DVT complete diagnostic approach resident survival guide

Probability of infective endocaritis	Characteristics
Definite diagnosis by pathological criteria	❑ Microorganisms demonstrated by culture or histological examination of a vegetation, OR ❑ Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Definite diagnosis by clinical criteria	❑ 2 major criteria; OR ❑ 1 major criterion and 3 minor criteria; OR ❑ 5 minor criteria
Possible diagnosis	❑ 1 major criterion and 1 minor criterion; OR ❑ 3 minor criteria
Rejected diagnosis	❑ Firm alternative diagnosis explaining evidence of IE, OR ❑ Resolution of IE syndrome with antibiotic therapy for 4 days, OR ❑ No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days, OR ❑ Does not meet criteria for possible IE as above

Criteria	Definite Infective Endocarditis According to Modified Duke Criteria
Pathological Criteria	Microorganisms demonstrated by culture or histological examination of a vegetation Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Clinical Criteria	2 major criteria; or 1 major criterion and 3 minor criteria; or 5 minor criteria
Possible IE	1 major criterion and 1 minor criterion; or 3 minor criteria
Rejected	Firm alternative diagnosis explaining evidence of IE; or Resolution of IE syndrome with antibiotic therapy for 4 days; or No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or Does not meet criteria for possible IE as above

Table

Management of focal atrial tachycardia Acute treatment Conversion in hemodynamically unstable patient ▸ DC cardioversion (Class I, level of evidence B) Conversion in hemodynamically stable patient ▸ Adenosine (Class IIa, level of evidence C) OR ▸ Verapamil (Class IIa, level of evidence C) OR ▸ Diltiazem (Class IIa, level of evidence C) OR ▸ Beta blocker (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Procainamide (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) Rate control ▸ Verapamil (Class I, level of evidence C) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Beta blocker (Class I, level of evidence C) OR ▸ Digoxin (Class IIb, level of evidence C) Prophylactic therapy Recurrent symptomatic atrial tachycardia ▸ Catheter ablation (Class I, level of evidence B) OR ▸ Beta blockers (Class I, level of evidence C) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Verapamil (Class I, level of evidence C) OR ▸ Disopyramide (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) Asymptomatic or symptomatic incessent atrial tachycardia ▸ Catheter ablation (Class I, level of evidence B) Asymptomatic and non-sustained atrial tachycardia ▸ No therapy (Class I, level of evidence C) OR ▸ Catheter ablation (Class III, level of evidence C) Management of focal and nonparoxysmal junctional tachycardia Focal junctional tachycardia ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) OR ▸ Catheter ablation (Class IIa, level of evidence C) Non paroxysmal junctional tachycardia ▸ Reverse digitalis toxicity (Class I, level of evidence C) AND ▸ Correct hypokalemia (Class I, level of evidence C) AND ▸ Treat myocardial ischemia (Class I, level of evidence C) OR ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Calcium channel blockers (Class IIa, level of evidence C) Management of recurrent AVNRT AVNRT with hemodynamic intolerance ▸ Catheter ablation (Class I, level of evidence B) OR ▸ Verapamil (Class IIa, level of evidence C) OR ▸ Diltiazem (Class IIa, level of evidence C) OR ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) Recurrent symptomatic AVNRT ▸ Catheter ablation (Class I, level of evidence B) OR ▸ Verapamil (Class I, level of evidence B) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Digoxin (Class IIb, level of evidence C) Recurrent AVNRT unresponsive to beta blockers and calcium channel blockers, patient not desiring radiofrequency ablation ▸ Flecainide (Class IIa, level of evidence B) OR ▸ Propafenone (Class IIa, level of evidence B) OR ▸ Sotalol (Class IIa, level of evidence B) OR ▸ Amiodarone (Class IIb, level of evidence C) Single episode of AVNRT or infrequent AVNRT in patients desiring complete control of arrhythmia ▸ Catheter ablation (Class I, level of evidence B)