observable. In clinical use, phenotyping refers to the trait that is being studied such as myocardial infarction (MI) or stroke. A phenotype such as MI may have numerous subphenotypes such as hypertension, hyperlipidemia, or sensitivity to tobacco use, each of which may also have its own subphenotypes such as salt sensitivity, lipid plaque stability, or nicotine addiction. The harmonization of phenotypes refers to having a common definition of the phenotype being studied (...) or the stability of their RNA transcripts, conferring an additional level of control of gene expression. Within a chromosome, the DNA molecule is part of a complex known as chromatin, which includes a group of proteins known as histones. Depending on the configuration of these histones, which can be altered via biochemical modifications, an area of a chromosome may be more open or closed to transcription. Biochemical modifications of DNA bases within or near a gene sequence can also affect the level

2017 American Heart Association

451. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association Full Text available with Trip Pro

- tional interviewing, self-efficacy, symptom management, and associated MeSH terms. Additional search terms for each of the cardiovascular conditions or diseases (eg, hypertension, myocardial infarction, ACS, CABG, PCI, acute cardiac event, atrial fibrillation, heart failure) and barriers to TPE (health literacy, cognition, and time barriers) were also used. A man- ual search of journals using a snowball technique was used to review reference lists for additional relevant studies. The Figure provides (...) predicted change in kilocalories expended (P=0.03) ACS indicates acute coronary syndrome; C, control; CABG, coronary artery bypass graft; CAD, coronary artery disease; CD, compact disc; CR, cardiac rehabilitation; CVD, cardiovascular disease; F/U, follow-up; GP, general practitioner; I, intervention; MI, myocardial infarction; PCI, percutaneous coronary intervention; PT, physical therapist; RCT, randomized controlled trial; RN, registered nurse; SF36, 36-Item Short-Form Health Survey; TPE, therapeutic

2017 American Heart Association

452. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

, stroke case fatality was 24% lower in African Americans than whites, an observation that was relatively consistent across stroke subtypes of infarction and hemorrhage. There is a strong age-related difference in the risk of intracerebral hemorrhage in African Americans compared with whites. At 55 to 74 years of age, African Americans were 1.8 times more likely to experience intracerebral hemorrhage, but that difference was only modestly greater (RR, 1.23 times) for ages ≥75 years. A pooled analysis (...) women. Atrial Fibrillation Although atrial fibrillation has long been recognized as a potent risk factor for stroke, , data from REGARDS recently documented that atrial fibrillation is also a potent risk factor for myocardial events, a finding confirmed in ARIC and in a meta-analysis of observational studies and clinical trials. Despite African Americans having more risk factors for the development of atrial fibrillation, studies have consistently documented a lower prevalence of either self

2017 American Heart Association

453. Recommendation on Design, Execution, and Reporting of Animal Atherosclerosis Studies: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

promoters. These gene deletions allow for development of coronary atherosclerosis and myocardial infarction when mice are doubly deficient in apoE (apolipoprotein E) and Ldlr (LDL receptor) or apoE and SR-BI (scavenger receptor BI). One of the most commonly used mouse models of atherosclerosis is apoE −/− mice. apoE −/− mice spontaneously develop hypercholesterolemia because of increased chylomicron remnant, very low-density lipoprotein (VLDL) and LDL cholesterol, with total cholesterol concentrations (...) and then distal coronary arteries after a prolonged period. Fatty streaks are the most common, but other lesions range from uncomplicated fibrous plaques to complex pathology containing necrotic cores, mineralization, hemorrhage, and medial destruction. Furthermore, rhesus monkeys consuming an atherogenic diet have a relatively high frequency of myocardial infarction. Coronary artery remodeling is similar between monkeys and humans with regard to the Glagov hypothesis of remodeling. Several original studies

2017 American Heart Association

454. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. Neuromuscular diseases (NMDs) encompass a broad spectrum of diagnoses with overlapping but distinct (...) years of age, increasing to ≈70% with symptomatic HF by age 40 years. Given that therapeutic intervention before symptom onset has a greater impact, the detection of abnormal LVEF affords the opportunity to act. Carriers of DMD/BMD should undergo cardiac evaluation with any symptoms. At a mean age of 44 years, DMD and BMD carriers have been shown to exhibit both decreased LVEF and evidence of myocardial fibrosis. In general, there are fewer published references regarding cardiac involvement in BMD

2017 American Heart Association

455. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. , Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%–51%). , Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus (...) and clinical or laboratory signs of hypoperfusionClinical hypoperfusion: Cold extremities, oliguria, mental confusion, dizziness, narrow pulse pressureLaboratory hypoperfusion: Metabolic acidosis, elevated serum lactate, elevated serum creatinine CI indicates cardiac index; CS, cardiogenic shock; ESC, European Society of Cardiology; HF, heart failure; IABP-SHOCK II, Intraaortic Balloon Pump in Cardiogenic Shock II; LV, left ventricular; MI, myocardial infarction; PCWP, pulmonary capillary wedge pressure

2017 American Heart Association

456. Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

childhood adversities and cardiometabolic health . Childhood Adversity and Cardiometabolic Outcomes Influence of Childhood Adversity on Cardiometabolic Outcomes Several review articles suggest that childhood adversity is associated with increased risk of cardiometabolic disease, including CVD mortality and numerous CVD outcomes such as myocardial infarction, stroke, ischemic heart disease, and coronary heart disease. , , A recent systematic review found that childhood maltreatment was associated (...) with CVD (myocardial infarction, stroke, ischemic heart disease, coronary heart disease) in 91.7% (22 of 24) of published studies. Research has also examined the relation between childhood adversity and risk factors for cardiometabolic disease. For example, several studies suggest that childhood adversity is associated with increased risk of hypertension and high blood pressure levels, although findings are mixed. , , Other studies also suggest that there may be an association between childhood

2017 American Heart Association

457. Chronic Obstructive Pulmonary Disease

study (a four-year, placebo controlled trial of tiotropium) found no significant increase in myocardial infarction or stroke in the tiotropium treated group. 59 Inhaled glucocorticosteroids (ICS). Recommendation: Add ICS to bronchodilator therapy in patients with features of asthma overlap. Consider adding ICS in patients with frequent (at least annual) severe COPD exacerbations despite maximal bronchodilation. ICS should not be used as monotherapy in COPD. However, ICS can provide additive benefit (...) varies. Reassessment after Severe Acute Exacerbation Recommendation: Reassess patients after hospital discharge for an acute COPD exacerbation. 19 UMHS COPD Guideline, November 2017 Assessment should include: • Spirometry about 3 months after the patient’s return to stability. Significant declines in baseline lung function can occur with exacerbations. • Ability to cope in their home environment • Inhaler technique and understanding of treatment regimen • Need for oxygen • Medical regimen

2017 University of Michigan Health System

458. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke

criteria (hemorrhagic infarction [HI] type 1, HI-2, parenchymal hematoma [PH] type 1, PH-2, or remote ICH), assess the degree of neurological worsening by National Institutes of Health Stroke Scale (NIHSS) point change, and provide an attribution of causality for the worsening. Epidemiology of sICH Incidence Early-phase randomized trials of fibrinolytic therapy in acute myocardial infarction required dose reduction of concurrent intravenous heparin because of excessive risk of sICH (pooled rate, 1.56 (...) %; range, 0.92%–2.80%). Rates of sICH in the 7 major published randomized trials of patients with acute myocardial infarction treated with alteplase and low-dose heparin ranged from 0.64% to 0.94%. Because of this feared complication, acute stroke clinical trials were designed to minimize this risk on the basis of previous acute myocardial infarction experience. The incidence of sICH after alteplase in the modern era at the standard dose of 0.9 mg/kg administered over 1 hour with a 10% bolus varies

2017 American Academy of Neurology

459. Management of Opioid Therapy (OT) for Chronic Pain

providers.[5] In the emergency department, at least 17% of discharges included prescriptions for opioids.[6,7] There has been limited research on the effectiveness of LOT for non-end-of-life pain. At the same time, there is mounting evidence of the ill effects of LOT, including increased mortality, OUD, overdose, sexual dysfunction, fractures, myocardial infarction, constipation, and sleep-disordered breathing.[8-10] Despite increasing awareness of the known harms of opioids, 259 million opioid

2017 VA/DoD Clinical Practice Guidelines

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