Trace mitral, tricuspid, and pulmonic regurgitation can be detected in 70% to 90% of normal individuals and has no adverse clinical implications.
STD AXIS HISTORY FORUM SERIAL
Repeat imaging to address the same question, when no pathology has been previously found and there has been no clinical change in the patient’s condition, is not indicated.ĭon’t order follow-up or serial echocardiograms for surveillance after a finding of trace valvular regurgitation on an initial echocardiogram. There is very little information on using stress echocardiography in asymptomatic individuals for the purposes of cardiovascular risk assessment, as a stand-alone test or in addition to conventional risk factors.ĭon’t repeat echocardiograms in stable, asymptomatic patients with a murmur/click, where a previous exam revealed no significant pathology. Stress echocardiography is mostly used in symptomatic patients to assist in the diagnosis of obstructive coronary artery disease. Society of Cardiovascular Computed Tomographyĭon’t routinely order coronary CT angiography for screening asymptomatic individuals.Ĭoronary CT angiography findings of coronary artery disease stenosis severity rarely offer incremental discrimination over coronary artery calcium scoring in asymptomatic individuals.ĭon’t use coronary artery calcium scoring for patients with known coronary artery disease (CAD) (including stents and bypass grafts).Ĭoronary artery calcium scoring is used for evaluation of individuals without known CAD and offers limited incremental prognostic value for individuals with known CAD, such as those with stents and bypass grafts.Īvoid using stress echocardiograms on asymptomatic patients who meet "low-risk" scoring criteria for coronary disease. Net reclassification of risk by coronary artery calcium scoring, when added to clinical risk scoring, is least effective in low-risk individuals. Potential harms of routine annual screening exceed the potential benefit.ĭon’t perform stress cardiac imaging or advanced noninvasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.Īsymptomatic, low-risk patients account for up to 45% of unnecessary “screening.” Testing should be performed only when the following findings are present: diabetes in patients older than 40 years peripheral arterial disease or greater than 2% yearly risk of coronary heart disease events.ĭon’t order coronary artery calcium scoring for screening purposes on low-risk asymptomatic individuals except for those with a family history of premature coronary artery disease. False-positive test results are likely to lead to harm through unnecessary invasive procedures, overtreatment, and misdiagnosis. There is little evidence that detection of coronary artery stenosis improves health outcomes in asymptomatic patients at low risk of coronary heart disease. American Academy of Allergy, Asthma and Immunology guidelinesĭon’t order annual electrocardiography or any other cardiac screening for asymptomatic, low-risk patients.Skin or serum-specific IgE testing for inhalants or foods is not indicated, unless there is a clear history implicating an allergen as a provoking or perpetuating factor for urticaria.Īmerican Academy of Allergy, Asthma and Immunology Routine extensive testing is neither cost-effective nor associated with improved clinical outcomes. Targeted laboratory testing based on clinical suspicion is appropriate. Limited laboratory testing may be warranted to exclude underlying causes. In the overwhelming majority of patients with chronic urticaria, a definite etiology is not identified. To see supporting references, click on the Recommendation.ĭon’t routinely do diagnostic testing in patients with chronic urticaria.
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