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| ===Clinical Clues to the Diagnosis of RAS===
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| {{familytree | | | | | | | | | | A01 | |A01=''' Determine if one or more of the following is present:''' <br> <div style="float: left; text-align: left ; height: 20.5em; width: 25em; padding:1em;"> ❑ Onset of hypertension before the age of 30 years or severe hypertension after the age of 55<br> ❑ Accelerated, resistant, or [[ malignant hypertension]]<br> ❑ Development of new [[azotemia]] or worsening renal function after administration of an [[ ACE inhibitor]] or [[ARB]] agent<br> ❑ Unexplained [[atrophic kidney]] or size discrepancy between kidneys >1.5 cm<br> ❑ Sudden, unexplained pulmonary edema<br> ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy<br>❑ Multi- vessel [[ CAD]]<br> ❑ Unexplained [[ CHF]]<br> ❑ Refractory [[angina]] </div>}} | | {{familytree | | | | | | | A01 | | | | | | | | A01=''' High risk criteria:''' <br><div style="float: left; text-align: left;"> ❑ Severe structural or [[ CAD]]<br>❑ Clinical or [[ ECG]] features suggesting arrhythmic syncope: <br> -syncope during exertion or supine <br> -palpitations at the time of syncope <br> - family history of[[ SCD]] <br> -non- sustained [[ VT]] <br> - conduction abnormalities with QRS > 120 ms <br> - [[sinus bradycardia]] <br> - pre- exited QRS complex <br> - prolonged or short QR interval <br> - brugada pattern <br> -[[ ARVC]] < br> ❑ Important comorbidities: < br> - Severe anemia < br> - Electrolyte intolerance </div> }} |
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| {{familytree | | | | B01 | | | | | | | | B02 | B01='''If yes:''' <br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with non-invasive imaging<br> </div>| B02= '''If no:'''<br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with invasive renal arteriography </div>}}
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| {{familytree | | | | C01 | | | | | | | | |!| | C01=<div style="height: 1em; width: 15em; padding:1em;">'''Is patient allergic to contrast'''</div>}}
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| {{familytree | | D01 | | D02 | | | | | | D03 | D01= '''If yes:'''<br> <div style=height: 1em; width: 10em; padding:1em;">❑ Proceed with US<br></div>| D02= '''If no check for:''' <br><div style=float: left; text-align: left; height: 16em; width: 10em; padding:1em;"> ❑ Implanted devices:<br>
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| - Pacemakers<br> | |
| - Defibrillators<br> | |
| - Cochlear implants<br> | |
| - Spinal cord stimulators <br> | |
| ❑ Claustrophobic patient </div>| D03= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral[[angiography]]</div>}}
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| {{familytree | | |!| E01 | | E02 | | | | |!| | | | E01=<div style="height: 3em; width: 10em; padding:1em;">If none of the above proceed with [[MRA]]
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| </div>| E02= <div style="height: 3em; width: 13em; padding:1em;">If yes to any of the above, proceed with [[CT]]</div>}} | |
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| {{familytree | | | F01 | | F02 | | | | | F03 | F01= <div style="height: 5em; width: 10em;">Negative noninvasive test but with high clinical suspicion </div>| F02= <div style="height: 3em; width: 10em;">Evidence of RAS </div>| F03= <div style="height: 3em; width: 10em;">Evidence of RAS </div>}}
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| {{familytree | | | G01 | | |!| | | | | | |!| G01= <div style="height: 2em; width: 10em; padding:1em;">'''Go to invasive imaging'''</div>}}
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| {{familytree | | | | | | | |`|-|-| H01 |-|'| H01= <div style="height: 7.5em; width: 10em; padding:1em;">'''Confirmed RAS:'''
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| ❑Proceed to medical therapy
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| ❑Consider revascularization</div>}}
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| {{familytree/end}} | | {{familytree/end}} |