Thoracic aortic disease screening: Difference between revisions
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An electrocardiogram should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection.<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An [[electrocardiogram]] should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection.<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' Given the relative infrequency of dissection-related coronary artery occlusion, the presence of [[ST-segment elevation]] suggestive of [[myocardial infarction]] should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for [[aortic dissection]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' The role of chest x-ray in the evaluation of possible thoracic aortic disease should be directed by the patient’s pretest risk of disease as follows:<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' The role of chest x-ray in the evaluation of possible thoracic aortic disease should be directed by the patient’s pretest risk of disease as follows:<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' Low risk: Chest x-ray should be performed on all low-risk patients, as it may either establish an alternative diagnosis or demonstrate findings that are suggestive of thoracic aortic disease, indicating the need for urgent definitive aortic imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' Low risk: Chest x-ray should be performed on all low-risk patients, as it may either establish an alternative diagnosis or demonstrate findings that are suggestive of thoracic aortic disease, indicating the need for urgent definitive aortic imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Urgent and definitive imaging of the aorta using transesophageal echocardiogram, computed tomographic imaging, or magnetic resonance imaging is recommended to identify or exclude thoracic aortic dissection in patients at high risk for the disease by initial screening. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Urgent and definitive imaging of the aorta using transesophageal echocardiogram, [[computed tomographic imaging]], or [[magnetic resonance imaging]] is recommended to identify or exclude thoracic [[aortic dissection]] in patients at high risk for the disease by initial screening. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | |colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | ||
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|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for [[aortic dissection]] by initial screening. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | ||
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Revision as of 15:43, 29 October 2012
Overview
2010 ACCF/AHA Guideline Recommendations: Evaluation and Management of Acute Thoracic Aortic Disease (DO NOT EDIT) [1]
Recommendations for Screening Tests
| Class I |
| "1. An electrocardiogram should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection." |
| "a. Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection. (Level of Evidence: B)" |
| "2. The role of chest x-ray in the evaluation of possible thoracic aortic disease should be directed by the patient’s pretest risk of disease as follows:" |
| "a. Intermediate risk: Chest x-ray should be performed on all intermediate-risk patients, as it may establish a clear alternate diagnosis that will obviate the need for definitive aortic imaging. (Level of Evidence: C)" |
| "b. Low risk: Chest x-ray should be performed on all low-risk patients, as it may either establish an alternative diagnosis or demonstrate findings that are suggestive of thoracic aortic disease, indicating the need for urgent definitive aortic imaging. (Level of Evidence: C)" |
| "3. Urgent and definitive imaging of the aorta using transesophageal echocardiogram, computed tomographic imaging, or magnetic resonance imaging is recommended to identify or exclude thoracic aortic dissection in patients at high risk for the disease by initial screening. (Level of Evidence: B)" |
| Class III (Harm) |
| "1. A negative chest x-ray should not delay definitive aortic imaging in patients determined to be high risk for aortic dissection by initial screening. (Level of Evidence: C) " |
2010 ACCF/AHA Guideline Recommendations: Other Cardiovascular Conditions Associated with Thoracic Aortic Aneurysm and Dissection (DO NOT EDIT) [1]
Recommendations for Bicuspid Aortic Valve and Associated Congenital Variants in adults
| Class I |
| "1. First-degree relatives of patients with a bicuspid aortic valve, premature onset of thoracic aortic disease with minimal risk factors, and/or a familial form of thoracic aortic aneurysm and dissection should be evaluated for the presence of a bicuspid aortic valve and asymptomatic thoracic aortic disease. (Level of Evidence: C) " |
| "2. All patients with a bicuspid aortic valve should have both the aortic root and ascending thoracic aorta evaluated for evidence of aortic dilatation. (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.