In addition to the prediction of cardiovascular risk, ambulatory blood-pressure monitoring, when used in conjunction with clinic blood-pressure assessments, is of potential value in a variety of other clinical conditions. Some of these conditions are:
Cardiology
Perioperative Cardiovascular Evaluation for Noncardiac Surgery
Clinical Predictors of Increased Perioperative Cardiovascular Risk (Myocardial Infarction, Heart Failure, Death)
Major
- Unstable coronary syndromes
- Acute or recent MI* with evidence of important ischemic risk by clinical symptoms or noninvasive study
- Unstable or severe† angina (Canadian class III or IV)
Diagnostic Criteria for Myocarditis
Myocarditis may present with a wide range of symptoms, ranging from mild dyspnea or chest pain that resolves without specific therapy to cardiogenic shock and death. Dilated cardiomyopathy with chronic heart failure is the major long-term sequela of myocarditis. Most often, myocarditis results from common viral infections; less commonly, specific forms of myocarditis may result from other pathogens, toxic or hypersensitivity drug reactions, giant-cell myocarditis, or sarcoidosis.
Electrocardiographic Diagnosis of Left Ventricular Hypertrophy (LVH)
Sokolow-Lyon index:
There are two criteria with these widely used indices:
* Sum of S wave in V1 and R wave in V5 or V6 >/= 3.5 mV (35 mm)
and/or
* R wave in aVL >/= 1.1 mV (11 mm)
TIMI Risk Score for ST-Elevation Myocardial Infarction (STEMI)
The TIMI risk score, based upon data from 15,000 patients with an ST segment elevation myocardial infarction eligible for fibrinolytic therapy, is a simple arithmetic sum of eight independent predictors of mortality.
Indications and Contraindications for Tilt Table Testing
Indications
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Recurrent syncope or single syncopal episode accompanied by physical injury or motor vehicle crash or occurring in a high-risk setting (for example, pilot, surgeon, commercial vehicle driver) and no evidence of structural cardiovascular disease; or presence of structural cardiovascular disease, but other causes of syncope ruled out by diagnostic testing
-
Syncope induced by or associated with exercise
- Further evaluation of patients in whom an apparent specific cause of syncope has been established (for example, asystole, high atrioventricular block) but susceptibility to neurocardiogenic syncope may affect treatment plan
Causes of Syncope
Cardiac causes
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Structural cardiac or cardiopulmonary disease (aortic stenosis, mitral stenosis, pulmonary stenosis, left atrial myxoma, aortic dissection, acute myocardial infarction, cardiac tamponade, pulmonary embolism, obstructive cardiomyopathy)
-
Cardiac arrhythmias (tachyarrhythmias, bradyarrhythmias)
-
Neurally mediated syncopal syndrome (includes neurocardiogenic or vasovagal syncope, carotid sinus syncope, and situational syncope)
-
Orthostatic (or postural) hypotension
Diagnostic Criteria for Acute Pericarditis
Diagnostic criteria include the following:
- pericarditic typical chest pain,
- pericardial friction rubs,
- widespread ST segment elevation or PR depressions not previously reported, and
- new or worsening pericardial effusion.
New Diagnostic Criteria for Myocardial Infarction (MI)
Criteria for acute, evolving or recent MI
Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI:
1) Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following:
JNC-VII Classification and management of blood pressure for adults
The classification is based on the average of two or more properly measured, seated blood pressure readings on each of two or more office visits.