MDCalc » Cardiology

Well’s Criteria for DVT

admin — Sat, 28 Feb 2009 14:44:33 +0000

Does this patient have deep vein thrombosis? Wells PS, Owen C, Doucette S, Fergusson D, Tran H. JAMA. 2006 Jan 11;295(2):199-207. Review.
Diagnosis and treatment of deep-vein thrombosis. Scarvelis D, Wells PS. CMAJ. 2006 Oct 24;175(9):1087-92. Review. Erratum in: CMAJ. 2007 Nov 20;177(11):1392.
Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. N Engl J Med. 2003 Sep 25;349(13):1227-35.

PERC Rule for Pulmonary Embolism

admin — Wed, 11 Feb 2009 14:42:47 +0000

Well’s Criteria for Pulmonary Embolism / PE

admin — Fri, 02 Jan 2009 04:35:11 +0000

Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20.

TIMI Risk Score for UA/NSTEMI

admin — Fri, 02 Jan 2009 04:33:47 +0000

Risk factors for CAD : Family history of CAD, Hypertension, Hypercholesterolemia, Diabetes, or Current Smoker (thanks to Jeff Geske at Mayo for this update!)

The TIMI Risk Score for Unstable Angina/Non-ST Elevation MI PubMed ID 10938172

TIMI Risk Score for STEMI

admin — Fri, 02 Jan 2009 04:29:51 +0000

TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation PubMed ID 11044416

San Francisco Syncope Rule to Predict Serious Outcomes

admin — Fri, 02 Jan 2009 04:27:13 +0000

Note: This rule has a 96% sensitivity and 62% specificity for serious outcome. Negative predictive value: 99.2%; positive predictive value 24.8%.

Serious Outcome in this study is defined as "death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing a return ED visit and hospitalization for a related event."

The San Francisco Syncope Rule to Predict Patients with Serious Outcomes

Mean Arterial Pressure (MAP)

admin — Fri, 02 Jan 2009 03:57:16 +0000

Mean Arterial Pressure ~= 1/3 * SBP + 2/3 * DBP

LDL Calculated

admin — Fri, 02 Jan 2009 03:55:59 +0000

LDL Cholesterol = Total Cholesterol - HDL - (TG / 5)

Latest LDL Guidelines (NCEP 2004 Update):

High Risk (known CAD, known other atherosclerotic dz, diabetes, etc): < 70 mg/dl
Moderate Risk (> 1 risk factor): <130 mg/dl
Lower Risk (0-1 risk factors): <160 mg/dl

Risk Factors:

Diabetes
Cigarette smoking
HTN (BP 140/90 mm Hg or on antihypertensive medication)
Low HDL cholesterol ( < 40 mg/dL)
Family history of premature CAD (CAD in male first-degree relative, or father less than 55, or female first-degree relative or mother less than 65)

Corrected QT Interval (QTc)

admin — Fri, 02 Jan 2009 03:47:08 +0000

Corrected QT (QT_C) = Bazett's Formula = QT Interval / √ (RR interval)
RR Interval = 60/HR

Normal QTc ≤ 440 msec. A longer QTc puts the patient at increased risk for torsade de pointes.

Some causes of prolonged QT:

CAD
Cardiomyopathy
Severe Bradycardia, High-Grade AV Block
Anti-Arrhythmics
Psychotropic Drugs
Other Drugs
HypoCa, other lyte abnormalities
Autonomic dysfunction
Hypothyroid
Hypothermia
Congenital Long QT Syndrome

CHADS2 Score for Atrial Fibrillation Stroke Risk

admin — Fri, 02 Jan 2009 03:44:18 +0000

Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

Active cancer?	Yes +1
Bedridden recently >3 days or major surgery within four weeks?	Yes +1
Calf swelling >3cm compared to the other leg?	Yes +1
Collateral (nonvaricose) superficial veins present?	Yes +1
Entire leg swollen?	Yes +1
Localized tenderness along the deep venous system?	Yes +1
Pitting edema, greater in the symptomatic leg?	Yes +1
Paralysis, paresis, or recent plaster immobilization of the lower extremity	Yes +1
Alternative diagnosis to DVT as likely or more likely?	Yes -2
Score	Points

Age < 50?	Yes
HR < 100?	Yes
O2 Sat on Room Air >94%?	Yes
No Prior History of DVT/PE?	Yes
No Recent Trauma or Surgery?	Yes
No Hemoptysis?	Yes
No Exogenous Estrogen?	Yes
No Clinical Signs Suggesting DVT?	Yes
Score	points

Clinical Signs and Symptoms of DVT?	Yes +3
PE Is #1 Diagnosis, or Equally Likely	Yes +3
Heart Rate > 100?	Yes +1.5
Immobilization at least 3 days, or Surgery in the Previous 4 weeks	Yes +1.5
Previous, objectively diagnosed PE or DVT?	Yes +1.5
Hemoptysis?	Yes +1
Malignancy w/ Treatment within 6 mo, or palliative?	Yes +1
Score

Age ≥ 65 years?	Yes +1
≥ 3 Risk Factors for CAD?	Yes +1
Known CAD (stenosis ≥ 50%)?	Yes +1
ASA Use in Past 7d?	Yes +1
Severe angina (≥ 2 episodes w/in 24 hrs)?	Yes +1
ST changes ≥ 0.5mm?	Yes +1
+ Cardiac Marker?	Yes +1
Score	points

Age ≥ 65 years?	< 65 +0 65-74 +2 ≥ 75 +3
DM or HTN or Angina?	Yes +1
SBP < 100 mmHg?	Yes +3
HR > 100 bpm?	Yes +2
Killip Class II-IV?	Yes +2
Weight < 67 kg (147.7 lbs)?	Yes +1
Anterior ST Elevation or LBBB?	Yes +1
Time to Treatment > 4 hrs?	Yes +1
Score	points

Congestive Heart Failure history?	Yes +1
Hematocrit < 30%?	Yes +1
ECG Abnormal ?	Yes +1
Shortness of Breath History?	Yes +1
Systolic BP < 90 mmHg at Triage?	Yes +1
Score	points

Total Cholesterol	mg/dL
HDL	mg/dL
Triglycerides	mg/dL
Calculated LDL	mg/dL

Congestive Heart Failure history?	Yes +1
Hypertension history?	Yes +1
Age ≥ 75?	Yes +1
Diabetes Mellitus history?	Yes +1
Stroke symptoms previously or TIA?	Yes +2
Score	points

The adjusted stroke rate was the expected stroke rate per 100 person-years derived from the multivariable model assuming that aspirin was not taken.

Systolic BP	mm Hg
Diastolic BP	mm Hg
MAP	mm Hg