What Is Ischemic Vascular Disease
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Cardiac Imaging Guidelines Effective October 1, 2021
Cigna Medical Coverage Policies – Radiology Cardiac Imaging Guidelines Effective October 1, 2021 ____________________________________________________________________________________ Instructions for use The following coverage policy applies to health benefit plans administered by Cigna. Coverage policies are intended to provide guidance in interpreting certain standard Cigna benefit plans and are used by medical directors and other health care professionals in making medical necessity and other coverage determinations. Please note the terms of a customer’s particular benefit plan document may differ significantly from the standard benefit plans upon which these coverage policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a coverage policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the coverage policy. In the absence of federal or state coverage mandates, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of: 1. The terms of the applicable benefit plan document in effect on the date of service 2. Any applicable laws and regulations 3. Any relevant collateral source materials including coverage policies 4. The specific facts of the particular situation Coverage policies relate exclusively to the administration of health benefit plans. Coverage policies are not recommendations for treatment and should never be used as treatment guidelines. This evidence-based medical coverage policy has been developed by eviCore, Inc. Some information in this coverage policyy m na ot apply to all benefit plans administered by Cigna. These guidelines include procedures eviCore does not review for Cigna. -
National Taiwan University Hospital Hsinchu Branch Research Protocol 2018
National Taiwan University Hospital Hsinchu Branch Research Protocol 2018 1. Project name Prevalence and Outcomes of Peripheral Artery Disease in Sepsis Patients in the Medical Title Intensive Care Unit Principal Department of Internal Medicine, Cardiovascular Division investigator Mu-Yang Hsieh, Attending Physician Table of Contents 1. Project name.........................................................................................................................................................1 2. Abstract................................................................................................................................................................3 Background...............................................................................................................................................................3 Methods....................................................................................................................................................................3 3. Background..........................................................................................................................................................4 Prior research in this field.........................................................................................................................................4 Sepsis and peripheral artery disease..............................................................................................................4 Peripheral artery disease- its impact on the outcomes..................................................................................4 -
Disentangling the Multiple Links Between Renal Dysfunction and Cerebrovascular Disease Dearbhla Kelly, Peter Malcolm Rothwell
Cerebrovascular disease J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-320526 on 11 September 2019. Downloaded from REVIEW Disentangling the multiple links between renal dysfunction and cerebrovascular disease Dearbhla Kelly, Peter Malcolm Rothwell ► Additional material is ABSTRact consequences of renal dysfunction,and diseases that published online only. To view, Chronic kidney disease (CKD) has a rapidly rising can cause both CKD and stroke. please visit the journal online (http:// dx. doi. org/ 10. 1136/ global prevalence, affecting as many as one-third jnnp- 2019- 320526). of the population over the age of 75 years. CKD is ASSOciatiONS BETWEEN CKD AND a well-known risk factor for cardiovascular disease CEREBROVASCULAR DISEASE Centre for the Prevention and, in particular, there is a strong association with Stroke risk of Stroke and Dementia, stroke. Cohort studies and trials indicate that reduced Nuffield Department of Clinical There is conflicting evidence about whether CKD, Neurosciences, University of glomerular filtration rate increases the risk of stroke by specifically low estimated glomerular filtration Oxford, Oxford, UK about 40% and that proteinuria increases the risk by rate (eGFR), is a risk factor for stroke indepen- about 70%. In addition, CKD is also strongly associated dent of traditional cardiovascular risk factors. In Correspondence to with subclinical cerebrovascular abnormalities, vascular a meta-analysis of 22 634 people from four popu- Dr Dearbhla Kelly, Centre for cognitive impairment and -
Peripheral Vascular Disease (PVD) Fact Sheet
FACT SHEET FOR PATIENTS AND FAMILIES Peripheral Vascular Disease (PVD) What is peripheral vascular disease? Vascular disease is disease of the blood vessels (arteries and veins). Peripheral vascular disease (PVD) affects The heart receives blood, the areas that are “peripheral,” or outside your heart. sends it to The most common types of PVD are: the lungs to get oxygen, • Carotid artery disease affects the arteries and pumps that carry blood to your brain. It occurs when it back out. one or more arteries are narrowed or blocked by plaque, a fatty substance that builds up inside artery walls. Carotid artery disease can increase Veins carry Arteries carry your risk of stroke. It can also cause transient blood to your oxygen-rich [TRANZ-ee-ent] ischemic [iss-KEE-mik] attacks (TIAs). heart to pick blood from up oxygen. your heart TIAs are temporary changes in brain function to the rest of that are sometimes called “mini-strokes.” your body. • Peripheral arterial disease (PAD) often affects the arteries to your legs and feet. It is also caused by Healthy blood vessels provide oxygen plaque buildup, and can for every part of your body. cause pain that feels like a dull cramp or heavy tiredness in your hips or legs when • Venous insufficiency affects the veins, usually you exercise or climb stairs. in your legs or feet. Your veins have valves that This pain is sometimes Damaged Healthy keepvalve blood fromvalve flowing backward as it moves called claudication. If PAD toward your heart. If the valves stop working, blood worsens, it can cause cold Plaque can build backs up in your body, usually in your legs. -
Tissue Responses to Ischemia
PERSPECTIVE SERIES Tissue responses to ischemia SERIES INTRODUCTION Tissue ischemia: pathophysiology and therapeutics Gregg L. Semenza Institute of Genetic Medicine, The Johns Hopkins University School of Medicine, CMSC-1004, 600 North Wolfe Street, Baltimore, Maryland 21287-3914, USA. Phone: (410) 955-1619; Fax: (410) 955-0484; E-mail: [email protected]. This issue of the JCI contains the first articles in a Per- has been the preconditioning phenomena that have spective series that focuses on ischemia, the major been demonstrated in virtually every organ, including cause of mortality in the developed world. The specific the heart and brain. Thus, exposure of an organ or tis- mechanisms and consequences of ischemia differ in sue to one or more brief episodes of ischemia will pro- each tissue or organ, which reflects differences in vide protection against subsequent prolonged ischemia anatomy and physiology. For this reason, the series has that would otherwise result in infarction. The precon- been organized to include articles on cerebral (Dennis ditioning stimulus provides an immediate but short- Choi and colleagues), myocardial (Sandy Williams and lived “first window” of protection, which occurs over a Ivor Benjamin), and skeletal muscle (Jeff Isner) period of minutes to hours and requires the altered ischemia, as well as discussions of ischemia in epithe- activity of pre-existing proteins, as well as a delayed but lial tissues (Sanjay Nigam and colleagues) and hypox- sustained “second window” of protection, which per- ia-induced pulmonary vascular remodeling (Norbert sists over a period of hours to days and depends on new Voelkel and Rubin Tuder). In each case, the authors protein synthesis. -
Medullary Ischemia: Clinical and Radiological Approach
Edorium J Radiol 2021;7:100018R02MT2021. THIAM et al. 1 www.edoriumjournalofradiology.com ORIGINALCASE REPORT ARTICLE PEER REVIEWEDOPEN | OPEN ACCESS ACCESS Medullary ischemia: Clinical and radiological approach Mbaye THIAM, Khalifa Ababacar MBAYE, Rokhaya DIAGNE, Amath FALL, Khadiatou Ndiaye DIOUF, Sokhna BA ABSTRACT doi: 10.5348/100018R02MT2021CR Introduction: Spinal cord infarction is a serious neurovascular emergency due to its short-, medium-, and long-term complications. INTRODUCTION Case Report: A 54-year-old patient with no previous history or particular condition hospitalized for an acute Medullary infarction is a serious neurovascular spinal cord injury, with magnetic resonance imaging emergency due to its short-, medium-, and long-term (MRI) showing medullar ischemia without any etiology complications. Spinal cord ischemia is under-diagnosed found. The evolution was marked by a good motor in our continent due to the difficult accessibility of evolution. magnetic resonance imaging (MRI), which is the Conclusion: Medullary infarction is a serious pathology examination of choice for the diagnosis of spinal cord under-diagnosed in our context because of the difficult vascular damage, and also due to its clinical similarities accessibility of MRI. with acute spinal cord injury (inflammatory damage, vascular malformation, spinal bleeding). The etiologies Keywords: Ischemia, MRI, Spinal cord are numerous and heterogeneous such as traumatic causes, arterial dissection, hypotension, atherosclerosis, toxicity, fibrocartilage embolization, sub-renal abdominal How to cite this article aneurysm repair, epidural anesthesia, and vasculitis THIAM M, MBAYE KA, DIAGNE R, FALL A, [1, 2]. We describe the clinico-radiological aspects of a DIOUF KN, BA S. Medullary ischemia: Clinical 54-year-old female patient diagnosed with spinal cord and radiological approach. -
Gait Variability Patterns Are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion Sara A
University of Nebraska at Omaha DigitalCommons@UNO Journal Articles Department of Biomechanics 11-2010 Gait Variability Patterns are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion Sara A. Myers University of Nebraska at Omaha, [email protected] Nicholas Stergiou University of Nebraska at Omaha, [email protected] Iraklis Pipinos University of Nebraska Medical Center Jason Johanning University of Nebraska Medical Center Follow this and additional works at: https://digitalcommons.unomaha.edu/biomechanicsarticles Part of the Biomechanics Commons Recommended Citation Myers, Sara A.; Stergiou, Nicholas; Pipinos, Iraklis; and Johanning, Jason, "Gait Variability Patterns are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion" (2010). Journal Articles. 56. https://digitalcommons.unomaha.edu/biomechanicsarticles/56 This Article is brought to you for free and open access by the Department of Biomechanics at DigitalCommons@UNO. It has been accepted for inclusion in Journal Articles by an authorized administrator of DigitalCommons@UNO. For more information, please contact [email protected]. 1 1 Gait variability pattern are altered in healthy young individuals during the acute 2 reperfusion phase of ischemia-reperfusion. 3 Sara A. Myers MS1, Nick Stergiou PhD1,4, Iraklis I. Pipinos MD2,3, Jason M. Johanning MD2,3 4 1 Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE 5 2Dept of Surgery, University of Nebraska Medical Center, Omaha, NE 6 3Dept of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, NE 7 4College of Public Health, University of Nebraska Medical Center, Omaha, NE 8 9 Corresponding Author: Jason M. -
Study Protocol, Status of Data Collection, an Assessment Of
ISCHEMIA Trial Protocol International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Sponsor: National Heart, Lung, and Blood Institute (NHLBI) Study Chair Judith S. Hochman, MD Study Co-Chair David J. Maron, MD Clinical Coordinating Center Cardiovascular Clinical Research Center New York University School of Medicine Statistical and Data Coordinating Duke Clinical Research Institute Center Protocol Version Date: January 18, 2012 Protocol Date: Jan.18.2012 Version 1.0 1 PROTOCOL VERSION AND AMENDMENT TRACKING Version Number/Amendment Approval Date Protocol Date: Jan.18.2012 Version 1.0 2 Protocol Signature Page The signature below constitutes the approval of this protocol and the attachments, and provides the necessary assurances that this trial will be conducted according to all stipulations of the protocol, including all statements regarding confidentiality, and according to local legal and regulatory requirements and applicable regulations and ICH guidelines. Version Date: January 18, 2012 _________________________________ _________________________ Signature of Principal Investigator Date _________________________________ Printed Name of Principal Investigator _________________________________ Name of Facility _________________________________ Location of Facility (City, Country) Protocol Date: Jan.18.2012 Version 1.0 3 CLINICAL TRIAL SUMMARY Title International Study of Comparative Health Effectiveness with Medical and Invasive Approaches Study Objectives Primary objective is to determine whether an -
Effects on Cardiac Function
www.nature.com/scientificreports OPEN Efects on cardiac function, remodeling and infammation following myocardial ischemia–reperfusion injury or unreperfused myocardial infarction in hypercholesterolemic APOE*3‑Leiden mice Niek J. Pluijmert1*, Cindy I. Bart1, Wilhelmina H. Bax1, Paul H. A. Quax2,3 & Douwe E. Atsma1 Many novel therapies to treat myocardial infarction (MI), yielding promising results in animal models, nowadays failed in clinical trials for several reasons. The most used animal MI model is based on permanent ligation of the left anterior descending (LAD) coronary artery in healthy mice resulting in transmural MI, while in clinical practice reperfusion is usually accomplished by primary percutaneous coronary interventions (PCI) limiting myocardial damage and inducing myocardial ischemia–reperfusion (MI‑R) injury. To evaluate a more similar murine MI model we compared MI‑R injury to unreperfused MI in hypercholesterolemic apolipoprotein (APO)E*3‑Leiden mice regarding efects on cardiac function, left ventricular (LV) remodeling and infammation. Both MI‑R and MI resulted in signifcant LV dilation and impaired cardiac function after 3 weeks. Although LV dilation, displayed by end‑diastolic (EDV) and end‑systolic volumes (ESV), and infarct size (IS) were restricted following MI‑R compared to MI (respectively by 27.6% for EDV, 39.5% ESV, 36.0% IS), cardiac function was not preserved. LV‑wall thinning was limited with non‑transmural LV fbrosis in the MI‑R group (66.7%). Two days after inducing myocardial ischemia, local leucocyte infltration in the infarct area was decreased following MI‑R compared to MI (36.6%), whereas systemic circulating monocytes were increased in both groups compared to sham (130.0% following MI‑R and 120.0% after MI). -
Cardiovascular Disease Session Guidelines
Cardiovascular Disease Session Guidelines This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars on the 3rd Wednesday of each month to address topics related to risk adjustment documentation and coding Next scheduled webinar: • Wednesday, February 28th • Topic: Respiratory Disease CNC does not accept responsibility or liability for any adverse outcome from this training for any reason including undetected inaccuracy, opinion, and analysis that might prove erroneous or amended, or the coder/physician’s misunderstanding or misapplication of topics. Application of the information in this training does not imply or guarantee claims payment. Agenda • Statistics • Amputation Status & Atherosclerosis • Angina Pectoris • Acute Myocardial Infarction • Specified Heart Arrhythmias • Congestive Heart Failure • Pulmonary Hypertension • Cardiomyopathy • Hypertensive Heart disease Statistics • Nearly 35 percent of Tarrant County and Dallas area deaths each year are attributed to cardiovascular disease. • About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths • Heart disease is the leading cause of death for both men and women • Every year about 735,000 Americans have a heart attack. Of these, (approximately 70%) 525,000 are a first heart attack and (approximately 30%)210,000 happen in people who have already had a heart attack Amputations There are nearly 2 million people living with limb loss in the United States Approximately 185,000 amputations occur in the United States each -
Vascular Disease in the Elderly
Chapter 13: Vascular Disease in the Elderly Nobuyuki Bill Miyawaki* and Paula E. Lester† *Division of Nephrology and †Division of Geriatrics, Winthrop University Hospital, Mineola, New York PHYSIOLOGIC EFFECTS OF AGING ON stiffening of medium and large arteries lined with BLOOD VESSEL ELASTICITY AND atheromatous plaques. The progressive accumula- COMPLIANCE tion of atherosclerotic plaque continues with aging and often remains silent until lesions reach a critical The aging process is commonly associated with in- stenotic threshold or rupture, leading to dimin- creased vascular rigidity and decreased vascular ished organ perfusion. Arterial stiffening also leads compliance. This process reflects the accumulation to an increase in pulse wave velocity and an en- of smooth muscle cells and connective tissue in the hancement in central aortic systolic pressure.3 The walls of major blood vessels. Endothelial cells and increased waveform velocity allows the backward smooth muscle cells constitute most of vessel wall reflective wave to return earlier back to the heart. cellularity and the remainder of the wall is com- The resulting increases of the left ventricular myo- posed of extracellular matrix including collagen cardial load and the loss of coronary perfusion at and elastin. Although aging has minimal effect on the onset of diastole may potentiate myocardial the muscular tunica media layer thickness, aging ischemia.3 leads to profound progressive thickening of the tu- Common ailments in the elderly including dia- nica intima layer comprised -
A Review on the Pathophysiology and Management of Anterior Spinal Artery Syndrome
J Spine Res Surg 2020; 2 (4): 085-096 DOI: 10. 26502/fjsrs0019 Review Article A Review on the Pathophysiology and Management of Anterior Spinal Artery Syndrome Masum Rahman1*, Sajedur Rahman2, Abu Bakar Siddik3, Mohammad D Hossain2, Juna Musa4, Radzi Hamjah5, Salman Salehin6, Mohmmad Alvi1, Lucas P Carlstrom1, Desmond A Brown1 1Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA 2Jalalabad Ragib Rabeya Medical College and hospital, Sylhet, Bangladesh 3Northern International Medical College and Hospital, Dhaka, Bangladesh 4Department of Surgery, Critical Care Trauma, Mayo Clinic, Rochester, MN, USA 5Harvard TH Chan School of Public Health, Massachusetts, USA 6Department of Internal Medicine, University of Texas Medical Branch (UTMB), Texas, USA *Corresponding Author: Masum Rahman, Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA, Tel: +1 (507) 319-9044; E- mail: [email protected] Received: 01 October 2020; Accepted: 09 October 2020; Published: 20 October 2020 Citation: Masum Rahman, Sajedur Rahman, Abu Bakar Siddik, Mohammad D Hossain, Juna Musa, Radzi Hamjah, Salman Salehin, Mohmmad Alvi, Lucas P Carlstrom, Desmond A Brown. A Review on the Pathophysiology and Management of Anterior Spinal Artery Syndrome. Journal of Spine Research and Surgery 2 (2020): 085-096. Abstract blood flow disruption is essential for patient As an uncommon cause of spinal cord infarction, management. This review article highlights the critical anterior spinal cord syndrome can manifest with motor clinical manifestation of Anterior spinal artery paralysis, loss of pain, and temperature sensation distal syndrome. It also describes etiology, pathogenesis, to the lesion site. The primary pathogenesis of this diagnosis, prognosis, possible management, and syndrome is the disruption of blood flow in the anterior complications.