Cardiovascular & Pulmonary
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Final Program for the ATS International Conference Is Available in Printed and Digital Format
WELCOME TO ATS 2017 • WASHINGTON, DC Welcome to ATS 2017 Welcome to Washington, DC for the 2017 American Thoracic Society International Conference. The conference, which is expected to draw more than 15,000 investigators, educators, and clinicians, is truly the destination for pediatric and adult pulmonary, critical care, and sleep medicine professionals at every level of their careers. The conference is all about learning, networking and connections. Because it engages attendees across many disciplines and continents, the ATS International Conference draws a large, diverse group of participants, a dedicated and collegial community that inspires each of us to make a difference in patients’ lives, now and in the future. By virtue of its size — ATS 2017 features approximately 6,700 original research projects and case reports, 500 sessions, and 800 speakers — participants can attend David Gozal, MD sessions and special events from early morning to the evening. At ATS 2017 there will be something for President everyone. American Thoracic Society Don’t miss the following important events: • Opening Ceremony featuring a keynote presentation by Nobel Laureate James Heckman, PhD, MA, from the Center for the Economics of Human Development at the University of Chicago. • Ninth Annual ATS Foundation Research Program Benefit honoring David M. Center, MD, with the Foundation’s Breathing for Life Award on Saturday. • ATS Diversity Forum will feature Eliseo J. Pérez-Stable, MD, Director, National Institute on Minority Health and Health Disparities at the National Institutes of Health. • Keynote Series highlight state of the art lectures on selected topics in an unopposed format to showcase major discoveries in pulmonary, critical care and sleep medicine. -
The Pulmonary Manifestations of Left Heart Failure*
The Pulmonary Manifestations of Left Heart Failure* Brian K. Gehlbach, MD; and Eugene Geppert, MD Determining whether a patient’s symptoms are the result of heart or lung disease requires an understanding of the influence of pulmonary venous hypertension on lung function. Herein, we describe the effects of acute and chronic elevations of pulmonary venous pressure on the mechanical and gas-exchanging properties of the lung. The mechanisms responsible for various symptoms of congestive heart failure are described, and the significance of sleep-disordered breathing in patients with heart disease is considered. While the initial clinical evaluation of patients with dyspnea is imprecise, measurement of B-type natriuretic peptide levels may prove useful in this setting. (CHEST 2004; 125:669–682) Key words: Cheyne-Stokes respiration; congestive heart failure; differential diagnosis; dyspnea; pulmonary edema; respiratory function tests; sleep apnea syndromes Abbreviations: CHF ϭ congestive heart failure; CSR-CSA ϭ Cheyne-Stokes respiration with central sleep apnea; CPAP ϭ continuous positive airway pressure; Dlco ϭ diffusing capacity of the lung for carbon monoxide; DM ϭ membrane conductance; FRC ϭ functional residual capacity; OSA ϭ obstructive sleep apnea; TLC ϭ total lung ϭ ˙ ˙ ϭ capacity; VC capillary volume; Ve/Vco2 ventilatory equivalent for carbon dioxide early 5 million Americans have congestive heart For a detailed review of the pathophysiology of N failure (CHF), with 400,000 new cases diag- high-pressure pulmonary edema, the reader is re- nosed each year.1 Unfortunately, despite the consid- ferred to several excellent recent reviews.2–4 erable progress that has been made in understanding the pathophysiology of pulmonary edema, the pul- monary complications of this condition continue to The Pathophysiology of Pulmonary challenge the bedside clinician. -
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Phenotype definition for the Vanderbilt Genome-Electronic Records project Identifying genetics determinants of normal QRS duration (QRSd) Patient population: • Patients with DNA whose first electrocardiogram (ECG) is designated as “normal” and lacking an exclusion criteria. • For this study, case and control are drawn from the same population and analyzed via continuous trait analysis. The only difference will be the QRSd. Hypothetical timeline for a single patient: Notes: • The study ECG is the first normal ECG. • The “Mildly abnormal” ECG cannot be abnormal by presence of heart disease. It can have abnormal rate, be recorded in the presence of Na-channel blocking meds, etc. For instance, a HR >100 is OK but not a bundle branch block. • Y duration = from first entry in the electronic medical record (EMR) until one month following normal ECG • Z duration = most recent clinic visit or problem list (if present) to one week following the normal ECG. Labs values, though, must be +/- 48h from the ECG time Criteria to be included in the analysis: Criteria Source/Method “Normal” ECG must be: • QRSd between 65-120ms ECG calculations • ECG designed as “NORMAL” ECG classification • Heart Rate between 50-100 ECG calculations • ECG Impression must not contain Natural Language Processing (NLP) on evidence of heart disease concepts (see ECG impression. Will exclude all but list below) negated terms (e.g., exclude those with possible, probable, or asserted bundle branch blocks). Should also exclude normalization negations like “LBBB no longer present.” -
Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: the First Report from Korea
Journal of Clinical Medicine Article Early Outcomes of Percutaneous Pulmonary Valve Implantation with Pulsta and Melody Valves: The First Report from Korea Ah Young Kim 1,2 , Jo Won Jung 1,2, Se Yong Jung 1,2 , Jae Il Shin 1,2 , Lucy Youngmin Eun 1,2 , Nam Kyun Kim 3 and Jae Young Choi 1,2,* 1 Division of Pediatric Cardiology, Center for Congenital Heart Disease, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; [email protected] (A.Y.K.); [email protected] (J.W.J.); [email protected] (S.Y.J.); [email protected] (J.I.S.); [email protected] (L.Y.E.) 2 Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea 3 Department of Pediatrics, Emory University, Atlanta, GA 30322, USA; [email protected] * Correspondence: [email protected] Received: 25 July 2020; Accepted: 24 August 2020; Published: 26 August 2020 Abstract: Percutaneous pulmonary valve implantation (PPVI) is used to treat pulmonary stenosis (PS) or pulmonary regurgitation (PR). We described our experience with PPVI, specifically valve-in-valve transcatheter pulmonary valve replacement using the Melody valve and novel self-expandable systems using the Pulsta valve. We reviewed data from 42 patients undergoing PPVI. Twenty-nine patients had Melody valves in mostly bioprosthetic valves, valved conduits, and homografts in the pulmonary position. Following Melody valve implantation, the peak right ventricle-to-pulmonary artery gradient decreased from 51.3 11.5 to 16.7 3.3 mmHg and right ventricular systolic pressure ± ± fell from 70.0 16.8 to 41.3 17.8 mmHg. -
Some Notes on Clinical Heart Disease
PRESENT fclLf "iO THE ARft-'iY MEDICAL LIBRARY SURGEONS ivr BY THE ASS'H.OF MILITARY March, 1939] NOTES ON CLINICAL HEART DISEASE : KELLY 129 When we speak of left-sided failure, e.g., hyper- tensive heart failure or failure of the left ven- Original Articles tricle behind high systemic blood pressure, we / visualize adequate filling but inadequate empty- ing of the left side of the heart with correspond- SOME NOTES ON CLINICAL HEART ing increase in its size. Our conception of right- DISEASE* sided heart failure, e.g., failure of the right ventricle behind mitral stenosis or behind chronic By GERARD KELLY, f.r.c.p. (I.) bronchitis and emphysema is precisely similar. MAJOR, I.M.S. Just over a century ago an English physician, Professor of Clinical Medicine; Medical College James Hope, inspired by the work of Corvoisart, Hospitals, Calcutta evolved the ' of cardiac ' back-pressure theory' HAVE these few notes in order to failure. As an obstacle to the circulation', he in c]' compiled ' Jcate to the general practitioner something of said, operates on the heart in a retrograde substance of heart disease: there is direction, the cavity situated immediately hing in them for the specialist. behind is the first to suffer from its influence Otherwise back of the ^y choice and I have stated, congestion failing in c i a?ly partly by request chamber is the cardinal feature of uded a few remarks on the following :? congestive failure rather than inadequate of the The or output v problem of the cardio- C problems failing chamber. -
Ministry of Health of Ukraine Kharkiv National Medical University
Ministry of Health of Ukraine Kharkiv National Medical University PHYSICAL METHODS OF CARDIOVASCULAR SYSTEM EXAMINATION. INQUIRY AND GENERAL INSPECTION OF THE PATIENTS WITH CARDIOVASCULAR PATHOLOGY. INSPECTION AND PALPATION OF PRECORDIAL AREA Methodical instructions for students Рекомендовано Ученым советом ХНМУ Протокол №__от_______2017 г. Kharkiv KhNMU 2017 Physical methods of cardiovascular system examination. Inquiry and general inspection of the patients with cardiovascular pathology. Inspection and palpation of precordial area / Authors: Т.V. Ashcheulova, O.M. Kovalyova, O.V. Honchar. – Kharkiv: KhNMU, 2016. – 16 с. Authors: Т.V. Ashcheulova O.M. Kovalyova O.V. Honchar INQUIRY OF A PATIENT WITH CARDIOVASCULAR PATHOLOGY The main complaints in patients with cardiovascular disease include: 1. Dyspnea, asthma attacks 2. Pain in the heart region 3. Palpitations 4. Intermissions of heart beats 5. Swelling of the lower extremities and accumulation of fluid in cavities 6. Cough, hemoptysis 7. Dyspepsia 8. Asthenovegetative disorders: weakness, fatigue, decline in performance Dyspnea is a painful feeling of lack of air, one of the symptoms of heart failure, predominantly is of inspiratory type and can be associated with physical activity (in the early stages of compensation) or occur at rest (a sign of severe cardiac decompensation). It is a compensatory responsive activation of the respiratory center in case of congestion and decreased blood flow in larger and small circulation due to reduced myocardial contractility. Dyspnea is typical for heart failure on the background of valvular heart disease (especially mitral valve pathology), ischemic heart disease (angina pectoris, myocardial infarction, cardiosclerosis, arrhythmias and heart blockages), essential and symptomatic hypertension (due to chronic kidney disease, pheochromocytoma, Cushing's disease, primary aldosteronism etc.). -
Copyrighted Material
INDEX Abscess, 92 fi rst radiographic abnormalities, Absorption 81 coeffi cient, 7 infi ltrates, 153–154 of scatter, 9 mortality rates, 81 Acute lung injury (ALI), 79–81, 83 radiographic appearance of, Acute myocardial infarction, 73, 76, 81–83 151. See also Myocardial recovery phase, 85 infarction severe, 83 Acute respiratory distress Adenopathy, 18 syndrome (ARDS) Adhesive atelectasis, 90 case studies, 152–158 AIDS patients, 65, 141 characteristics of, 50, 60, 70, Air alveolograms, 137, 140 78–79 Air bronchograms, 18, 60–61, co-existing pneumonia, 157–158 63–64, 79, 82–85, 90–93, 138, CT scans, 83–84 142, 153–154 defi ned, 80COPYRIGHTEDAir cysts, MATERIAL 55 diagnosis, 80–81 Air-fl uid levels, 44 etiologies, 80, 82–83 Air space density, 78 exudate phase of, 81–82 Air to tissue ratio, 47 ICU Chest Radiology: Principles and Case Studies, by Harold Moskowitz Copyright © 2010 John Wiley & Sons, Inc. 171 172 INDEX Airway obstruction, 21 development of, 60, 63 Alignment, grid-x-ray beam, 9, 11 effusion distinguished from, 92 Allergic pneumonitis, 128 etiologies, 25, 90 Alveoli incidence of, 90 air conditions, 46 left lung, 170 capillary membrane, 82–83 lobar, 93, 120 consolidation, 65 lower lobe, 120, 129 densities, 16, 78, 155–156, 158 obstructive, 90–91 distension of, 50, 83 passive, 90–92 edema, 71–72, 75–76 peripheral subsegmental, 93 overinfl ation of, 50 plate-like, 93 Aneurysms, 19, 89 pneumonia associated with, Angel wings, 75–76 93–94, 163 Angiograms radiographic appearance of, coronary, 166 93–94 selective pulmonary, 114 treatment of, -
ACR Appropriateness Criteria® Dyspnea–Suspected Cardiac Origin
Revised 2016 American College of Radiology ACR Appropriateness Criteria® Dyspnea–Suspected Cardiac Origin Variant 1: Dyspnea due to heart failure. Ischemia not excluded. Radiologic Procedure Rating Comments RRL* X-ray chest 9 ☢ US echocardiography transthoracic resting 9 O US echocardiography transthoracic stress 9 O SPECT or SPECT/CT MPI rest and stress 9 ☢☢☢☢ Rb-82 PET/CT heart 8 ☢☢☢ MRI heart function and morphology 8 without and with IV contrast O MRI heart with function and vasodilator stress perfusion without and with IV 8 O contrast CTA coronary arteries with IV contrast 8 ☢☢☢ Arteriography coronary with 8 ventriculography ☢☢☢ MRI heart with function and inotropic 7 stress without and with IV contrast O US echocardiography transesophageal 5 O This procedure may be appropriate but MRI heart function and morphology there was disagreement among panel 5 without IV contrast members on the appropriateness rating as O defined by the panel’s median rating. This procedure may be appropriate but MRI heart with function and inotropic there was disagreement among panel 5 stress without IV contrast members on the appropriateness rating as O defined by the panel’s median rating. This procedure may be appropriate but CT heart function and morphology with IV there was disagreement among panel 5 contrast members on the appropriateness rating as ☢☢☢☢ defined by the panel’s median rating. CT coronary calcium 5 ☢☢☢ *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level ACR Appropriateness Criteria® 1 Dyspnea-Suspected Cardiac Origin Variant 2: Dyspnea due to suspected nonischemic heart failure. -
2010 Common Diagnosis Codes: Cardiology
22010010 CommonCommon DiagnoDiagnossisis CCodeodess:: CardiologyCardiology Code Description Code Description Code Description 038.9 Unspec septicemia 405.91 Unspec renovascular hypertension 425.8 Cardiomyopathy diseases classifi ed elsewhere 244.9 Unspec acquired hypothyroidism 410 AMI anterolateral wall episode care unspec 425.9 Secondary cardiomyopathy unspec 250 Diabetes mellitus w/o comp Type II not uncontrolled 410.01 initial episode care 426.0 Atrioventricular block complete 250.01 Diabetes mellitus w/o complication Type I not 410.02 AMI anterolateral wall subsequent episode care 426.10 Atrioventricular block unspec uncontrolled 410.1 AMI other anterial wall episode care unspec 426.11 First degree atrioventricular block 250.02 Diabetes mellitus w/o comp Type II uncontrolled 410.11 initial episode care 426.12 Mobitz (type) ii atrioventricular block 250.8 Type II diabetes mellitus w/ other spec 410.12 subsequent episode care 426.13 Other second degree atrioventricular block manifestations, not uncontrolled 410.21 AMI inferolarteral wall initial episode care 426.2 Left bundle branch hemiblock 250.9 Type II diabetes mellitus w/unspec complication, not 410.31 AMI inferoposterior wall initial episode of care 426.3 Other left bundle branch block uncontrolled 410.4 AMI other inferior wall episode care unspec 426.4 Right bundle branch block 272 Pure hypercholesterolemia 410.41 initial episode care 426.50 Bunble branch block unspec 272.1 Pure hyperglyceridemia 410.42 AMI other inferior wall subsequent episode care 426.52 Right bundle branch -
Vena Cava Backflow and Right Ventricular Stiffness in Pulmonary Arterial Hypertension
Early View Original article Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension J. Tim Marcus, Berend E. Westerhof, Joanne A. Groeneveldt, Harm Jan Bogaard, Frances S. de Man, Anton Vonk Noordegraaf Please cite this article as: Marcus JT, Westerhof BE, Groeneveldt JA, et al. Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension. Eur Respir J 2019; in press (https://doi.org/10.1183/13993003.00625-2019). This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Copyright ©ERS 2019 Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension J. Tim Marcus1, Berend E. Westerhof2,3, Joanne A. Groeneveldt2, Harm Jan Bogaard2, Frances S. de Man2 and Anton Vonk Noordegraaf2 Affiliations: 1Amsterdam UMC, Vrije Universiteit Amsterdam, Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 2Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; 3Amsterdam UMC, University of Amsterdam, Medical Biology, Section of Systems Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands. Correspondence: Dr. J.T. Marcus Amsterdam UMC, Vrije Universiteit Amsterdam, Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, Amsterdam Netherlands phone: +31 20 4440179 e-mail: [email protected] Abstract Vena cava (VC) backflow is a well-recognized clinical hallmark of right ventricular (RV) failure in pulmonary arterial hypertension (PAH). -
Primary Prevention of Pulmonary Heart Disease
Heart disease resources Primary prevention of pulmonary vented or diagnosed, and adequately treated, heart disease it must be recognized as a specific form of both acute and chronic heart disease. Such PULMONARY HEART DISEASE STUDY GROUP: recognition can be facilitated by the accep- Chairman: ROY H. BEHNKE, M.D. tance of a single definition of the disease Members: S. GILBERT BLOUNT, M.D.; entity. Pulmonary heart disease, cor pulmo- J. DAVID BRISTOW, M.D.; VIRGINIA CARRIERI, R.N.; JOHN A. PIERCE, M.D.; nale, is here defined as: Alteration in structure ARTHUR SASAHARA, M.D.; or function of the right ventricle resulting ALFRED SOFFER, M.D. from disease affecting the structure or func- Consultant: RICHARD GREENSPAN, M.D. tion of the lung or its vasculature, except when Introduction this alteration results from disease of the left Pulmonary heart disease, cor pulmonale, is side of the heart or congenital heart disease. a major form of heart disease yet there is reasonable evidence that it can be prevented. Incidence and prevalence Support for this contention rests in the fact Effective programs of prevention are facili- that the causative or precedent pulmonary tated by an accurate assessment of the scope diseases are in large part preventable. Primary and magnitude of the health problem. Chronic prevention of the related pulmonary diseases obstructive lung disease (bronchitis and/or is thus the initial and basic step in the pre- emphysema) is by far the most important of vention of cor pulmonale. Such an under- the respiratory diseases associated with pul- taking is a major task. It can only be achieved monary heart disease. -
ICD-10-CM TRAINING May 2013
ICD-10-CM TRAINING May 2013 Circulatory System The Ear Linda Dawson, RHIT, AHIMA Approved ICD-10 Trainer Diseases of the circulatory system I00-I02 Acute rheumatic fever I05-I09 Chronic rheumatic heart disease I10-I15 Hypertensive diseases I20-I25 Ischemic heart disease I26-I28 Pulmonary heart disease and diseases of the pulmonary circulation I30-I52 Other forms of heart disease I60-I69 Cerebrovascular disease I70-I79 Diseases of the arteries, arterioles and capillaries I80-I89 Diseases of veins, lymphatic vessels and lymph nodes, NEC I95-I99 Other and unspecified disorders of the circulatory system The Heart Here is a short video clip on the heart http://www.rightdiagnosis.com/animations/how-the-heart- works.htm Hypertension types changed Deletion of the codes: benign, malignant and unspecified. Hypertension table is no longer necessary. Essential (primary) hypertension I10 Includes: High blood pressure Hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic) Hypertension with Heart Disease: I50.0 or I51.4-I51.9 Assigned to a code from Ill when a causal relationship is stated or implied as in “Hypertensive Heart Disease.” ***Use an additional code from I50.- Heart failure in those patients with heart failure. Hypertensive Chronic Kidney Disease - Code I12 when both hypertension and a condition classifiable to N18.- (Chronic kidney disease) are present. Hypertensive Heart and Chronic Kidney Disease – I13 Assign combination codes when both hypertensive kidney disease and hypertensive heart disease are stated in the diagnosis. Assign additional code for Heart failure if present. I50. Hypertension Uncontrolled – May be untreated hypertension or hypertension not responding to current therapeutic regimen. Controlled – This diagnostic statement usually refers to an existing state of hypertension under control by therapy.