scholarly journals Evaluation of a diagnostic algorithm for heart disease in neonates.

BMJ ◽  
1991 ◽  
Vol 302 (6782) ◽  
pp. 935-939 ◽  
Author(s):  
R C Franklin ◽  
D J Spiegelhalter ◽  
F J Macartney ◽  
K Bull
Keyword(s):  
Heart Disease ◽  
Diagnostic Algorithm

scholarly journals A Decade of NT-proBNP in Acute Kawasaki Disease, from Physiological Response to Clinical Relevance

Children ◽  
2018 ◽  
Vol 5 (10) ◽  
pp. 141 ◽  
Author(s):  
Audrey Dionne ◽  
Nagib Dahdah
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Confidence Interval ◽  
Positive Likelihood Ratio ◽  
Biological Marker ◽  
Febrile Illness ◽  
Diagnostic Algorithm ◽  
Acquired Heart Disease ◽  
Acute Kawasaki Disease

Kawasaki disease (KD) is an inflammatory febrile illness of early childhood and the primary cause of acquired heart disease during childhood. Coronary artery aneurysms (CAA) are a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely diagnosis in the first ten days of fever is crucial to reduce the risk of coronary artery complications. Nitrogen-terminal B-type natriuretic peptide (NT-proBNP), originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. The utility of NT-proBNP as a biological marker in KD is based on the universal myocardial inflammatory component early in the course of the disease. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls, with a pooled sensitivity of 89% (95% confidence interval 78–95), and a specificity of 72% (95% confidence interval 58–82). The positive likelihood ratio is 3.2:1 (95% confidence interval 2.1–4.8). Moreover, patients with resistance to intravenous immunoglobulin treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. Nevertheless, the non-specificity of NT-proBNP to KD limits its use as a stand-alone test. In this light, a tentative associative retrospective diagnostic algorithm was highly reliable for including all cases at risk of CAA, which warrants further prospective studies for a better diagnostic index of suspicion and risk stratification of patients.

scholarly journals Generating cause of death information to inform health policy: implementation of an automated verbal autopsy system in the Solomon Islands

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew Reeve ◽  
Hafizur Chowdhury ◽  
Pasyodun Koralage Buddhika Mahesh ◽  
Gregory Jilini ◽  
Rooney Jagilly ◽  
...  
Keyword(s):  
Health Policy ◽  
Heart Disease ◽  
Cause Of Death ◽  
Solomon Islands ◽  
Effective Means ◽  
Diagnostic Algorithm ◽  
Cost Effective ◽  
Chronic Respiratory Disease ◽  
Tablet Devices ◽  
Medical Certification

Abstract Background Good quality cause of death (COD) information is fundamental for formulating and evaluating public health policy; yet most deaths in developing countries, including the Solomon Islands, occur at home without medical certification of cause of death (MCCOD). As a result, COD data in such contexts are often of limited use for policy and planning. Verbal autopsies (VAs) are a cost-effective way of generating reliable COD information in populations lacking comprehensive MCCOD coverage, but this method has not previously been applied in the Solomon Islands. This study describes the establishment of a VA system to estimate the cause specific mortality fractions (CSMFs) for community deaths that are not medically certified in the Solomon Islands. Methods Automated VA methods (SmartVA) were introduced into the Solomon Islands in 2016. Trained data collectors (nurses) conducted VAs on eligible deaths to December 2020 using electronic tablet devices and VA responses were analysed using the Tariff 2.0 automated diagnostic algorithm. CSMFs were generated for both non-inpatient deaths in hospitals (i.e. ‘dead on/by arrival’) and community deaths. Results VA was applied to 914 adolescent-and-adult deaths with a median (IQR) age of 62 (45–75) years, 61% of whom were males. A specific COD could be diagnosed for more than 85% of deaths. The leading causes of death for both sexes combined were: ischemic heart disease (16.3%), stroke (13.5%), diabetes (8.1%), pneumonia (5.7%) and chronic-respiratory disease (4.8%). Stroke was the top-ranked cause for females, and ischaemic heart disease the leading cause for males. The CSMFs from the VAs were similar to Global Burden of Disease (GBD) estimates. Overall, non-communicable diseases (NCDs) accounted for 73% of adult deaths; communicable, maternal and nutritional conditions 15%, and injuries 12%. Six of the ten leading causes reported for facility deaths in the Solomon Islands were also identified as leading causes of community deaths based on the VA diagnoses. Conclusions NCDs are the leading cause of adult deaths in the Solomon Islands. Automated VA methods are an effective means of generating reliable COD information for community deaths in the Solomon Islands and should be routinely incorporated into the national mortality surveillance system.

scholarly journals Biomarker levels, left ventricular dysfunction, and severity of coronary pathology in elderly patients with coronary heart disease

2012 ◽  
Vol 11 (5) ◽  
pp. 39-44
Author(s):  
L. R. Mirzakhanova ◽  
F. A. Kuliev ◽  
E. I. Shorikov
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Reactive Protein ◽  
End Diastolic Volume ◽  
Lv Dysfunction ◽  
Coronary Artery Pathology

Aim. To assess the levels of selected biomarkers and the type of left ventricular (LV) dysfunction in geriatric patients, in regard to their age, gender, and the severity of coronary artery pathology. Material and methods. In total, 135 geriatric patients with coronary heart disease (CHD) were examined. The diagnostic algorithm was based on the results of coagulogram, blood biochemistry, measurement of C-reactive protein (CRP) levels, treadmill test, echocardiography (EchoCG), coronary angiography (CA), and LV ventriculography (LVG). Results. Decreased hematocrit levels (p<0,05), increased levels of urea (p<0,05) and creatinine (p<0,05), reduced LV ejection fraction (p<0,05), increased end-diastolic volume (p<0,05), as well as restrictive type of LV dysfunction, were among age-dependent determinants of angina progression in elderly patients. The major determinant of ischemia severity was multi-vessel coronary pathology, manifested in higher angina classes, reduced exercise capacity (p<0,05), and impaired local LV contractility (p<0,05). Conclusion. To objectively assess the severity of clinical course of CHD in elderly patients, the following data should be taken into account: hematocrit and CRP levels, increased levels of creatinine and urea, and the results of EchoCG, CA, and LVG.

scholarly journals Diagnostics and treatment of congenital heart diseases in newborns

2015 ◽  
Vol 96 (4) ◽  
pp. 628-632 ◽  
Author(s):  
L M Mirolyubov ◽  
D Yu Petrushenko ◽  
J B Kalinicheva ◽  
D R Sabirova
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Medical History ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Diagnostic Algorithm ◽  
Critical Conditions ◽  
Patient Treatment ◽  
Maternity Hospitals ◽  
The Republic

Aim. Early detection and timely appropriate surgical treatment of congenital heart disease in order to reduce infant mortality. Methods. The algorithm was designed for the prediction of critical conditions in congenital heart disease in newborns. The algorithm is simple to use, because it does not set a pediatrician-neonatologist a difficult task for the accurate diagnosis of congenital heart disease, but leads physician from the syndromic diagnosis to a certain group of diseases and, therefore, appropriate strategy of patient treatment and management. The algorithm combines both syndromes and hemodynamic conditions causing them. The conditions are divided into fetal-dependent and fetal-independent, which determines the time of surgery. The questionnaire consisting of a series of questions with multiple choice answers helps the doctor to see into the symptoms and syndromes. The questions are made in a way to emphasize the certain signs, the details of medical history and disease progression to pediatricians. It is important to notice that 13 out of 20 questions are based on the medical history and clinical picture, 7 questions are based on the test results such as electrocardiography, radiography, and do not include echocardiography. Results. Since 2000, the questionnaire was implemented in the Republic of Tatarstan as a recommended diagnostic algorithm for examining newborns with congenital heart disease. Since 2003, the questionnaire and algorithm for prediction of the critical conditions was introduced by the order №867 of the Ministry of Health of the Republic of Tatarstan «On measures to improve health care in congenital heart disease in children». Remote consultations with maternity hospitals are strictly based on them. They carry a certain training load, and when doctors pronounce aloud all the items of the test, the examination algorithm gradually becomes automatic. Conclusion. During 13 years of using the proposed diagnostic algorithm for congenital heart disease with physiological rationale for palliative care and timely terms of surgery, the mortality rate from congenital heart disease in the Republic of Tatarstan has significantly dropped.

Instrumental diagnostic methods for chronic coronary heart disease

2021 ◽  
pp. 14-23
Author(s):  
S. Yu. Bartosh-Zelenaya
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Invasive Coronary Angiography ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Coronary Syndrome ◽  
Chronic Coronary Heart Disease ◽  
Electrocardiogram Monitoring ◽  
Instrumental Methods ◽  
Test Probability

The review provides modern insights into methods for identifying a variety of scenarios that are currently classified as chronic coronary syndrome and involve different risks for subsequent cardiovascular events. The assessment of pre-test probability and determinants that enhance and reduce the possibility of diagnosing coronary heart disease are considered. The necessity and sequence of application of both simple instrumental methods of diagnostics of chronic coronary disease (electrocardiography, ambulatory electrocardiogram monitoring, exercise electrocardiogram, echocardiography) and more complex ones requiring specially trained personnel and modern equipment (stress echocardiography, computed tomography and invasive coronary angiography) are discussed. The recommended modern diagnostic algorithm in symptomatic patients with suspected coronary heart disease is presented.

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