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Guidelines for Management of Myocardial Infraction

September 20, 2010 By Leave a Comment

If you are wondering what the procedure and guidelines are for the management of myocardial infraction, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:

Target Population
  • Adults with ST-elevation myocardial infarction (STEMI)
  • Adults at risk of STEMI

Management before ST-elevation Myocardial Infarction (STEMI)

  1. Identification of patients at risk of STEMI
  2. Patient education for early recognition and response to STEMI

Management after Onset of STEMI

  1. Management of out-of-hospital cardiac arrest
    • Activation of Emergency Medical System (EMS)
    • Early defibrillation
    • Early advanced cardiac life support
    • Cardiopulmonary resuscitation training program for families

Prehospital Issues

  1. Training of emergency medical services systems personnel to respond to patients with chest pain and/or cardiac arrest
  2. Prehospital chest pain evaluation and treatment
  3. Prehospital fibrinolysis
  4. Prehospital destination protocols

Initial Recognition and Management in the Emergency Department (ED)

  1. Optimal strategies for ED triage
  2. Initial patient evaluation
    • History
    • Physical examination
    • Electrocardiogram
    • Laboratory examinations
    • Measurement of biomarkers of cardiac damage
    • Imaging
  3. Management
    • Oxygen
    • Nitroglycerin
    • Analgesia
    • Aspirin
    • Beta-blockers
    • Reperfusion (pharmacological reperfusion, percutaneous coronary intervention, acute surgical perfusion)
    • Ancillary reperfusion therapy, including aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitors
    • Other pharmacological measures, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, strict glucose control (e.g., insulin for people with diabetes), magnesium, calcium channel blockers (e.g., verapamil, diltiazem)

For the entire guideline, please visit the website here.

Filed Under: Diagnostic Procedures, Guidelines

Guidelines for Device-based Therapy for Arrhythmias

September 17, 2010 By Leave a Comment

If you are wondering what the procedure and guidelines are for a doctor’s diagnostic exam for abnormal heart beats, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:
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Filed Under: Diagnostic Procedures, Guidelines, Treatment Tagged With:

Guidelines for Atrial Fibrillation Diagnostic

September 17, 2010 By Leave a Comment

If you are wondering what the procedure and guidelines are for a doctor’s diagnostic exam for atrial fibrillation, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:

Target Population

Patients with atrial fibrillation

Clinical Evaluation

  1. History and physical examination
  2. Electrocardiogram
  3. Transthoracic echocardiography
  4. Blood tests including thyroid, renal, and hepatic function
  5. Additional tests, as needed, including
    • Six-minute walk test
    • Exercise testing
    • Holter monitoring
    • Transesophageal echocardiography (TEE)
    • Electrophysiological study
    • Chest radiography

Management

  1. Rate control
    • Pharmacological control, using calcium channel blockers (diltiazem and verapamil), beta-blockers (esmolol, metoprolol, propranolol), digoxin, amiodarone
    • Atrioventricular nodal ablation
  2. Prevention of thromboembolism
    • Risk stratification
    • Anticoagulants (Vitamin K antagonists, aspirin, unfractionated heparin, low molecular weight heparin)
  3. Cardioversion
    • Pharmacological cardioversion
    • Direct-current (DC) cardioversion including pharmacological enhancement and prevention of thromboembolism
  4. Maintenance of sinus rhythm after cardioversion
    • Treatment of precipitating or reversible causes of atrial fibrillation
    • Pharmacological therapy, including propafenone, flecainide, or sotalol
    • Catheter ablation
  5. Consideration of special circumstances, including
    • Postoperative atrial fibrillation
    • Acute myocardial infarction
    • Wolff-Parkinson White preexcitation syndromes
    • Hyperthyroidism
    • Pregnancy
    • Hypertrophic cardiomyopathy
    • Pulmonary diseases

For the complete version of the guideline, please visit this website.

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Guidelines for Unstable Angina Diagnostic

September 17, 2010 By Leave a Comment

If you are wondering what the procedure and guidelines are for a doctor’s diagnostic exam in unstable angina, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:

Initial Evaluation and Management

  1. Clinical assessment, including 12-lead electrocardiogram, biomarker determination, physical examination, and stress test
  2. Instructions to call 9-1-1 if signs of acute coronary syndrome
  3. Pre-hospital aspirin (ASA) and nitroglycerin (NTG) as appropriate
  4. Risk stratification

Early Hospital Care

  1. Anti-ischemic and analgesic therapy, including NTG, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, angiotensin receptor blocker (ARB), morphine sulfate, long-acting nondihydro0pyridine calcium antagonists, supplemental oxygen
  2. Anti-platelet and anticoagulant therapy, including ASA, clopidogrel, glycoprotein (GP) IIb/IIIa inhibitors, enoxaparin, unfractionated heparin (UFH)
  3. Consideration of conservative versus invasive initial strategies
  4. Risk stratification at discharge

Revascularization

  1. Percutaneous coronary intervention (PCI)
  2. Coronary artery bypass graft (CABG) surgery

Post-Discharge Care

  1. Continuation of medications to control ischemia
  2. Long-term medical therapy, including anti-platelet therapy, beta blockers, inhibitors of the rennin-angiotensins-aldosterone system (ACE inhibitors, ARBs), NTG, calcium channel blockers, warfarin
  3. Secondary prevention, including lipid management, blood pressure control, treatment of diabetes mellitus, smoking cessation, weight management, physical activity, patient education, influenza immunization, depression screening, and pain relief
  4. Post-discharge follow-up and cardiac rehabilitation
  5. Consideration of special groups

For the rest of the guideline, please click here.

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Guidelines for Heart Failure Diagnosis

September 17, 2010 By Leave a Comment

If you are wondering what the procedure and guidelines are for a doctor’s diagnostic exam in chronic adult heart failure, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:

Guideline Objective(s)

To assist health care providers in clinical decision-making by describing a range of generally acceptable approaches for the prevention, diagnosis, and management of heart failure

Target Population

  • Adults with chronic heart failure associated with normal or low left ventricular ejection fraction , including consideration of the following special populations:
    • Women and men
    • High-risk ethnic minority groups (e.g., blacks)
    • Elderly patients
  • Adults at high risk of developing heart failure

Initial Assessments

  1. Thorough history and physical examination, including history of current and past alcohol and drug use, orthostatic blood pressure changes, weight and height, and calculation of body mass index
  2. Assessment of ability to perform routine and desired activities of daily living
  3. Laboratory testing: complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, fasting blood glucose, lipid profile, liver function tests, and thyroid-stimulating hormone.
  4. 12-lead electrocardiography
  5. Chest radiography (PA and lateral)
  6. Two-dimensional echocardiogram coupled with Doppler flow studies
  7. Coronary arteriography in appropriate patients
  8. Maximal exercise testing with or without measurement of respiratory gas exchange and/or blood oxygen saturation in appropriate patients
  9. Screening for hemochromatosis, sleep-disturbed breathing, or human immunodeficiency virus, in selected patients
  10. Diagnostic tests for rheumatologic diseases, amyloidosis, or pheochromocytoma, if indicated
  11. Endomyocardial biopsy, when specific diagnosis is suspected that would influence therapy
  12. Holter monitoring, if indicated.

The rest of the summary can be found here.

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