Eisenmenger’s syndrome diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Template:Eisenmenger's syndrome}}
{{Template:Eisenmenger's syndrome}}
{{CMG}}; {{AE}}
{{CMG}}'''; Associate Editor(s)-In-Chief:''' {{AIA}}, [[Priyamvada Singh|Priyamavada Singh, MBBS]] [mailto:psingh13579@gmail.com], [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
== Overview ==


== Diagnostic Study of Choice ==
==Overview==


=== Study of choice ===
==2018 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)<ref name="pmid30586767">Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM et al. (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=30586767 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.] ''Circulation'' 139 (14):e698-e800. [http://dx.doi.org/10.1161/CIR.0000000000000603 DOI:10.1161/CIR.0000000000000603] PMID: [https://pubmed.gov/30586767 30586767]</ref>==
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Care of adult patients with [[CHD]]-related PAH should be performed in centers that have shared expertise and training in both ACHD and [[PAH]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


OR
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' The evaluation of all ACHD patients with suspected PAH should include [[noninvasive]] assessment of [[cardiovascular]] [[anatomy]] and potential [[shunting]], as detailed below:<nowiki>"</nowiki>


The following result of [gold standard test] is confirmatory of [disease name]:
|-
* [Result 1]
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' [[Pulse oximetry]], with and without administration of supplemental oxygen, as appropriate. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
* [Result 2]


OR
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' [[Chest x-ray]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


[Name of the investigation] must be performed when:
|-
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''c.''' [[ECG]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


OR
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''d.''' Diagnostic cardiovascular imaging via [[TTE]], [[TEE]], [[MRI]], or [[CT]] as appropriate. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''e.''' [[Complete blood count]] and [[nuclear]] lung [[scintigraphy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


OR
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' If PAH is identified but its causes are not fully recognized, additional testing should include the following:<nowiki>"</nowiki>


The diagnostic study of choice for [disease name] is [name of the investigation].
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' [[Pulmonary function test]]s with volumes and [[diffusion capacity]] (diffusing capacity of the lung for [[carbon monoxide]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


OR
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' [[Pulmonary embolism]]-protocol [[CT]] with parenchymal lung windows. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


There is no single diagnostic study of choice for the diagnosis of [disease name].
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''c.''' Additional testing as appropriate to rule out contributing causes of PAH. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>


OR
|-
 
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''d.''' [[Cardiac catheterization]] at least once, with potential for [[vasodilator]] testing or anatomic intervention, at a center with expertise in catheterization, PAH, and management of CHD-PAH. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
|}
 
OR


[Disease name] is primarily diagnosed based on the clinical presentation.
{| class="wikitable"
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable to include a 6-minute walk test or similar nonmaximal cardiopulmonary [[exercise test]] as part of the functional assessment of patients with [[CHD]]-[[PAH]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>


===== Diagnostic results =====
==References==
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
{{reflist|2}}
* [Finding 1]
* [Finding 2]


===== Sequence of Diagnostic Studies =====
[[Category:Cardiology]]
The [name of investigation] must be performed when:
[[Category:Congenital heart disease]]
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
[[Category:Pediatrics]]
* A positive [test] is detected in the patient, to confirm the diagnosis.
[[Category:Disease]]
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].
 
==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Latest revision as of 05:20, 27 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Abdelrahman Ibrahim Abushouk, MD[2], Priyamavada Singh, MBBS [3], Kristin Feeney, B.S. [4]

Overview

2018 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[1]

Class I
"1. Care of adult patients with CHD-related PAH should be performed in centers that have shared expertise and training in both ACHD and PAH. (Level of Evidence: C)"
"2. The evaluation of all ACHD patients with suspected PAH should include noninvasive assessment of cardiovascular anatomy and potential shunting, as detailed below:"
"a. Pulse oximetry, with and without administration of supplemental oxygen, as appropriate. (Level of Evidence: C)"
"b. Chest x-ray. (Level of Evidence: C)"
"c. ECG. (Level of Evidence: C)"
"d. Diagnostic cardiovascular imaging via TTE, TEE, MRI, or CT as appropriate. (Level of Evidence: C)"
"e. Complete blood count and nuclear lung scintigraphy. (Level of Evidence: C)"
"3. If PAH is identified but its causes are not fully recognized, additional testing should include the following:"
"a. Pulmonary function tests with volumes and diffusion capacity (diffusing capacity of the lung for carbon monoxide). (Level of Evidence: C)"
"b. Pulmonary embolism-protocol CT with parenchymal lung windows. (Level of Evidence: C)"
"c. Additional testing as appropriate to rule out contributing causes of PAH. (Level of Evidence: C)"
"d. Cardiac catheterization at least once, with potential for vasodilator testing or anatomic intervention, at a center with expertise in catheterization, PAH, and management of CHD-PAH. (Level of Evidence: C)"
Class IIa
"1. It is reasonable to include a 6-minute walk test or similar nonmaximal cardiopulmonary exercise test as part of the functional assessment of patients with CHD-PAH. (Level of Evidence: C)"

References

  1. ↑ Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM et al. (2019) 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 139 (14):e698-e800. DOI:10.1161/CIR.0000000000000603 PMID: 30586767
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