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141. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

extremities. In patients who have not had a prior lower-extremity revascularization, clinical evidence of PAD includes typical limb symptoms with exercise and an ankle-brachial index (ABI) of ≤0.90. However, imaging evidence for significant occlusive disease is now more widely used to make the diagnosis, as are other noninvasive vascular laboratory tests. Some patients who have undergone a prior lower-extremity revascularization will have normal ABIs but still have PAD as the underlying disease (...) , Originally published 13 Dec 2018 Circulation. 2018;139:e10–e33 Peripheral artery disease (PAD) is a progressive atherosclerotic disease that affects >8 million Americans. Symptoms of PAD are caused by insufficient arterial blood flow to the lower extremities, which often results in ischemia-induced, debilitating leg discomfort associated with walking. Claudication, which is cramping, aching, or pain in the calves, thighs, or buttocks, is the classic symptom of PAD. Claudication is defined

2019 American Gastroenterological Association Institute

142. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

. Welty , Originally published 10 Dec 2018 Arteriosclerosis, Thrombosis, and Vascular Biology. 2018;39:e38–e81 Abstract One in 4 Americans >40 years of age takes a statin to reduce the risk of myocardial infarction, ischemic stroke, and other complications of atherosclerotic disease. The most effective statins produce a mean reduction in low-density lipoprotein cholesterol of 55% to 60% at the maximum dosage, and 6 of the 7 marketed statins are available in generic form, which makes them affordable (...) transplants. The risk of statin-induced serious muscle injury, including rhabdomyolysis, is <0.1%, and the risk of serious hepatotoxicity is ≈0.001%. The risk of statin-induced newly diagnosed diabetes mellitus is ≈0.2% per year of treatment, depending on the underlying risk of diabetes mellitus in the population studied. In patients with cerebrovascular disease, statins possibly increase the risk of hemorrhagic stroke; however, they clearly produce a greater reduction in the risk of atherothrombotic

2019 American Gastroenterological Association Institute

143. 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza Full Text available with Trip Pro

, with or without fever, should also be considered along with the patient’s underlying health and immune function (eg, fever without source in infants; new-onset neurologic signs and symptoms [seizures, altered mental status], more commonly in infants and young children, but possible in adults; new-onset cardiovascular events [heart failure, myocardial infarction or ischemia, cerebrovascular accident] in adults; and exacerbation of chronic medical conditions, with or without fever [particularly cardiac (...) complications associated with influenza in adults in a recent comprehensive review [63]. Exacerbation of chronic disease (eg, coronary artery disease, chronic pulmonary disease, asthma, heart failure) with influenza virus infection can result in severe illness [49, 63–69]. Influenza can trigger acute myocardial infarction [70]. Elderly persons with influenza may present without fever and milder systemic symptoms than younger patients, but with higher frequencies of altered mental status [71–75]. Data from

2019 Infectious Diseases Society of America

144. Tobacco Cessation Treatment

CVD deaths are attributable to cigarette smoking (5). Tobacco smoking adversely affectsallphasesoftheatherothromboticdiseaseprocess, including endothelial dysfunction (6),plaquedevelop- ment and destabilization (7), and imbalances of antith- rombotic and prothrombotic factors (8,9), culminating in acute cardiovascular (CV) events (10,11). Clinically, tobacco smoking increases the risk of coronary heart disease (CHD) (including myocardial infarction [MI] and sudden death), cerebrovascular disease (...) of stop- ping smoking (e.g., ?nancial savings, health bene?ts, behavioral control, setting an example for others), rather than focusing solely on the harms of continued smoking. For smokers who are post–myocardial infarction, the clinician can emphasize the rapid reduction in the chance of future CV morbidity and mortality by saying, for example, “Quitting smoking now is the best way for you to avoid another heart attack.” After percutaneous coronary intervention, coronary artery bypass grafting

2019 American College of Cardiology

145. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) Full Text available with Trip Pro

nutrition may have a role in the malnourished patient postoperatively Low Weak Smoking cessation Smoking should be stopped at least 4 weeks before surgery High Strong Alcohol dependency management Alcohol consumption (in alcohol abusers) should be avoided for at least 4 weeks before surgery Moderate Strong Anaemia management Anaemia should be identified, investigated and corrected preoperatively High Strong Pulmonary rehabilitation and prehabilitation Prehabilitation should be considered for patients (...) at least 4 weeks before surgery High Strong Alcohol dependency management Alcohol consumption (in alcohol abusers) should be avoided for at least 4 weeks before surgery Moderate Strong Anaemia management Anaemia should be identified, investigated and corrected preoperatively High Strong Pulmonary rehabilitation and prehabilitation Prehabilitation should be considered for patients with borderline lung function or exercise capacity Low Strong Admission Preoperative fasting and carbohydrate treatment

2020 ERAS Society

146. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

. Ann Thorac Surg . 2017;104(2):606-612. doi: Whang W, Bigger JT Jr; The CABG Patch Trial Investigators and Coordinators. Diabetes and outcomes of coronary artery bypass graft surgery in patients with severe left ventricular dysfunction: results from the CABG Patch Trial database. J Am Coll Cardiol . 2000;36(4):1166-1172. doi: Wong J, Zoungas S, Wright C, Teede H. Evidence-based guidelines for perioperative management of diabetes in cardiac and vascular surgery. World J Surg . 2010;34(3):500-513 (...) for the PREHAB study—Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery: a randomised controlled trial. BMJ Open . 2015;5(3):e007250. doi: Snowden CP, Prentis J, Jacques B, et al. Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people. Ann Surg . 2013;257(6):999-1004. doi: Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy

2020 ERAS Society

147. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association

-associated CVD tripled over the past 2 decades and accounted for 2.6 million disability-adjusted life-years per year, with the greatest impact in Sub-Saharan Africa and the Asia-Pacific regions ( ). PLWH have an excess risk of myocardial infarction (MI), , ischemic stroke, , heart failure (HF), , pulmonary hypertension, , and venous thrombosis. , Underlying mechanisms likely include an interplay among traditional risk factors, HIV-specific factors (eg, chronic immune activation/inflammation), , ART (...) and intracranial arteries respond to vascular risk factors and inflammation. Common pathways of atherosclerosis and CVD events relate more closely to extracranial (eg, proximal carotid arteries and aorta) than intracranial arterial causes of ischemic stroke. The body of evidence on the pathogenesis of HIV infection and CVD pertains largely to extracranial disease. , , However, more than one-third of ischemic stroke in HIV is the result of intracranial disease. , Advanced HIV infection is associated

2019 American Heart Association

148. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation Full Text available with Trip Pro

pressure of oxygen in arterial blood; PCI, percutaneous coronary intervention; PCPC, Pediatric Cerebral Performance Category; PEA pulseless electrical activity; ROSC, return of spontaneous circulation; SF-12, Short-Form Health Survey (12 Items); SpO 2 , peripheral oxygen saturation; SSEP, somatosensory evoked potentials; STEMI, ST-segment–elevation myocardial infarction; TFI, triaxial field induction; TTM, targeted temperature management; VAD, ventricular assist device; VF, ventricular fibrillation; VT (...) , and the following have been evaluated previously for inclusion in the risk-standardization model derived from the GWTG-R registry: heart failure, myocardial infarction, or diabetes mellitus; renal, hepatic, or respiratory insufficiency; baseline evidence of motor, cognitive, or functional deficits (central nervous system depression); acute stroke; acute nonstroke neurological disorder; pneumonia; hypotension; sepsis; major trauma; metabolic or electrolyte abnormality; and metastatic or hematologic malignancy

2019 American Heart Association

149. Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association Full Text available with Trip Pro

or coronary stent Prior heart valve repair or replacement Heart or heart-lung transplantation Table 4. Adverse Events Requiring Medical Evaluation and SET Interruption New, progressive, or rest angina (unstable angina) New, progressive, or rest dyspnea Hemodynamic instability during exercise Acute myocardial infarction Transient ischemic attack or acute stroke New or uncontrolled cardiac arrhythmia Ischemic limb pain at rest Acral (toe, foot) ulceration or gangrene SET indicates supervised exercise (...) rehabilitation exercise selection algorithm. TM indicates treadmill. *Relative contraindications to treadmill exercise include moderate to severe claudication within 1 to 2 minutes of normal paced walking, current foot wound, history of falls, shuffling or unsteady gait, or patient desire to avoid treadmill exercise. Training Intensity Training intensity should be based on the exercise modality, whether claudication or ischemic limb symptoms occur during the selected exercise modality, and the patient’s

2019 American Heart Association

150. Type 2 Diabetes Mellitus and Heart Failure Full Text available with Trip Pro

neuropathy). Although intensive glycemic control does not appear to reduce the risk of all-cause mortality, cardiovascular mortality, or stroke, it may reduce the risk of nonfatal myocardial infarction (MI). Although hyperglycemia with or without DM is associated with increased risk of developing HF, , available data suggest that intensive glycemic control in patients with established DM does not reduce the risk. The UKPDS (UK Prospective Diabetes Study), ADVANCE (Action in Diabetes and Vascular Disease (...) duration of HF, diuretic therapy, and higher New York Heart Association functional class. , , , Pathophysiology of DM and HF DM can contribute to the development of structural heart disease and HF via systemic, myocardial, and cellular mechanisms. A recent state-of-the art review provides a detailed account of the underlying mechanisms of DM-associated HF. DM commonly causes structural heart disease and HF via myocardial ischemia/infarction. Hyperglycemia and hyperinsulinemia accelerate atherosclerosis

2019 American Heart Association

151. Child Abuse, Elder Abuse, and Intimate Partner Violence

by the application of tests, examinations, history or other procedures which can be applied rapidly.” 1 A positive screen identifies patients with higher probability of abuse that require additional testing or evaluation. However, screening does not lead to a diagnosis of abuse, and an initial negative screen does not “rule out” abuse. Screening must occur across the trauma/emergency care continuum (emergency department [ED], intensive care unit [ICU], medical-surgical units, and rehabilitation (...) to the pediatric ICU with an acute, closed, traumatic cranial or intracranial injury; tool now also validated in an ED setting 19 y Imaging reveals “pre- existing brain malformation, disease, infection, or hypoxia- ischemia” y Injuries resulting from a motor vehicular collision The 4 variables used were: y Clinically significant respiratory compromise any time prior to admission; y Bruising of the torso, ears, neck; y Subdural hematoma or fluid bilaterally and/or in the interhemispheric fissure; y Any skull

2019 American College of Surgeons

152. Pediatric Post–Cardiac Arrest Care: A Scientific Statement From the American Heart Association

carbon dioxide tension influences cerebral perfusion in both children and adults. Preclinical studies suggest that hyperventilation decreases coronary perfusion and survival after cardiac arrest. Hyperventilation causes cerebral vasoconstriction and can decrease cerebral blood flow (CBF), thereby potentially exacerbating cerebral ischemia. Hypercapnia causes cerebral vasodilation and increases CBF. Cerebrovascular reactivity to carbon dioxide may be preserved in some patients after cardiac arrest (...) ventricular and RV systolic or diastolic dysfunction resulting in reduced cardiac output, arrhythmias, and pulmonary edema, which can result in recurrent cardiac arrest. Systemic Ischemia/Reperfusion The combination of systemic ischemia/reperfusion produces a state similar to the sepsis syndrome, with elevated cytokines, the presence of endotoxin in plasma, activation of coagulation pathways, and inhibition of anticoagulant pathways. , Transient critical illness hyperglycemia occurs after cardiac arrest

2019 American Heart Association

153. The Utility and Practice of Electrodiagnostic Testing in the Pediatric Population: An AANEM Consensus Statement

, University of Florida College of Medicine, Gainesville, Florida 3 Department of Pediatrics, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada 4 Department of Pediatrics, Northwestern University Feinberg School of Medicine and Lurie Children’s Hospital, Chicago, Illinois 5 National Institute of Neurological Disorders and Stroke, Bethesda, Maryland 6 Functional and Applied Biomechanics Section, Rehabilitation Medicine, National Institutes of Health Clinical Center (...) . In contrast to adults, radial neuropathy in childhood does not typically localize to the spiral groove; the posterior interosseous nerve and distal main radial trunk are more common sites of injury 15 . In the lower limbs, sciatic neuropathy in childhood has been associated with trauma 16 , iatrogenic causes 16 , compression 16 , various tumors 16,17 , including perineurioma 18 , and sometimes has vascular causes 16 , including occlusion of the inferior gluteal artery 19 . The other major mononeuropathy

2019 American Association of Neuromuscular & Electrodiagnostic Medicine

154. Standardization of Spirometry Full Text available with Trip Pro

for Spirometry Due to increases in myocardial demand or changes in blood pressure Acute myocardial infarction within 1 wk Systemic hypotension or severe hypertension Significant atrial/ventricular arrhythmia Noncompensated heart failure Uncontrolled pulmonary hypertension Acute cor pulmonale Clinically unstable pulmonary embolism History of syncope related to forced expiration/cough Due to increases in intracranial/intraocular pressure Cerebral aneurysm Brain surgery within 4 wk Recent concussion (...) and recovery from exacerbations To monitor people for adverse effects of exposure to injurious agents To watch for adverse reactions to drugs with known pulmonary toxicity Disability/impairment evaluations To assess patients as part of a rehabilitation program To assess risks as part of an insurance evaluation To assess individuals for legal reasons Other Research and clinical trials Epidemiological surveys Derivation of reference equations Preemployment and lung health monitoring for at-risk occupations

2019 American Thoracic Society

156. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

exertion, accelerates pulmonary flow in a pulsatile manner, and increases cardiac output by both heart rate and augmented stroke volume. Pulmonary pressures can normally increase up to 50 mm Hg (or even more) during exercise, leading to recruitment of lung vessels. The normal subpulmonary ventricle will also allow some compensation in disease states such as pulmonary pathway obstruction or any lung disease that may result in increased pulmonary vascular resistance. The absence of a subpulmonary (...) mechanics. During exercise, individuals with a normal heart increase their stroke volume by 20% to 50%; in contrast, such an exercise-induced increase may be completely absent in patients with Fontan circulation, most likely as a result of preload restriction. Chronic volume deprivation with lack of fiber stretch is known to decrease contractility and to increase muscle stiffness, resulting in increasing filling pressures. Moreover, abnormal ventriculo-vascular coupling may further compound ventricular

2019 American Heart Association

157. 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures Full Text available with Trip Pro

of Evidence; m-health, practice of medicine and public health supported by mobile devices; SM, structural measure; and USPSTF, US Preventive Services Task Force. 1.1. Scope of the Problem Failing to correctly diagnose and control HBP can put people at increased risk for cardiovascular disease, stroke, and renal failure. Recent analyses suggest that >100 million Americans currently have HBP, and the 2011–2014 US National Health and Nutrition Examination Survey estimated that 46% of US adults have HBP

2019 American Heart Association

158. Heart failure - chronic: Scenario: Confirmed heart failure with preserved ejection fraction

, myocardial infarction, stroke, cardiovascular hospitalization, or all-cause mortality [ ]. Optimally manage any comorbidities and precipitating factors The recommendation to ensure optimal management of comorbidities and precipitating factors is based on information in the NICE guideline [ ] and the guideline from the American College of Cardiology Foundation/American Heart Association Task Force [ ]. Screening for depression and anxiety The recommendation to screen for depression is based on evidence (...) . If depression is likely to have been precipitated by heart failure symptoms then reassess psychological status once the physical condition has stabilised. If depression is co-existing with heart failure then the person should be treated taking into account potential risks and benefits of drug treatment. Further information is available in the CKS topics on and . If suitable, ensure the person has been offered referral to a supervised exercise-based group rehabilitation programme for people with heart

2020 NICE Clinical Knowledge Summaries

159. Heart failure - chronic: Scenario: Confirmed heart failure with reduced ejection fraction

heart disease) is based on information in the NICE guideline [ ]. Prescribing a statin There is considerable evidence of the value of statin treatment in atherosclerotic disease. Two large placebo-controlled trials (n = 5011 and n = 4574) comparing statin treatment with placebo in chronic heart failure did not demonstrate a significant reduction in cardiovascular death, myocardial infarction, stroke, cardiovascular hospitalization, or all-cause mortality [ ]. Optimally manage any comorbidities (...) the person has been offered referral to a supervised exercise-based group rehabilitation programme for people with heart failure. The programme should offer psychological and education-based components. The person's heart failure should be . Comorbidities which may not be suitable for referral include uncontrolled ventricular response to atrial fibrillation, uncontrolled hypertension, and high-energy pacing devices set to be activated at rates likely to be achieved during exercise. Ensure the person

2020 NICE Clinical Knowledge Summaries

160. Updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension Full Text available with Trip Pro

; CXR, chest X-ray; ECG, electrocardiogram; FC, functional class; HIV, human immunodeficiency virus; HPAH, heritable pulmonary arterial hypertension; HR, high resolution; IPAH, idiopathic pulmonary arterial hypertension; LFT, liver function test; MRI, magnetic resonance imaging; PCH, pulmonary capillary hemangiomatosis; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; PVOD, pulmonary veno-occlusive disease; VQ, ventilation/perfusion; WHO, World Health Organization. Modified (...) , computed tomography; CTEPH, chronic thromboembolic pulmonary hypertension; CXR, chest X-ray; ECG, electrocardiogram; FC, functional class; HIV, human immunodeficiency virus; HPAH, heritable pulmonary arterial hypertension; HR, high resolution; IPAH, idiopathic pulmonary arterial hypertension; LFT, liver function test; MRI, magnetic resonance imaging; PCH, pulmonary capillary hemangiomatosis; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; PVOD, pulmonary veno-occlusive

2019 International Society for Heart and Lung Transplantation

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