Monitoring Cardiac Function in Intensive Care S M Tibby, I a Murdoch
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Medical Policy
bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Ambulatory Cardiac Monitors (Excluding Holter Monitors) Policy Number: OCA 3.35 Version Number: 24 Version Effective Date: 03/01/21 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan Well Sense Health Plan MassHealth Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options ◊ Notes: + Disclaimer and audit information is located at the end of this document. ◊ The guidelines included in this Plan policy are applicable to members enrolled in Senior Care Options only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of the prior authorization request. Review the member’s product-specific benefit documents at www.SeniorsGetMore.org to determine coverage guidelines for Senior Care Options. Policy Summary The Plan considers the use of ambulatory cardiac monitors in the outpatient setting to be medically necessary if the type of ambulatory cardiac monitor is covered for the Plan member and ALL applicable Plan criteria are met, as specified in the Medial Policy Statement and Limitations sections of this policy. Plan prior authorization is required. When the device is covered for the member, medically necessary ambulatory cardiac monitors utilized in the outpatient setting may include ambulatory cardiac event monitors, mobile cardiac outpatient telemetry, and/or single-use external ambulatory electrocardiographic monitoring patches available by prescription. Ambulatory Cardiac Monitors (Excluding Holter Monitors) + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. -
Cardiac Physiologyc As a Country
Type to enter text CardiacCardiovascular PhysiologyC as a Physiology Country Doc EpisodeEpisode 2:2: The EKG Electrocardiography I Patrick Eggena, M.D. Novateur Medmedia Type EPISODEto enter text 2 Type to enter text THE EKG by Patrick Eggena, M.D. i Copyright This Episode is derived from: Course in Cardiovascular Physiology by Patrick Eggena, M.D. © Copyright Novateur Medmedia, LLC. April 13, 2012 The United States Copyright Registration Number: PAu3-662-048 Ordering Information via iBooks: ISBN 978-0-9905771-1-9 Cardiac Physiology as a Country Doc, Episode 2: The EKG. Contact Information: Novateur Medmedia, LLC 39 Terry Hill Road, Carmel, NY 10512 email: [email protected] Credits: Oil Paintings by Bonnie Eggena, PsD. Music by Alan Goodman from his CD Under the Bed, Cancoll Music, copyright 2005 (with permission). Illustrations, movies, text, and lectures by Patrick Eggena, M.D. Note: Knowledge in the basic and clinical sciences is constantly changing. The reader is advised to carefully consult the instruc- tions and informational material included in the package inserts of each drug or therapeutic agent before administration. The Country Doctor Series illustrates Physiological Principles and is not intended as a guide to Medical Therapeutics. Care has been taken to present correct information in this book, however, the author and publisher are not responsible for errors or omissions or for any consequence from application of the information in this work and make no warranty, expressed or implied, with re- spect to the contents of this publication or that its operation will be uninterrupted and error free on any particular recording de- vice. -
Angiotensin II Protocol
Angiotensin II (Giapreza ™) Protocol Background Sepsis and septic shock are medical emergencies that affect millions of people each year and killing as many as 1 in 4.1 The cornerstones of therapy are fluid resuscitation, early appropriate antibiotics, source control if needed and vasopressors. A small portion of patients fail to respond to these therapies and develop refractory shock. The definition of refractory septic shock varies in the literature but is generally considered to be hypotension, with end-organ dysfunction, requiring high-dose vasopressor support.2 The associated mortality of refractory septic shock is up to 60% and as high as 80-90% in patients requiring more than 1 mcg/kg/min of norepinephrine.2,3 Patients who develop refractory septic shock comprise a very small portion of the population in large randomized controlled trials therefore limited data is available regarding outcomes and management. Indications: Angiotensin II (Ang II) is a vasoconstrictor used to increase blood pressure in adults with septic or other distributive shock. Administration: Starting dose of 5 (nanograms) ng/kg/min intravenously via central line only. Titration: Every 5 minutes by increments of 5 ng/kg/min as needed. Maximum dose should not exceed 80 ng/kg/min (During the first 3 hours of administration); after the first 3 hours the maintenance (maximum) dose is 40 ng/kg/min. Monitoring: Critical care setting only with telemetry, arterial blood pressure, and continuous SpO2 monitoring. DVT Prophylaxis should be started (unless contraindicated) -
Bed-Based Ballistocardiography: Dataset and Ability to Track Cardiovascular Parameters
sensors Article Bed-Based Ballistocardiography: Dataset and Ability to Track Cardiovascular Parameters Charles Carlson 1,* , Vanessa-Rose Turpin 2, Ahmad Suliman 1 , Carl Ade 2, Steve Warren 1 and David E. Thompson 1 1 Mike Wiegers Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, USA; [email protected] (A.S.); [email protected] (S.W.); [email protected] (D.E.T.) 2 Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA; [email protected] (V.-R.T.); [email protected] (C.A.) * Correspondence: [email protected] Abstract: Background: The goal of this work was to create a sharable dataset of heart-driven signals, including ballistocardiograms (BCGs) and time-aligned electrocardiograms (ECGs), photoplethysmo- grams (PPGs), and blood pressure waveforms. Methods: A custom, bed-based ballistocardiographic system is described in detail. Affiliated cardiopulmonary signals are acquired using a GE Datex CardioCap 5 patient monitor (which collects ECG and PPG data) and a Finapres Medical Systems Finometer PRO (which provides continuous reconstructed brachial artery pressure waveforms and derived cardiovascular parameters). Results: Data were collected from 40 participants, 4 of whom had been or were currently diagnosed with a heart condition at the time they enrolled in the study. An investigation revealed that features extracted from a BCG could be used to track changes in systolic blood pressure (Pearson correlation coefficient of 0.54 +/− 0.15), dP/dtmax (Pearson correlation coefficient of 0.51 +/− 0.18), and stroke volume (Pearson correlation coefficient of 0.54 +/− 0.17). Conclusion: A collection of synchronized, heart-driven signals, including BCGs, ECGs, PPGs, and blood pressure waveforms, was acquired and made publicly available. -
Insights from Computational Modeling Into the Contribution of Mechano-Calcium Feedback on the Cardiac End-Systolic Force-Length Relationship
fphys-11-00587 May 28, 2020 Time: 19:46 # 1 ORIGINAL RESEARCH published: 29 May 2020 doi: 10.3389/fphys.2020.00587 Insights From Computational Modeling Into the Contribution of Mechano-Calcium Feedback on the Cardiac End-Systolic Force-Length Relationship Megan E. Guidry1, David P. Nickerson1, Edmund J. Crampin2,3, Martyn P. Nash1,4, Denis S. Loiselle1,5 and Kenneth Tran1* 1 Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand, 2 Systems Biology Laboratory, School of Mathematics and Statistics, The University of Melbourne, Melbourne, VIC, Australia, 3 ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, School of Chemical and Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia, 4 Department of Engineering Science, The University of Auckland, Auckland, Edited by: New Zealand, 5 Department of Physiology, The University of Auckland, Auckland, New Zealand Leonid Katsnelson, Institute of Immunology and Physiology (RAS), Russia In experimental studies on cardiac tissue, the end-systolic force-length relation (ESFLR) Reviewed by: has been shown to depend on the mode of contraction: isometric or isotonic. The Andrey K. Tsaturyan, Lomonosov Moscow State University, isometric ESFLR is derived from isometric contractions spanning a range of muscle Russia lengths while the isotonic ESFLR is derived from shortening contractions across a Aurore Lyon, range of afterloads. The ESFLR of isotonic contractions consistently lies below its Maastricht University, Netherlands isometric counterpart. Despite the passing of over a hundred years since the first insight *Correspondence: Kenneth Tran by Otto Frank, the mechanism(s) underlying this protocol-dependent difference in the [email protected] ESFLR remain incompletely explained. -
Hemodynamic Monitoring and Circulatory Assist Devices
Hemodynamic Monitoring Hemodynamic Monitoring and Circulatory Assist Devices • Measurement of pressure, flow, and oxygenation within the cardiovascular system • Includes invasive and noninvasive measurements (Relates to Chapter 66, – Systemic and pulmonary arterial pressures “Nursing Management: Critical Care,” in the textbook) Hemodynamic Monitoring Hemodynamic Monitoring • Invasive and noninvasive measurements • Invasive and noninvasive measurements (cont’d) (cont’d) – Central venous pressure (CVP) – Stroke volume (SV)/stroke volume index (SVI) – Pulmonary artery wedge pressure (PAWP) – O2 saturation of arterial blood (SaO2) – Cardiac output (CO)/cardiac index (CI) – O2 saturation of mixed venous blood (SvO2) Hemodynamic Monitoring Hemodynamic Monitoring General Principles General Principles • Preload: Volume of blood within ventricle at • Contractility: Strength of ventricular end of diastole contraction • Afterload: Forces opposing ventricular • PAWP: Measurement of pulmonary capillary ejection pressure; reflects left ventricular end‐diastolic – Systemic arterial pressure pressure under normal conditions – Resistance offered by aortic valve – Mass and density of blood to be moved 1 Hemodynamic Monitoring Principles of Invasive Pressure General Principles Monitoring • CVP: Right ventricular preload or right • Equipment must be referenced and zero ventricular end‐diastolic pressure under balance to environment and dynamic normal conditions, measured in right atrium response characteristics optimized or in vena cava close to heart • -
Clinical Research Protocol
DOCUMENT APPROVAL PAGE Document Number: Rev: Page: 90D0167 C 1 of 32 Title: Ambulatory Remote Patient Monitoring using the µCor Heart Failure and Arrhythmia Management System (PATCH) Feasibility Study: Protocol NCT04512703 Author: Ramu Perumal, PhD Date: 9-February-2018 Approvals ( “ ” indicates approval signature required) Medical Affairs: Date: Marketing: Date: Clinical Operations: Date: Billing/Reimbursement: Date: IE/QE Engineering: Date: Support Service: Date: Service Operations: Date: Technology Applications: Date: OEM Regulatory: Date: OEM Engineering: Date: Documentation Control: Date Archived: Electronic File info: (if applicable) *If multiple files (such as multiple sheets of a drawing) list file info separately File name: Size (in bytes) Time & Date (or Date & Time) 90D0167_revC.docx Transferred File info: (To be completed by Documentation Control) File name: Size (in bytes) Time & Date (or Date & Time) 90d0167_revc.doc 90d0167_revc.pdf ZOLL Services Form Number: 90A0001-A01 Form REV Level: A DOCUMENT REVISION HISTORY PAGE Document Number: Rev: Page: 90D0167 C 2 of 32 Title: Ambulatory Remote Patient Monitoring using the µCor Heart Failure and Arrhythmia Management System (PATCH)Feasibility Study: Protocol Revision History Of Document CO Rev Number Description of Change Author Effective Date FI NA First version RP 7/17/17 A NA Changed the device name from Continuous Mobile Cardiac RP 8/22/17 Telemetry System to uCor Heart Failure and Arrhythmia Management System. B NA The following changes were made: RP 10/16/17 1. Removed CE-mark reference for the device 2. Subjects no longer have to send photographs of the skin and device placement. Instead, they will note their skin condition and device location on the subject diary 3. -
Strategic Review of Cardiac Physiology Services in England: Final Report
STRATEGIC REVIEW OF CARDIAC PHYSIOLOGY SERVICES IN ENGLAND: FINAL REPORT Strategic Review of Cardiac Physiology Services in England Page 1 Final Report: 12/05/2015 CONTENTS Page Foreword 3 Summary of recommendations 4 Background 7 Purpose of the Review 8 Working arrangements and governance 8 Delivering a service model for the future 8 Delivering a cardiac physiology service to quality standards 16 Developing a cardiac physiology workforce for the future 18 Commissioning for quality 20 Appendix 1: 23 Cardiac physiology services in summary Appendix 2: 27 Working arrangements and governance Appendix 3: 28 Award in Practical Electrocardiography (APECG) Appendix 4: 29 Proposed possible key performance indicators Appendix 5: 30 Current status of standards development across a range of cardiac physiology investigations Appendix 6: 32 Current training, accreditation and standards Appendix 7: 33 National Review of Cardiac Physiology Services - Modelling the Future Workforce References 34 Glossary 36 Acknowledgements 38 Strategic Review of Cardiac Physiology Services in England Page 2 Final Report: 12/05/2015 FOREWORD In 2013, the Department of Health published the Cardiovascular Outcomes Strategy, a call to action to the health and care systems, which set out ten key actions to deliver for patients with cardiovascular disease improvements in their health outcomes. Cardiac physiology services are key to delivering the improved treatment and care, which is the ambition of the Outcomes Strategy. This Strategic Review of Cardiac Physiology Services was set up to make recommendations to NHS England, Health Education England and across the health and care system about the innovations in service delivery, models of care and workforce configuration which are needed to transform patients’ experience of cardiovascular disease care. -
Appropriate Usage of Continuous Cardiac Monitoring in the Inpatient Setting: a Literature Review
Arch Intern Med Res 2021; 4 (2): 062-065 DOI: 10.26502/aimr.0057 Review Article Appropriate Usage of Continuous Cardiac Monitoring in the Inpatient Setting: A Literature Review Sara Whyte1, Krishna Vedala1*, Philip T Sobash1, Raghuveer Vedala2, Kalyan Gonugunta1 Review Article 1Department of Internal Medicine, White River Health System, Arkansas, USA 2Department of Family Medicine, University of Oklahoma Health Sciences Center, Oklahoma, USA *Corresponding author: Krishna Vedala, Department of Internal Medicine, White River Health System, Batesville, Arkansas, USA Received: 31 March 2021; Accepted: 08 April 2021; Published: 21 April 2021 Citation: Sara Whyte, Krishna Vedala, Philip T Sobash, Raghuveer Vedala, Kalyan Gonugunta. Appropriate Usage of Continuous Cardiac Monitoring in the Inpatient Setting: A Literature Review. Archives of Internal Medicine Research 4 (2021): 062-065. Keywords: Telemetry ed, life-threatening arrhythmias [5, 6]. Electrocardiographic monitoring (telemetry) in the In patients presenting with chest pain and indications for inpatient setting has significant utility, but is constrained acute coronary syndrome (ACS), telemetry is warranted by rising healthcare costs, rare detection of significant in the early phases (<24 hours) for intermediate- or events and potential for great alert fatigue [1, 2]. In high-risk non-ST elevated-ACS or ST-segment- 2017, the American Heart Association (AHA) published elevation of myocardial infarction (STEMI), until ruled updated practice standards for telemetry monitoring that out [3]. Cardiac arrest is the leading cause of death addressed overuse, appropriate use, alarm management among adults in the United States, and most common and documentation in electronic medical records [3, 4]. cause of death after MI [7]. In patients with myocardial Here, we review their recommendations for indication infarction (MI), after cardiac arrest, during temperature for telemetry utilization on the hospital floor. -
Cardiac Physiology
Chapter 20 Cardiac Physiology LENA S. SUN • JOHANNA SCHWARZENBERGER • RADHIKA DINAVAHI K EY P OINTS • The cardiac cycle is the sequence of electrical and mechanical events during the course of a single heartbeat. • Cardiac output is determined by the heart rate, myocardial contractility, and preload and afterload. • The majority of cardiomyocytes consist of myofibrils, which are rodlike bundles that form the contractile elements within the cardiomyocyte. • The basic working unit of contraction is the sarcomere. • Gap junctions are responsible for the electrical coupling of small molecules between cells. • Action potentials have four phases in the heart. • The key player in cardiac excitation-contraction coupling is the ubiquitous second messenger calcium. • Calcium-induced sparks are spatially and temporally patterned activations of localized calcium release that are important for excitation-contraction coupling and regulation of automaticity and contractility. • β -Adrenoreceptors stimulate chronotropy, inotropy, lusitropy, and dromotropy. • Hormones with cardiac action can be synthesized and secreted by cardiomyocytes or produced by other tissues and delivered to the heart. • Cardiac reflexes are fast-acting reflex loops between the heart and central nervous system that contribute to the regulation of cardiac function and the maintenance of physiologic homeostasis. In 1628, English physician, William Harvey, first advanced oxygen (O2) and nutrients and to remove carbon dioxide the modern concept of circulation with the heart as the (CO2) and metabolites from various tissue beds. generator for the circulation. Modern cardiac physiology includes not only physiology of the heart as a pump but also concepts of cellular and molecular biology of the car- PHYSIOLOGY OF THE INTACT HEART diomyocyte and regulation of cardiac function by neural and humoral factors. -
Pleth Variability Index: a Dynamic Measurement to Help Assess to Help Measurement a Dynamic Index: Variability Pleth Responsiveness and Fluid Physiology
Pleth Variability Index: A Dynamic Measurement to Help Assess TECHNICAL BULLETIN TECHNICAL Physiology and Fluid Responsiveness SUMMARY PVI®, an index available with Masimo SET® pulse oximetry, is the first and only noninvasive, continuous, easy-to-use method to help clinicians manage fluid responsiveness in sedated patients under positive pressure ventilation. Other clinical uses have also been developed for PVI, including helping clinicians to assess the effects of positive end expiratory pressure on cardiac index and to identify patients at risk for hypotension during anesthesia induction. PVI, along with the other innovative noninvasive monitoring technologies available with the Masimo rainbow SET® platform (SpHb®, SpCO®, SpMet®, RRa™), has helped clinicians to realize improved patient outcomes while lowering the cost of care. INTRODUCTION Many pulse oximetry technologies display a processed and filtered representation of the photoplethysmosgraphic waveform. Each manufacturer uses unique proprietary algorithms to calculate the waveform displayed on the pulse oximeter. Masimo has extracted and processed information from the waveform to create two physiologic indices, perfusion index (PI) and pleth variability index (PVI). PI is calculated by indexing the infrared (IR) pulsatile signal against the nonpulsitile signal and expressing this number as a percentage. Masimo SET® PI has been shown to be useful to gauge the severity of illness in newborns1, 2 to assess the effectiveness of epidural blocks3, 4 to indicate successful interscalene nerve block placement in awake patients5 and to quantify peripheral perfusion for diagnosis of congenital heart disease in newborns.6 PVI is the first and only commercially available measurement that automatically and continuously calculates the respiratory variations in the photoplethysmosgraphic waveform. -
Cardiac Monitoring Infographic
Cardiac monitors have been used for years to help physicians determine if patients are experiencing EVOLUTION OF THE irregular heartbeats (arrhythmias) that are causing recurrent fainting, palpitations, unexplained stroke, or atrial fibrillation. Over time, these devices have grown smaller—and smarter—and the latest devices ™ are revolutionizing the world of cardiac monitoring. Reveal LINQ CARDIAC MONITOR Insertable Cardiac Monitor Cardiac monitors have evolved from large, wired, external devices to small and simple, yet powerful, systems that monitor a patient’s MCT Wire-free Wearable Miniaturized Insertable 1 Holter Monitor Event Monitor heartbeat for up to three years, (Mobile Cardiac Telemetry) MCT Monitor Cardiac Monitor without the bulk and inconvenience of traditional devices. KEY External, adhesive-backed = Duration of use monitor improves patient Nearly invisible on most comfort and convenience patients; approximately = Not water resistant with “peel and stick” 1/3 the size of an AAA battery and safe for use simplicity and remote in an MRI setting. = Water resistant monitoring capabilities. 24–48 hours Up to 30 days Up to 30 days Up to 30 days Up to 3 years = Worn externally = Worn internally = Device automatically transmits data to physicians via wireless connectivity 1. Reference the Reveal LINQ ICM Clinician Manual for usage parameters. Brief Statement: REVEAL LINQ™ LNQ11 Insertable Cardiac Monitor and Patient Assistant Patient Assistant Operation of the Patient Assistant near sources of electromagnetic interference, such as