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Echocardiography Use in Pediatric Heart Patients

Echocardiography Use in Pediatric Heart Patients

With the rapid advance-ment of cardiovascular imaging technologies, it is important for physicians to understand how best to incorporate these options into clinical care and how to choose between imaging modalities. Recently, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and other expert societies released the first appropriate use criteria (AUC) for suspected heart disease in pediatric patients. The AUC document specifically addressed the use of initial transthoracic echocardiography in outpatient pediatric cardiology. “The purpose of the new criteria is to improve patient care and outcomes in a cost-effective manner as well as enhance quality within practices,” explains David G. Nykanen, MD, FACC, FRCPC, FSCAI, who was a member of the AUC technical panel that developed the document. “We wanted to give clinicians a roadmap to follow when determining whether or not it was appropriate to use echocardiograms in this complex patient population.” Echocardiography: Judicious Use For the AUC document, experts identified 113 indications for outpatient pediatric echocardiography based on common clinical scenarios and/or clinical practice guidelines. Each indication was then rated for echocardiographic assessment as “appropriate,” “may be appropriate,” or “rarely appropriate.” Dr. Nykanen says the AUC document can familiarize pediatricians and pediatric cardiologists on when echocardiography may help elucidate a diagnosis and when other diagnostic pathways may be more useful. “Echocardiograms are expensive diagnostic tests,” he says. “We need to be judicious with how and why we order these tests.” The writing committee offered assistance for determining the reasonable role of initial transthoracic echocardiography when evaluating pediatric patients in outpatient settings, and tackled various aspects for consideration. “For example,” says Dr. Nykanen, “we...
Women & IHD: Coming to a Consensus

Women & IHD: Coming to a Consensus

In recent decades, physicians have used the male model of testing to identify coronary artery disease (CAD) in women, but studies show that there are gender-specific differences in the pathophysiology of coronary atherosclerosis. “These differences are multifactorial and include obstructive and non-obstructive CAD as well as dysfunction of the coronary microvasculature and endothelium,” explains Jennifer H. Mieres, MD, FACC, FASNC, FAHA. “As such, the term ischemic heart disease (IHD) best describes the varied pathophysiology in women. Women with IHD are at increased risk for coronary events.” Using the male model approach has led to under-diagnosis and under-treatment of IHD for women, which in turn has led to higher case fatality rates and greater morbidity. More recently, efforts have been made to ensure gender equality in the quantity and quality of research by better representing women in clinical trials and registries. These efforts were made to optimize management strategies for women with suspected and known IHD. A New Consensus on Coronary Artery Disease in Women In 2005, the American Heart Association (AHA) published a consensus statement on the use of CAD imaging for evaluating symptomatic women with suspected myocardial ischemia. Since that time, many reports have provided additional high-quality evidence, including data on coronary CT angiography (CCTA) and cardiac MRI (CMR). In 2014, the AHA updated this statement and published it in Circulation. The update provides sex-specific data on the diagnostic and prognostic accuracy for exercise treadmill testing (ETT) with electrocardiography, stress echocardiography, stress myocardial perfusion imaging (MPI) with single-photon emission CT or positron emission tomography, stress CMR, and CCTA. “In the past, clinicians didn’t recognize the importance of non-obstructive...

Social Media Tips for Doctors

Recently, I was asked for personal advice on using Twitter. There are many articles out there that say we (physicians) don’t know how to properly use social media. Social media can be a very powerful tool in medicine. It can not only help us get medical information out there to our patients, but it can also help us connect with people, colleagues, and organizations to give us more visibility—whether for career advancement, media contacts, or just to get our voices heard. Social Media Basics: These are some of the tips I have come up with for doctors who want to take advantage of the many opportunities social media can offer: 1. Never communicate to patients through social media outlets. It is a set up for disaster and HIPAA violations. 2. Social media can be used for educating patients. Patients can follow you on these pages to get information about your practice and whatever medical information you wish to share. Twitter… 3.  Twitter is useful for growing your professional connections. It can be leveraged so you get known and also connect with other doctors, healthcare information technology people, media, etc. Patients can follow you on Twitter, but it generally is not a useful method of providing patient information because tweets are limited to 140 characters. 4. Choose your followers carefully. Block those who spam or troll you (“trolls” are people who negatively post with the deliberate intent of provoking a reaction). Many people will try to sell you things. Monitor your account because it is not uncommon for it to be hacked. 5. Grow your network. Have a group that...
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