RM-3A Clinical Diagnosis Reference Guide RM-3A Cardiovascular and ANS Medical Device
|
|
- Moses Poole
- 5 years ago
- Views:
Transcription
1 RM-3A Clinical Diagnosis Reference Guide RM-3A Cardiovascular and ANS Medical Device The RM-3A medical device is a powerful analytical tool in managing your patients health. Scientifically validated and FDA cleared, this medical device performs a range of tests covered and reimbursed by most insurance companies. This system is fast, non-invasive and takes less than 5 minutes to complete an assessment. The one-page Physician Dashboard provides a comprehensive overview of a patient s health at-a-glance. The analytical system provides patient insights covering 8 key risk factors that are described in the pages that follow. Depending on the risk score for each factor, you will be able to determine the best course of action to resolve the patient s condition as well as motivate your patient to immediate action. 8 RISK FACTORS: AUTONOMIC NERVOUS SYSTEM DYSFUNCTION SUDOMOTOR DYSFUNCTION ENDOTHELIAL DYSFUNCTION INSULIN RESISTANCE CARDIOMETABOLIC RISK SMALL FIBER NEUROPATHY CARDIAC AUTONOMIC NEUROPATHY CARDIOVASCULAR DISEASE VIA PLETHYSMOGRAPHY RM-3A Clinical Diagnosis Reference Guide Page 1
2 8 Risk Factors How the RM- 3A helps you better assess and manage your patient s cardiovascular and autonomic nervous system health. 1 ANSD: AUTONOMIC NERVOUS SYSTEM DYSFUNCTION RISK Problems with the ANS can range from mild to life threatening. Sometimes only one part of the nervous system is affected. In other cases, the entire ANS is affected. Some conditions are temporary and can be reversed, while others are chronic and will continue to worsen over time. Diseases such as Diabetes or Parkinson s disease can cause irregularities with the ANS. Problems with ANS regulation often involve organ failure, or the failure of the nerves to transmit a necessary signal. 2 SudoD: SUDOMOTOR DYSFUNCTION RISK Sudomotor dysfunction testing may indicate to physicians of a patient s peripheral nerve and cardiac sympathetic dysfunction. Neuropathy is a common complication in diabetes mellitus (DM), with 60% 70% of patients affected over lifetime. Symptoms of neuropathy are very common, and sub-clinical neuropathy is more common than clinical neuropathy. Neuropathy may remain undetected, and progress over time leading to serious complications. The most common associated clinical condition is peripheral neuropathy, affecting the feet. Autonomic nerve involvement is common but probably the most undiagnosed. Low scores in the sudomotor may lead a medical provider to look at clinical neuropathy. 3 EndoD: ENDOTHELIAL DYSFUNCTION RISK Current evidence suggests that endothelial function is an integrative marker of the net effects of damage from traditional and emerging risk factors on the arterial wall and its intrinsic capacity for repair. Endothelial dysfunction, detected as the presence of reduced vasodilating response to endothelial stimuli, has been observed to be associated with major cardiovascular risk factors, such as aging, hyperhomocysteinemia, post menopause state, smoking, diabetes, hypercholesterolemia, and hypertension. 4 IR: INSULIN RESISTANCE RISK Insulin resistance is defined clinically as the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization in an individual as much as it does in a normal population. Insulin resistance occurs as part of a cluster of cardiovascular metabolic abnormalities commonly referred to as The Insulin Resistance Syndrome or The Metabolic Syndrome. This cluster of abnormalities may lead to the development of type 2 diabetes, accelerated atherosclerosis, hypertension or polycystic ovarian syndrome depending on the genetic background of the individual developing the insulin resistance. 5 CMR: CARDIOMETABOLIC RISK The specific factors that can cause this increased risk include: obesity (particularly central), hyperglycemia, hypertension, insulin resistance and dyslipoproteinemia. When patients have one or more risk factors and are physically inactive or smoke, the cardiometabolic risk is increased even more. Medical conditions that often share the above characteristics, such as type 2 diabetes, can also increase card iometabolic risk. The primary focus of cardiometabolic risk treatment is management of each high risk factor, including dyslipoproteinemia, hypertension, and diabetes. The management of these subjects is based principally on lifestyle measures, but various anti hypertensive, lipid- lowering, insulin sensitizing, anti- obesity and antiplatelet drugs could be helpful in reducing cardiometabolic risk. 6 SFN: SMALL FIBER NEUROPATHY RISK A small fiber neuropathy occurs when damage to the peripheral nerves predominantly or entirely affects the small myelinated fibers or unmyelinated C fibers. The specific fiber types involved in this process include both small somatic and autonomic fibers. The sensory functions of these fibers include thermal perception and nociception. These fibers are involved in many autonomic and enteric functions. 7 CAN: CARDIAC AUTONOMIC NEUROPATHY RISK High blood glucose levels over a period of years may cause a condition called autonomic neuropathy. This is damage to the nerves that control the regulation of involuntary function. When the nerve damage affects the heart, it is called cardiac autonomic neuropathy (CAN). CAN encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control, vascular dynamics and the body s ability to adjust blood pressure. CAN is a significant cause of morbidity and mortality associated with a high risk of cardiac arrhythmias and sudden death. 8 PTG CVD: PLETHYSMOGRAPHY CARDIOVASCULAR DISEASE RISK The PTG CVD risk factor is the combined total of the other seven risk factors assessments. It takes into consideration the cardiovascular, as well as, the autonomic nervous system (ANS) measurements. RM-3A Clinical Diagnosis Reference Guide Page 2
3 RM-3A DASHBOARD A Review of the 8 Key Risk Factors (Bar Graphs) Please note: The information contained within this document is designed as a guide to help the qualified Medical Provider (MD, DO, PA, NP or APN) identify levels of risk for possible health issues contained herein. These potential health issues are only a small representation of some of the potential issues that a particular patient may or may not have. Only a qualified Medical Provider (MD, DO, PA, NP or APN) may utilize this analytical data to diagnose and provide specific treatment regimens for any health issue. Renua Medical, any of its employees, agents and/or other affiliates does not claim to diagnose or to suggest in any way that any Medical Provider (MD, DO, PA, NP or APN) follow these examples for diagnosing a patient, unless the Medical Provider (MD, DO, PA, NP or APN) determines on his/her own behalf that any of these said health issues may or may not exist for each patient. This reference guide lists other additional testing that a Medical Provider (MD, DO, PA, NP or APN) might opt to have done for a patient. However, Renua Medical does not in any way claim that these tests are the only tests available, are applicable for all patients, are necessary, or should ever be run at all. All decisions on testing and diagnose remain the responsibility of a qualified Medical Provider (MD, DO, PA, NP or APN). RISK FACTOR NOTE: Be advised that indicator levels for interpretation of either normal or elevated are as follows: Green = Normal Range Yellow = Elevated Orange = Abnormal RM-3A Clinical Diagnosis Reference Guide Page 3
4 Autonomic Nervous System Dysfunction (ANSD) See 1st Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary The autonomic nervous system (ANS) controls several basic bodily functions. These include heart rate, body temperature, breathing rate, digestion, and many other systems. You don t have to consciously think about these systems in order for them to work. The ANS provides the connection between your brain and your internal organs. For instance, it connects to the heart, liver, sweat glands, and even the interior muscles of your eye. The ANS is made up of two subsystems: the sympathetic autonomic nervous system (SANS) and the parasympathetic autonomic nervous system (PANS). Most organs have nerves from both the sympathetic and parasympathetic systems. The SANS usually stimulates organs. For instance, it increases heart rate and blood pressure when necessary. The PANS, on the other hand usually slows down bodily processes. For example, it reduces heart rate and blood pressure. There are certainly exceptions. Digestion and urination, for instance are stimulated by the PANS and slowed by the SANS. The general responsibility of the SANS is to trigger emergency responses when required. These fight or flight responses get you ready to respond to stressful situations. The PANS, on the other hand, conserves your energy and restores tissues for ordinary functions. Problems with the ANS can range from mild to life threatening. Sometimes only one part of the nervous system is affected. In other cases, the entire ANS is affected. Some conditions are temporary and can be reversed, while others are chronic and will continue to worsen over time. Diseases such as diabetes or Parkinson s disease can cause irregularities with the ANS. Problems with ANS regulation often involve organ failure, or the failure of the nerves to transmit a necessary signal. Your autonomic nervous system is the part of your nervous system that controls involuntary actions, such as the beating of your heart and the widening or narrowing of your blood vessels. When something goes wrong in this system, it can cause serious problems, including blood pressure problems, heart problems, and trouble with breathing and swallowing, and erectile dysfunction in men. Autonomic nervous system disorders can occur alone or as the result of another disease, such as Parkinson s disease, alcoholism and diabetes. Problems can affect either part of the system, as in complex regional pain syndromes or all of the system. Some types are temporary, but many worsen over time. When they affect your breathing or heart function, these disorders can be life-threatening. Patients with ANS disorder often receive complete physical skin exam performed (ml), hemoglobin A1C measurement, other diagnostic procedures (interview; evaluation; consultation), lipid panel, ultrasonography, wound-care management, physical therapy exercises and echocardiography. Blurred Vision Elevated Blood Sugar Extreme Thirst Fatigue Frequent Urination Heartburn Increased Hunger Nausea Numbness & Tingling in Hands or Feet Vomiting Possible Condition(s) Diabetes Cardiovascular Disease (CVD) Metabolic Disorders Refers to the graphs on Page 3 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). PTGTP Helps identify the risk of insulin resistance and therefore prediabetes, as well as, possible heart disease and metabolic disorders. High number may be associated with fatty liver and atherosclerosis. Possibly the need to modify diet and increase exercise. STRESS 1 Correlated to C reactive Protein is a marker for sympathetic failure. High numbers indicate a risk for heart disease. PTGVLFi This is a marker for impaired glucose testing (IGT) and Microcirculation complications. High numbers indicate a risk of diabetes. PTG R Provides 3 homeostatic markers (see Full Physician s Report Summary page 6). The sum of the amplitudes of all peaks is the PTG index. This is used to evaluate CVD; A score of 0 = normal, 1 = borderline and 2 = abnormal. Additional Testing (At Physician s discretion) Hemoglobin A1C Lipid Profile Complete Blood Count Cardio Vascular Disease Insulin Resistance CMP (Complete Metabolic Profile) Ultrasound RM-3A Clinical Diagnosis Reference Guide Page 4
5 Sudomotor Dysfunction (SudoD) See 2nd Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary The Sudomotor Dysfunction is a common feature of diabetic autonomic neuropathy. This generally manifests as anhidrosis of the extremities, which may be accompanied by hyperhidrosis in the trunk. Initially, patients display a loss of thermoregulatory sweating in a glove and stocking distribution that, with progression of autonomic neuropathy, extends from the lower to the upper extremities and to the anterior abdomen, conforming to the length dependency of diabetic neuropathy. This process ultimately may result in global anhidrosis. Hyperhidrosis may also accompany diabetic autonomic neuropathy. Excessive sweating may occur as a compensatory phenomenon involving proximal regions such as the head and trunk that are spared in a dying-back neuropathy. Gustatory sweating is the abnormal production of sweat that appears over the face, head, neck, shoulders, and chest after eating (even non-spicy foods). Lower ESR is suggestive of sudomotor dysfunction. Lower ESR at feet is significantly associated both with increasing symptoms (MNSI A) and increasing score on physical abnormalities (MNSI B). Lower ESR at feet was also significantly associated with increasing VPT by biothesiometry (P < ), and with higher number of abnormal CAN results (P < ). ESR was associated with postural fall in blood pressure (sympathetic abnormality) (P < ), but not with heart rate variability (HRV) tests (parasympathetic abnormalities). The Sudomotor dysfunction testing may indicate to physicians of a patients peripheral nerve and cardiac sympathetic dysfunction, Neuropathy is a common complication in diabetes mellitus (DM), with 60% 70% of patients affected over lifetime. Symptoms of neuropathy are very common, and sub-clinical neuropathy is more common than clinical neuropathy. Neuropathy may remain undetected, and progress over time leading to serious complications. The most common clinical affection is peripheral neuropathy, affecting the feet. Autonomic nerve involvement is common but probably the most undiagnosed. Low scores in the sudomotor may lead one to look at clinical neuropathy. Some of the autonomic neuropathies are amenable to treatment of the underlying disease. For example, early detection and treatment of the underlying cancer is the primary treatment for paraneoplastic autonomic neuropathy. In other cases, drug treatment is required. Some patients with autoimmune autonomic neuropathy have been found to be responsive to intravenous gammaglobulin (Heafield et al 1996; Smit et al 1997). Occasionally, multiple therapies may be required; there is evidence that patients may respond with combined therapy even if they had not responded with either treatment]. Burning Sensation Difficulty Digesting Food Dizziness or Fainting Exercise Intolerance Possible Microcirculation Issues Sexual Difficulties Sluggish Pupil Reaction Sweat Abnormalities Tingling Hands and Feet Urinary Problems Possible Condition(s) Diabetes Cardiovascular Disease Peripheral & Distal Neuropathies Refers to the graphs on Page 7 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). ESRNO Is a marker of electrical skin response to nitric oxide (NO) production and vasodilation. This marker reflects microcirculation blood flow. Decreased ESR NO indicates microcirculation. A low number indicates signs of poor micro vascularization and increased risk of distal neuropathy. ESRL Is a marker of sweat gland nerve density. This marker reflects post sympathetic nerve density. The peak reflects C-fiber density. A low number is an early detection of Peripheral distal neuropathy. Peak C Is a marker of sweat gland function and reflects maximum number of water and chlorine released on the electrode plate after stimulation. Decreased Peak C is either due to nerve damage or hypohidrosis (low sweat). An abnormal number (high or low) can be attributed to hyperhidrosis. (Excessive Sweat): A low number found with nerve damage. Additional Testing (At Physician s discretion) Breathing Test Gastrointestinal testing (Gastric emptying) QSART Urodynamic testing (Bladder/ Urinary Tract) Ultrasound RM-3A Clinical Diagnosis Reference Guide Page 5
6 Endothelial Dysfunction (EndoD) See 3rd Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary In vascular diseases, endothelial dysfunction is a systemic pathological state of the endothelium (the inner lining of blood vessels) and can be broadly defined as an imbalance between vasodilating and vasoconstricting substances produced by (or acting on) the endothelium. Current evidence suggests that endothelial function is an integrative marker of the net effects of damage from traditional and emerging risk factors on the arterial wall and its intrinsic capacity for repair. This endothelial-dependent vascular biology is critical, not only in the initiation and progression of atherosclerosis, but also in the transition from a stable to an unstable disease state with attendant risks. As a result, study of endothelial function in clinical research has emerged as an important end point that complements measurement of circulating risk factors, imaging techniques for structural arterial diseases burden (such as carotid intima media thickness, intravascular ultrasound, computed tomography), and traditional cardiovascular clinical outcomes. Endothelial dysfunction, detected as the presence of reduced vasodilating response to endothelial stimuli, has been observed to be associated with major cardiovascular risk factors, such as aging, hyperhomocysteinemia, post menopause state, smoking, diabetes, hypercholesterolemia, and hypertension. Endothelial dysfunction responds favorably to a healthful diet and exercise. Exercising to maintain a healthy weight decreases a person s risk of developing certain diseases, including type 2 diabetes and high blood pressure. Aerobic Exercise: The heart is a muscle and needs a good workout. Aerobic exercise gets the heart pumping and quickens breathing, resulting in a more efficient delivery of oxygen-carrying blood cells. Strength and flexibility training are of benefit too. Pharmacologic interventions may include: ACE inhibitors used for treating high blood pressure and heart failure Nitrate therapy Lipid-lowering pharmaceuticals used for managing blood cholesterol levels Alpha-beta blockers for blood pressure management Novel therapies that include ranolazine, aminophylline and experimental therapies. External counter pulsation (ECP) therapy is another treatment option. Lying on a table or bed, pressure cuffs are fitted to the patient s thighs, hips and calves. The cuffs inflate and deflate in sync with the patient s heart rhythm, supplying the heart with extra oxygen-rich blood in the resting phase. The extra blood supply stimulates growth of the surrounding blood vessels, improving the supply of blood to the heart. Angina Cardiovascular Disease Chest Pain that Goes Away with Rest Heartburn Pain in Calves Stroke TIA Possible Condition(s) Endothelial Dysfunction (ANS Biomarker of Atherosclerosis) Refers to the graphs and charts on Page 6 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). PTGTP This marker helps identify risk of insulin resistance and therefore pre-diabetes as well as possible heart disease and metabolic disorders, high number may be associated with fatty liver and atherosclerosis. Possibly need to modify diet and increase exercise. PTG R This analysis provides 3 homeostatic markers. The sum of the amplitudes of all peaks is the PTG index. This is used to evaluate PTG CVD score. 0 = normal, 1 = borderline and 2 = abnormal to calculate CVD possibilities. PTGVLFi A marker for impaired glucose testing (IGT) and microcirculation complications. High numbers indicate a risk of diabetes. RI (REFLECTION INDEX) Small and medium arterial stiffness. Marker for atherosclerosis SDda This is an indicator that correlates with angiotensin system level activity. High numbers are associated with increased angiotensin activity. Additional Testing (At Physician s discretion): C-reactive protein (CRP) Stress Test Ultrasound Angiograph RM-3A Clinical Diagnosis Reference Guide Page 6
7 Insulin Resistance (IR) See 4th Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary IR is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Insulin resistance typically develops with obesity and heralds the onset of type 2 diabetes. It is as if insulin is knocking on the door of muscle. The muscle hears the knock, opens up, and lets glucose in. But with insulin resistance, the muscle cannot hear the knocking of the insulin (the muscle is resistant ). The pancreas makes more insulin, which increases insulin levels in the blood and causes a louder knock. Eventually, the pancreas produces far more insulin than normal and the muscles continue to be resistant to the knock. As long as one can produce enough insulin to overcome this resistance, blood glucose levels remain normal. Once the pancreas is no longer able to keep up, blood glucose starts to rise, initially after meals, eventually even in the fasting state. Type 2 diabetes is now overt. Insulin resistance is defined clinically as the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization in an individual as much as it does in a normal population. Insulin action is the consequence of insulin binding to its plasma membrane receptor and is transmitted through the cell by a series of protein-protein interactions. Two major cascades of protein-protein interactions mediate intracellular insulin action: one pathway is involved in regulating intermediary metabolism and the other plays a role in controlling growth processes and mitoses. The regulation of these two distinct pathways can be dissociated. Several mechanisms have been proposed as possible causes underlying the development of insulin resistance and the insulin resistance syndrome. These include: (1) genetic abnormalities of one or more proteins of the insulin action cascade (2) fetal malnutrition (3) increases in visceral adiposity. Insulin resistance occurs as part of a cluster of cardiovascular-metabolic abnormalities commonly referred to as The Insulin Resistance Syndrome or The Metabolic Syndrome. This cluster of abnormalities may lead to the development of type 2 diabetes, accelerated atherosclerosis, hypertension or polycystic ovarian syndrome depending on the genetic background of the individual developing the insulin resistance. In addition to the A1C test, other blood tests can check your blood glucose levels. A fasting blood glucose test repeat if needed after first test. Certain foods can help a patient to lose weight and even manage their blood sugar. For instance, vegetables are low in calories and carbohydrates, making them an ideal food for people who are trying to manage their blood sugar and lose weight. Skip whole milk and full-fat yogurts since insulin resistance can worsen when you consume foods high in saturated fat Exercise can help prevent diabetes by lowering blood sugar and reducing weight. It also helps the cells become more sensitive to insulin. There are no symptoms that can tell a patient insulin resistance is present by the way he/she feels. Likewise, a patient won t know if he/she has most of the other conditions that are a part of insulin resistance syndrome (high blood pressure, low good cholesterol levels and high triglycerides). That said, the following symptoms could potentially be flags to check further for Insulin Resistance: Blurred Vision Elevated Blood Sugar Extreme Thirst Fatigue Increased Hunger Refers to the graphs on Page 1 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). IR (INSULIN RESISTANCE) High numbers indicate need of weight management, optimization /diet modification, increase risk of heart and metabolic disease. Additional Testing (At Physician s discretion) A1C Blood Glucose Testing Ultimately, patient must see a doctor for an evaluation to determine if IR is a possible diagnosis. Possible Condition(s) Insulin Resistance RM-3A Clinical Diagnosis Reference Guide Page 7
8 Cardiometabolic Risk (CMR) See 5th Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary Cardiometabolic Risk refers to a condition in which the possibilities of developing atherosclerotic cardiovascular (CV) disease and diabetes mellitus are significantly enhanced as a consequence of the presence of insulin resistance and atherogenic dyslipidemia, the latter being characterized by the presence of low high-density lipoprotein (HDL)- cholesterol and high triglyceride levels. CMR is particularly prevalent in the hypertensive populations and those patients diagnosed as having metabolic syndrome. The specific factors that can cause this increased risk include: obesity (particularly central), hyperglycemia, hypertension, insulin resistance and dyslipoproteinemia. When patients have one or more risk factors and are physically inactive or smoke, the cardiometabolic risk is increased even more. In addition, when these risk factors occur in clusters, they can greatly increase the risk of CVD. Medical conditions that often share the above characteristics, such as type 2 diabetes, can also increase cardiometabolic risk. As such, the term can be used to persons already diagnosed with chronic disease. The primary focus of cardiometabolic risk treatment is management of each high risk factor, including dyslipoproteinemia, hypertension, and diabetes. The management of these subjects is based principally on lifestyle measures, but various antihypertensive, lipid-lowering, insulin sensitising, anti-obesity and antiplatelet drugs could be helpful in reducing cardiometabolic risk. Lifestyle modifications may counteract the effect of the underlying risk factors. Moreover, hypertensives also require a tight BP control, a choice of antihypertensive treatment not producing other metabolic disturbances, and, quite often, parallel drug treatment for associated metabolic risk factors (dyslipidemia, insulin resistance, and prothrombotic and proinflammatory states). In addition, a diet rich in fruits, vegetables & low-fat dairy products (DASH diet) substantially lower BP in comparison to the standard American diet. A key feature of metabolic syndrome that explains the increased cardiometabolic risk is an enhanced prothrombotic state, especially in the presence of insulin resistance. Postprandial hyperglycemia, increased free fatty acids and elevated triglyceride levels may all have adverse effects on platelets, coagulation and fibrinolysis. Pharmacological interventions targeting these abnormalities have the potential to reduce thrombosis. Antiplatelet drugs represent an option in the management of hypertensives with cardiometabolic risk. Dizziness Headaches Myocardial Infarction Swelling of Ankles Possible Condition(s) High Cholesterol Heart Disease High Blood Pressure Diabetes Refers to the graphs on Page 3 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). RI (REFLECTION INDEX) If elevated, this indicates possible small and medium arterial stiffness. Marker for atherosclerosis. LF/HF Indicates ANS balance. If the value is high (greater than 2), it indicates sympathetic system predominance and possibility of mental stress or anxiety. If the value is low (less than 0.5), it indicates parasympathetic system predominance and possibility of fatigue or depression. PTGTP Helps identify risk of insulin resistance and therefore prediabetes as well as possible heart disease and metabolic disorders. High number may be associated with fatty liver and atherosclerosis. Possibly need to modify diet and increase exercise. BMI (BODY MASS INDEX) A measure of body fat based on weight in relation to height, and applies to most adults aged 20 and over. According to the Affordable Healthcare Act, if a patient is over a 27 BMI with at least 2 co-morbidities (or 30 BMI regardless of co-morbidities), Physician must offer Obesity Counseling (which is Medicare and private insurance reimbursable). If they do not, and are not on Electronic Medical Records, their Medicare reimbursements may be reduced up to 2% (according to the Meaningful Use Act.) STRESS.I Correlated to C reactive Protein is a marker for sympathetic failure. High numbers indicate a risk for heart disease. T.Power Is the main indicator of ANS activity. Low numbers may indicate a sedentary lifestyle and may indicate the need to increase activity. TP may also define the variability, or degree of fluctuation in the length of the intervals between beats. A low HRV score is associated with poor prognosis for patients who are post Myocardial Infarction (MI) and increased risk of autonomic neuropathy in diabetes population. ESRNO Is a maker of electrical skin response to nitric oxide (NO) production and vasodilation. This marker reflects microcirculation blood flow. Decreased ESR NO indicates microcirculation. A low number indicates signs of poor micro vascularization and increased risk of distal neuropathy. Additional Testing (At Physician s discretion) Cholesterol Blood pressure checks Hemoglobin A1C Glucose testing (BG, OGTT, etc) ABI CBC (Complete Blood Count) Carotid Ultrasound CMP (Complete Metabolic Profile) RM-3A Clinical Diagnosis Reference Guide Page 8
9 Small Fiber Sensory Neuropathy (SFN) See 6th Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary A small fiber neuropathy occurs when damage to the peripheral nerves predominantly or entirely affects the small myelinated fibers or unmyelinated C fibers. The specific fiber types involved in this process include both small somatic and autonomic fibers. The sensory functions of these fibers include thermal perception and nociception. These fibers are involved in a number of autonomic and enteric functions. Most small fiber neuropathies occur in a length-dependent fashion, resulting in loss of function in a stocking distribution in the lower extremities. When the condition is more advanced, a glove-like loss in the upper extremities also may occur. Anatomically, the small nerve fibers may be damaged or destroyed in these conditions, resulting in a loss of small nerve fibers and/or abnormal nerve fiber morphology. However, the pathogenesis of injury to small nerve fibers is not well understood. Small nerve fiber neuropathies can occur without large nerve fiber involvement, but in some cases they occur concomitantly or progress to involve large nerve fibers. Symptoms of small fiber neuropathy can vary widely in severity. Many individuals report the gradual onset of distal symptoms that include vague disturbances of sensation in the feet. These symptoms may include the feeling of a wrinkle in a sock that cannot be removed or of small pebbles or sand in the shoe. Others may report a cold-like pain, tingling or a pins and needles sensation. More severe symptoms of small fiber neuropathy may include burning pain that often is persistent, although it may vary in intensity throughout the day. There are several different classes of medications and lifestyle changes commonly used to treat neuropathic pain. Treatments should be based on evidence of safety, efficacy in other neuropathic conditions, tolerability, drug interactions, comorbid conditions, and cost. These include antidepressants, anticonvulsants, opioids, and topical treatments. Tricyclic antidepressants (TCAs) consistently are recommended as first tier drugs across all guidelines. Serotonin norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressants commonly used for the treatment of neuropathic pain. In addition to antidepressants, anticonvulsants also are routinely recommended for the treatment of neuropathic pain. Non-pharmacologic agents: Some patients may benefit from cool or warm soaks, soft socks, and foot tents. Other treatments include transcutaneous electrical nerve stimulation, acupuncture, physical therapy and massage. Burning Sensations Painful Contact with Socks or Bed Sheets Pebble or Sand-like Sensation in Shoes Pins and Needles Sensation in Feet Stabbing or Electrical Shock Sensation Possible Condition(s) Small Fiber Neuropathy Refers to the graphs on Page 7 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). ESRNO Is a marker of electrical skin response to nitric oxide (NO) production and vasodilation. This marker reflects microcirculation blood flow. Decreased ESR NO indicates microcirculation. A low number indicates signs of poor micro vascularization and increased risk of small fiber neuropathy. ESR L Is a marker of sweat gland nerve density. This marker reflects post sympathetic nerve density. The peak reflects C- fiber density. Low number is an early detection of peripheral distal neuropathy. Peak C Is a marker of sweat gland function and reflects maximum number of water and chlorine released on the electrode plate after stimulation. Decreased Peak C is either due to nerve damage or hypohidrosis (low sweat). An abnormal number (high or low) can be attributed to hyperhidrosis (Excessive Sweat): A low number found with nerve damage to hyperhidrosis. (Excessive Sweat): A low number found with nerve damage. Additional Testing (At Physician s discretion) Skin Biopsy Nerve Conduction Testing Other Pain Management Testing RM-3A Clinical Diagnosis Reference Guide Page 9
10 Cardiometabolic Autonomic Neuropathy (CAN) See 7th Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary High blood glucose levels over a period of years may cause a condition called autonomic neuropathy. This is damage to the nerves that control the regulation of involuntary function. When the nerve damage affects the heart, it is called cardiac autonomic neuropathy (CAN). CAN includes damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in vascular dynamics, heart rate control, and the body s ability to adjust blood pressure. CAN is a significant cause of morbidity and mortality associated with many cardiac arrhythmias and sudden death. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy. There is now clear evidence that suggests activation of inflammatory cytokines in diabetic patients and that these correlate with abnormalities in sympathovagal balance. Dysfunction of the autonomic system predicts cardiovascular risk and sudden death in patients with type 2 diabetes. It also occurs in pre-diabetes, providing opportunities for early intervention. The window of opportunity for aggressive control of all the traditional risk factors for cardiovascular events or sudden death with intensification of therapy is with short duration diabetes, the absence of cardiovascular disease and a history of severe hypoglycemic events. To this list we can now add autonomic dysfunction and neuropathy, which are the most powerful predictors of risk for mortality. Normally, our heart rate increases when we sit up and stand up, as well as, when we start to exercise. It slows down when we are resting. If the heart rate and blood pressure do not adjust quickly to our need for increased blood flow, we can become dizzy, lose our balance and in some cases faint. This is called orthostatic hypotension. CAN is not a disease of the heart it is a problem with the nerves that control the heart rate. The nerves that signal the heart to beat faster are called cardiac autonomic nerves. Damage to these nerves may cause a heart rate that stays high, even at rest, instead of rising and falling in response to the body s needs and activities. One effect is that blood pressure may drop when you stand up. Another danger is that people with CAN may have heart attacks without feeling the pain and symptoms that signal a problem. There are a number of possible pharmaceutical solutions for helping keep blood pressure from dropping too low. In addition, several agents have become available for the correction of functional defects in the autonomic nervous system. Restoration of autonomic balance is possible and has been shown with therapeutic lifestyle changes, increased physical activity, diabetes treatment, b-adrenergic blockers and potent anti-oxidants, such as a-lipoic acid. There are several steps one can take to make living with CAN easier and safer. Move slowly when moving from a lying down to a seated position or from a sitting to standing position. Avoid lying down for long periods of time (other than for sleep). Exercise is strongly encouraged. When exercising, include gradual, prolonged warm-up and cool-down periods so that your heart rate can adjust to your muscles need for more oxygen. Keep the pace of your workout at a comfortable level. Water exercise may be ideal because the pressure exerted by water helps return blood to the heart. Blurred Vision Cold, Clammy, Pale Skin Depression Fainting (Syncope) Fatigue Dizziness or Lightheadedness Possible Condition(s) Hypotension Lack of Concentration Nausea Rapid, Shallow Breathing Thirst Refers to the graphs and charts on Page 5 of a patient s RM- 3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). SPRV2 This marker is correlated with norepinephrine response. Low number may indicate orthostatic hypotension; high numbers indicate increased sympathetic response and release of norepinephrine (often associated with increased vascular constriction). DPRS This marker reflects the sympathetic adrenergic response. High number may indicate orthostatic hypotension. Low numbers are considered normal. E/I This marker reflects the parasympathetic response to a challenge. High number may indicate problem with autonomic nerve (dysautonomia). Vals.R This marker reflects parasympathetic response. High score may indicate dysautonomia and/or vagal syndrome. K30/15 This marker reflects parasympathetic response to change in posture. High score may indicate problems with autonomic nerve disorders (dysautonomic). Additional Testing (At Physician s discretion) Blood Glucose EKG Echocardiogram Cardiac Ultrasound Holter Monitor Additional cardiac testing RM-3A Clinical Diagnosis Reference Guide Page 10
11 Plethysmography Cardiovascular Disease (PTG CVD) See 8th Risk Factor Bar on Page 1 of RM-3A Physician s Full Report Summary The PTG CVD risk factor is the combined total of the other seven risk factors assessments. This is done by collecting information on both systems using time-domain, geometric, frequency- domain and non-linear methods and algorithms. The information is then applied to the cardiovascular health of the patient. Plethysmography (PTG) is used to detect blood volume changes in the microvascular bed of tissue. The PTG waveform comprises a pulsatile ( AC ) physiological waveform attributed to cardiac synchronous changes in the blood volume with each heartbeat, and is superimposed on a slowly varying ( DC ) baseline with various lower frequency components attributed to respiration, sympathetic nervous system activity and thermoregulation. PTG provides valuable information about the cardiovascular system such as measuring oxygen saturation, blood pressure and cardiac output, assessing autonomic function, detecting peripheral vascular disease and heart rate variability (HRV). HRV is the physiological variation in the time interval between heartbeats. It is measured by the variation in the beat-to-beat interval. Reduced HRV has been shown to be a predictor of mortality after myocardial infarction. A range of other outcomes/conditions may also be associated with lower HRV, including congestive heart failure, diabetic neuropathy, depression, and post-cardiac transplant. It is important to note that HRV measures fluctuations in autonomic inputs to the heart rather than the mean level of autonomic inputs. Thus, both withdrawal and saturating high levels of autonomic input to the heart can lead to diminished HRV. Heart rate and rhythm are largely under the control of the autonomic nervous system. The parasympathetic influence on heart rate is mediated via release of acetylcholine by the vagus nerve. The sympathetic influence on heart rate is mediated by release of epinephrine and norepinephrine. Because peripheral arterial disease is associated with the two other major atherosclerotic conditions, coronary artery disease (heart disease) and cerebrovascular disease (stroke), treatment may range from management of risk factors to surgical procedures. There are two main goals for treatment of peripheral artery/vascular disease: control the symptoms and halt the progression of the disease to lower the risk of heart attack, stroke, and other complications. Specific treatment may include lifestyle modifications to control risk factors, including regular exercise, proper nutrition, and smoking cessation. Aggressive treatment of existing conditions that may aggravate PVD, such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol) and medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls. & Condition(s): Aortic Aneurysms Atrial Fibrillation Cardiomyopathy Endocarditis Heart Attack Stroke Venous Thrombosis Refers to the graphs on Page 3 of a patient s RM-3A Physician s Full Report Summary. Physician evaluation recommended if the following markers are elevated (yellow) or abnormal (orange). RI (REFLECTION INDEX) If elevated, this indicates possible small and medium arterial stiffness. Marker for atherosclerosis. LF/HF Indicates ANS balance. If the value is high (greater than 2), it indicates sympathetic system predominance and possibility of mental stress or anxiety. If the value is low (less than 0.5), it indicates parasympathetic system predominance and possibility of fatigue or depression. PTGTP Helps identify risk of insulin resistance and therefore prediabetes as well as possible heart disease and metabolic disorders, high number may be associated with fatty liver and atherosclerosis. Possibly need to modify diet and increase exercise. BMI (BODY MASS INDEX) A measure of body fat based on weight in relation to height, and applies to most adults aged 20 and over. According to the Affordable Healthcare Act, if a patient is over a 27 BMI with at least 2 co-morbidities (or 30 BMI regardless of comorbidities), Physician must offer Obesity Counseling (which is Medicare and private insurance reimbursable). If they do not, and are not on Electronic Medical Records, their Medicare reimbursements may be reduced up to 2% (according to the Meaningful Use Act.) STRESS.I Correlated to C reactive Protein is a marker for sympathetic failure. High numbers indicate a risk for heart disease. T.Power Is the main indicator of ANS activity. Low numbers may indicate a sedentary lifestyle and may indicate the need to increase activity. TP may also define the variability, or degree of fluctuation in the length of the intervals between beats. A low HRV score is associated with poor prognosis for patients who are post Myocardial Infarction (MI) and increased risk of autonomic neuropathy in diabetes population. ESRNO Is a maker of electrical skin response to nitric oxide (NO) production and vasodilation. This marker reflects microcirculation blood flow. Decreased ESR NO indicates microcirculation. A low number indicates signs of poor micro vascularization and increased risk of distal neuropathy. Additional Testing (At Physician s discretion) Coronary artery testing Cardiometabolic Profile lab tests BNP (Brain Natriauretic Peptide) Carotid total plaque area, LDL-P RM-3A Clinical Diagnosis Reference Guide Page 11
12 777 East William Street, Suite #210 Carson City, Nevada RM-3A Clinical Diagnosis Reference Guide Page 12
RM- 3A Full Report Review How to Use the 8 Risk Factors
RM- 3A Full Report Review How to Use the 8 Risk Factors RM- 3A Cardiovascular and ANS Medical Device The RM- 3A medical device is a powerful analytic tool in managing your patients health. Scientifically
More informationRM-3A Cardiovascular & ANS Medical Device
RM-3A Cardiovascular & ANS Medical Device The RM-3A medical device is a powerful analytical tool in managing your patients health. Scientifically validated and FDA cleared, this medical device performs
More informationHeart Disease. Signs and Symptoms
Heart Disease The term "heart disease" refers to several types of heart conditions. The most common type is coronary artery disease, which can cause heart attack, angina, heart failure, and arrhythmias.
More informationANS1 : Sudopath & TM Oxi
ANS1 : Sudopath & TM Oxi Assessment of: Autonomic Nervous System Cardiovascular System Sudomotor Function Endothelial (arterial) Function Clinical Applications: Early Detection of risk for Peripheral Small
More informationCommon Diabetes-related Terms
Common Diabetes-related Terms A1C An A1C test measures a person's average blood glucose level over two to three months. Hemoglobin is the part of a red blood cell that carries oxygen to the cells and sometimes
More informationwith SERIES ANALYTICAL SYSTEM Clinical, Billing & Orientation Reference Guide
with SERIES ANALYTICAL SYSTEM Clinical, Billing & Orientation Reference Guide RM-3A Series Analytical System INTRODUCTION Thank you for purchasing your RM-3A Series Analytical System (RM-3A SAS)! We appreciate
More informationCardiovascular Diseases and Diabetes
Cardiovascular Diseases and Diabetes LEARNING OBJECTIVES Ø Identify the components of the cardiovascular system and the various types of cardiovascular disease Ø Discuss ways of promoting cardiovascular
More informationCardiac Pathophysiology
Cardiac Pathophysiology Evaluation Components Medical history Physical examination Routine laboratory tests Optional tests Medical History Duration and classification of hypertension. Patient history of
More informationHemoglobin. What is it? Why is iron important? What food sources contain iron?
Hemoglobin What is it? Why is iron important? What food sources contain iron? Poor Diet Lack of Iron and B12 vitamins in the diet Blood Loss Pregnancy Genetics Fatigue due to cells and tissues not being
More informationGuide to Cardiology Care at Scripps
Guide to Cardiology Care at Scripps Cardiology is the word in health care associated with heart, but the body s vascular system is also an important part of heart care. Your body has more than 60,000 miles
More informationHypertension and Hyperlipidemia. University of Illinois at Chicago College of Nursing
Hypertension and Hyperlipidemia University of Illinois at Chicago College of Nursing 1 Learning Objectives 1. Provide a basic level of knowledge regarding hypertension and hyperlipidemia and care coordinators/
More informationHEART DISEASE HEART CONDITIONS, RISKS AND PROTECTION
Spotlight on Health 2017 HEART DISEASE HEART CONDITIONS, RISKS AND PROTECTION Heart disease is the leading cause of death for both men and women worldwide, accounting for over 17 million deaths per year.
More informationAutonomic Nervous System
Autonomic Nervous System Keri Muma Bio 6 Organization of the Nervous System Efferent Division Somatic Nervous System Voluntary control Effector = skeletal muscles Muscles must be excited by a motor neuron
More informationAcoustic neuroma s/p removal BPPV (Crystals)- 50% of people over 65 y/ o with dizziness will have this as main reason for dizziness
Dizziness and the Heart Mended Hearts Inservice Karen Hansen, PT, DPT, Cert Vestibular Rehab, CEAS Tennessee Therapy & Balance Center, LLC July 21, 2016 Balance We maintain balance with input from our
More informationCardiovascular Disease Risk Factors:
Cardiovascular Disease Risk Factors: Risk factors are traits or habits that increase a person's chances of having cardiovascular disease. Some risk factors can be changed. These risk factors are high blood
More informationMonthly WellPATH Spotlight November 2016: Diabetes
Monthly WellPATH Spotlight November 2016: Diabetes DIABETES RISK FACTORS & SELF CARE TIPS Diabetes is a condition in which the body does not produce enough insulin or does not use the insulin produced
More informationINTRODUCTORY TEXT BOX
INTRODUCTORY TEXT BOX Diagnostic Partners provides a range of onsite, in-office cardiac and vascular diagnostic testing services. From Resting Echocardiograms to Abdominal Aorta scans, each study is performed
More informationCourse: Exercise and Aging for Special Populations
Copyright EFS Inc. All Rights Reserved. Course: Exercise and Aging for Special Populations Session 2: Cardiovascular and Metabolic Disease Considerations for Exercise Program Design Presentation Created
More informationThe signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.
DIABETIC NEUROPATHY Overview Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerve fibers throughout your body, but diabetic neuropathy
More informationPatients First. Risk Reduction for Heart and Vascular Disease. High blood cholesterol is one of the major risk factors for heart and vascular disease.
Patient Education HEALTH AND WELLNESS High blood cholesterol is one of the major risk factors for heart and vascular disease. Risk Reduction for Heart and Vascular Disease Risk factors are habits, traits
More informationStructure and organization of blood vessels
The cardiovascular system Structure of the heart The cardiac cycle Structure and organization of blood vessels What is the cardiovascular system? The heart is a double pump heart arteries arterioles veins
More informationHSN301 REVISION NOTES TOPIC 1 METABOLIC SYNDROME
HSN301 REVISION NOTES TOPIC 1 METABOLIC SYNDROME What does the term Metabolic Syndrome describe? Metabolic syndrome describes a cluster of cardio-metabolic conditions that increase one's risk of developing
More informationCardiac Rehabilitation Centre Pre-Admission Recommendations
Cardiac Rehabilitation Centre Pre-Admission Recommendations The following recommendations are for individuals who have been referred to the Cardiac Rehabilitation Centre (CRC) and have temporarily been
More informationDiabetes Mellitus Type 2
Diabetes Mellitus Type 2 What is it? Diabetes is a common health problem in the U.S. and the world. In diabetes, the body does not use the food it digests well. It is hard for the body to use carbohydrates
More informationThe World Health Organization (WHO) has described diabetes mellitus as Metabolic
1.1. Background The World Health Organization (WHO) has described diabetes mellitus as Metabolic disorder of multiple etiology characterized by chronic hyperglycemia with disturbances of carbohydrate,
More informationLecture 8 Cardiovascular Health Lecture 8 1. Introduction 2. Cardiovascular Health 3. Stroke 4. Contributing Factors
Lecture 8 Cardiovascular Health 1 Lecture 8 1. Introduction 2. Cardiovascular Health 3. Stroke 4. Contributing Factors 1 Human Health: What s Killing Us? Health in America Health is the U.S Average life
More informationOutcomes: By the end of this session the student will be able to:
Outcomes: By the end of this session the student will be able to: Discuss the cardiovascular system Identify the normal changes that occur with ageing Explain the nurses role in the care of residents with
More informationPatient Information VERSACLOZ (VER sa kloz) (clozapine) Oral Suspension
Patient Information VERSACLOZ (VER sa kloz) (clozapine) Oral Suspension Read this Patient Information before you start taking VERSACLOZ and each time you get a refill. There may be new information. This
More informationDiabetes. HED\ED:NS-BL 037-3rd
Diabetes HED\ED:NS-BL 037-3rd Diabetes Diabetes mellitus is an epidemic disease and based on a recent study published on 2011, the estimated number of affected people is 366 million worldwide and the number
More informationThe recommended protocol is for all patients suffering from diabetes to have yearly foot checks. This was checking the foot pulses and doing
Foot disease is a common long-term complication of diabetes. There are different types of foot disease caused by diabetes, but they all stem from a similar process. Raised blood sugar for a prolonged amount
More informationWHAT IS ATHEROSCLEROSIS?
ATHEROSCLEROSIS WHAT IS ATHEROSCLEROSIS? Atherosclerosis is a narrowing of the arteries that can significantly reduce the blood supply to vital organs such as the heart, brain and intestines. In atherosclerosis,
More informationCalifornia Cardiovascular Consultants Medical Associates
Patient information: Heart Attack What is a heart attack? A heart attack, also called myocardial infarction, or MI, is what happens when one of the arteries that supply blood to the heart gets blocked.
More informationAutonomic Nervous System Testing Creating Central Balance
Autonomic Nervous System Testing Creating Central Balance Overview of the Autonomic Nervous System Our nervous system is comprised of many different components. Some portions help us think, others give
More informationYOUR GUIDE TO. Understanding Your Angina Diagnosis and Treatment
YOUR GUIDE TO Understanding Your Angina Diagnosis and Treatment Our goal at the Mercy Health Heart Institute is to help you be well. Our experienced team includes cardiologists, cardiovascular surgeons,
More informationCoach on Call. Thank you for your interest in Lifestyle Changes as a Treatment Option. I hope you find this tip sheet helpful.
It was great to talk with you. Thank you for your interest in. I hope you find this tip sheet helpful. Please give me a call if you have more questions about this or other topics. As your UPMC Health Plan
More informationCardiovascular System and Health. Chapter 15
Cardiovascular System and Health Chapter 15 Cardiovascular Disease Leading cause of death in U.S. Claims 1 life every 43 seconds Often, the first sign is a fatal heart attack Death Rates #1 CVD #2 Cancer
More informationAdvanced Concepts of Personal Training Study Guide Answer Key
Advanced Concepts of Personal Training Study Guide Answer Key Lesson 22 Working with Special Populations LESSON TWENTY TWO Lesson Twenty Two Working with Special Populations WORKING WITH SPECIAL POPULATIONS
More informationDo Now pg What is the fight or flight response? 2. Give an example of when this response would kick in.
Do Now pg 81 1. What is the fight or flight response? 2. Give an example of when this response would kick in. Autonomic Nervous System The portion of the PNS that functions independently (autonomously)
More informationDiabetes Mellitus. Disclaimer. Multimedia Health Education
Disclaimer This movie is an educational resource only and should not be used to manage Diabetes or blood sugar control.all decisions about management of diabetes must be made in conjunction with your Physician
More informationThe Endocrine System 2
The Endocrine System 2 Continuing on from the previous instalment, we will now look at the adrenal glands, the pancreas and the gonads as parts of the endocrine system. Adrenal Glands The adrenal glands
More information10/8/2018. Lecture 9. Cardiovascular Health. Lecture Heart 2. Cardiovascular Health 3. Stroke 4. Contributing Factor
Lecture 9 Cardiovascular Health 1 Lecture 9 1. Heart 2. Cardiovascular Health 3. Stroke 4. Contributing Factor 1 The Heart Muscular Pump The Heart Receives blood low pressure then increases the pressure
More informationTraining Your Caregiver: Diabetes
Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate,
More informationFebruary Heart Health Education
February Heart Health Education What can go wrong? We will look at two different unhealthy heart conditions: Heart Failure and Heart Attacks. Heart Failure Heart failure is a condition in which the heart
More informationQANS ASSESSMENT SYSTEM
Comprehensive Non Invasive System Includes: Autonomic Balance Analysis Cardiovascular Pulse Wave Velocity Analysis ECG Analysis Cardiovascular Fitness Analysis Metabolic Report Arterial Vascular Assessment
More informationA Healthy Heart. IN BRIEF: Your Guide to
IN BRIEF: Your Guide to A Healthy Heart If you re like most people, you may think of heart disease as a problem for other folks. If you re a woman, you may believe that being female protects you from heart
More informationUnderstanding Diabetes
Patient Education Understanding Diabetes This handout describes diabetes, the complications related to the disease, and how you can prevent these complications. Blood Sugar Control Diabetes is a disease
More informationall about your heart...
For a healthy heart If you smoke, stop smoking. Eat lots of fruit and vegetables and less fat. Be more active every day. Be a healthy weight. Relax take time out for yourself. Local contact: For more information
More informationThis information explains heart failure, including causes and signs of heart failure, how heart failure is diagnosed, and how it s treated.
PATIENT & CAREGIVER EDUCATION Heart Failure This information explains heart failure, including causes and signs of heart failure, how heart failure is diagnosed, and how it s treated. About Heart Failure
More informationAtherosclerosis. Atherosclerosis happens when the blood vessels
Atherosclerosis Atherosclerosis happens when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff sometimes restricting blood flow
More informationDischarge Instructions after Carotid Endarterectomy
after Carotid Endarterectomy Your surgeon was Dr.. When you go home, an adult should stay with you until morning. You should resume your normal activity as tolerated. You may eat a normal diet. Drink plenty
More informationPOSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS) IT S NOT THAT SIMPLE
POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME (POTS) IT S NOT THAT SIMPLE POTS Irritable heart syndrome. Soldier s heart. Effort syndrome. Vasoregulatory asthenia. Neurocirculatory asthenia. Anxiety neurosis.
More informationHeart Attack. PART 2. Health Issues of Special Interest to Women. Heart and Artery Diseases. Chapter 4
PART 2. Health Issues of Special Interest to Women Heart Attack Heart and Artery Diseases Chapter 4 You may not know that diseases of the heart and arteries (primarily heart attack, heart disease, high
More informationArrhythmias. Pulmonary Artery
Arrhythmias Introduction Cardiac arrhythmia is an irregularity of the heart beat that causes the heart to beat too slowly, too fast, or irregularly. There are different types of arrhythmias. Most arrhythmias
More informationPreventing Diabetes. prevent or delay type 2 diabetes from
Preventing Diabetes Introduction Diabetes is a common condition. If not controlled, diabetes can lead to serious complications such as blindness, amputations, and even death. Before people develop diabetes,
More informationClinical Care Performance. Financial Year 2012 to 2018
Clinical Care Performance Financial Year 2012 to 2018 SHP Clinical Care Performance Diabetes Mellitus Hyperlipidemia Hypertension Diabetes Mellitus Find out how our patients are doing for: HbA1C HbA1c
More informationLESSON ASSIGNMENT Given the trade and/or generic name of an adrenergic blocking agent, classify that agent as either an alpha or beta blocker.
LESSON ASSIGNMENT LESSON 8 Adrenergic Blocking Agents. TEXT ASSIGNMENT Paragraphs 8-1 through 8-5. LESSON OBJECTIVES 8-1. Given a group of statements, select the statement that best describes one of the
More informationCoronary Artery Disease
Coronary Artery Disease This information is at http://www.nhlbi.nih.gov/health/dci/diseases/cad/cad_all.html and is provided by the NHLBI, one of the Institutes of the National Institutes of Health. To
More informationDiabetes. What you need to know
Diabetes What you need to know Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca 2016 University Health Network. All rights reserved. This information
More informationTopic 1: Lifestyle, Health and Risk
alevelbiology.co.uk Topic 1: Lifestyle, Health and Risk SPECIFICATION Many animals have a heart and circulation (mass transport to overcome limitations of diffusion in meeting the requirements of organisms).
More informationAtrial Fibrillation. Damage to your heart caused by a heart attack or rheumatic heart disease
Atrial Fibrillation GENERAL INFORMATION: What is atrial fibrillation? Atrial fibrillation is a condition that causes the atria (top chambers of the heart) to shake or quiver. Normally, there is 1 contraction
More informationHeart Health C M Y K. Fotolia
Heart Health C M Y K Fotolia PAGE 2 HEART HEALTH RECOVERY Life After Heart Attack O vercoming a heart attack may seem like an overwhelming feat. While it will be a lifelong recovery, you can still live
More informationRisk Factors for Heart Disease
Risk Factors for Heart Disease Risk Factors we cannot change (Age, Gender, Family History) Risk Factors we can change (modifiable) Smoking Blood pressure Cholesterol Diabetes Inactivity Overweight Stress
More informationP R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
More informationPrediabetes 101. What is it and what can I do about it? Intermountainhealthcare.org/diabetes
Prediabetes 101 What is it and what can I do about it? Patient Education Intermountainhealthcare.org/diabetes What do you already know about prediabetes? Fact or Fiction? There are often no symptoms of
More informationHeart Disease (Coronary Artery Disease)
Heart Disease (Coronary Artery Disease) Understanding how the heart works To understand heart disease, you must first know how the heart works. The heart is like any other muscle, requiring blood to supply
More informationAN EARLY WARNING SYSTEM FOR CARDIOVASCULAR DISEASE
AN EARLY WARNING SYSTEM FOR CARDIOVASCULAR DISEASE Good for your patients. Good for your practice. Using the AngioDefender system to complement your patients care routine enables you to: Improve your patient
More informationARTERIAL STIFFNESS ASSESSMENT COMMENTS:
ARTERIAL STIFFNESS ASSESSMENT 10% Low small artery stiffness risk. However, we detect mild vasoconstriction in small artery. No large arterial stiffness has been detected. High Blood Pressure & Arterial
More informationDedicated To. Course Objectives. Diabetes What is it? 2/18/2014. Managing Diabetes in the Athletic Population. Aiden
Managing Diabetes in the Athletic Population Dedicated To Aiden Michael Prybicien, LA, ATC, CSCS, CES, PES Athletic Trainer, Passaic High School Overlook Medical Center & Adjunct Faculty, William Paterson
More informationPhysical Activity/Exercise Prescription with Diabetes
Physical Activity/Exercise Prescription with Diabetes B R AD H I NTERMEYER C E P A C SM S A NFORD H E ALTH C A RDIAC R E H AB A N D D I ABE TES E XE RCISE The adoption and maintenance of physical activity
More informationMany factors can increase the likelihood of platelets becoming spiky and hyperactive. These include:
Many factors can increase the likelihood of platelets becoming spiky and hyperactive. These include: Ageing Our body uses nitric oxide to calm platelets and keep blood vessels relaxed. However, the amount
More informationWhat is Diabetes Mellitus?
Normal Glucose Metabolism What is Diabetes Mellitus? When the amount of glucose in the blood increases, After a meal, it triggers the release of the hormone insulin from the pancreas. Insulin stimulates
More informationThe Endocrine Pancreas (Chapter 10) *
OpenStax-CNX module: m62118 1 The Endocrine Pancreas (Chapter 10) * Ildar Yakhin Based on The Endocrine Pancreas by OpenStax This work is produced by OpenStax-CNX and licensed under the Creative Commons
More informationHypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to
Hypertension The normal radial artery blood pressures in adults are: Systolic arterial pressure: 100 to 140 mmhg. Diastolic arterial pressure: 60 to 90 mmhg. These pressures are called Normal blood pressure
More informationCardiovascular disease, studies at the cellular and molecular level. Linda Lowe Krentz Bioscience in the 21 st Century September 23, 2009
Cardiovascular disease, studies at the cellular and molecular level Linda Lowe Krentz Bioscience in the 21 st Century September 23, 2009 Content Introduction The number 1 killer in America Some statistics
More informationHeart Failure. Symptoms and Treatments. FloridaHospital.com
Heart Failure Symptoms and Treatments FloridaHospital.com Understanding Heart Failure According to the American Heart Association, one in five people over age 40 will develop heart failure. Right now,
More informationDiabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center
Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??
More informationOrthostatic Hypotension (Postural Hypotension)
Orthostatic Hypotension (Postural Hypotension) Authors: SCIRE Community Team Reviewed by: Darryl Caves, PT Last updated: April 9, 2018 Changes to blood pressure control after spinal cord injury (SCI) may
More informationC1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders
C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders GENERAL ISSUES REGARDING MEDICAL FITNESS-FOR-DUTY 1. These medical standards apply to Union Pacific Railroad (UPRR) employees
More informationmajor public health burden
HYPERTENSION INTRODUCTION Hypertension is one of the major public health burden in the recent times. Hypertension remains a challenging medical condition among the noncommunicable diseases of ever growing
More informationAS OCR PHYSICAL EDUCATION The Vascular System
AS OCR PHYSICAL EDUCATION The Vascular System Learning Objectives: - Distribution of Cardiac output at rest and during exercise - Role of the Vasomotor centre, arterioles and pre-capillary sphincters -
More information7/6/2012. University Pharmacy 5254 Anthony Wayne Drive Detroit, MI (313)
University Pharmacy 5254 Anthony Wayne Drive Detroit, MI 48202 (313) 831-2008 Be able to identify the signs of a heart attack or stoke Identify what puts you at a higher risk for cardiovascular disease,
More informationChapter 24 Diabetes Mellitus
Chapter 24 Diabetes Mellitus Classification of Diabetes Mellitus Acute Effects of Diabetes Mellitus Chronic Complications of Diabetes Mellitus: Early Stages Chronic Complications of Diabetes Mellitus:
More informationThis information explains the advice about the care and treatment of people with stable angina that is set out in NICE clinical guideline 126.
Information for the public Published: 1 July 2011 nice.org.uk About this information NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments
More informationRick Fox M.A Health and Wellness Specialist
Metabolic Diseases Rick Fox M.A Health and Wellness Specialist Metabolic Diseases Metabolism is the process your body uses to get or make energy from the food you eat. Food is made up of proteins, carbohydrates
More informationStroke - prevent it!
Stroke - prevent it! M a k e h e a l t h y l i f e s t y l e y o u r c h o i c e. Contents 1 What is a stroke? 3 What are the risk factors for a stroke? 5 What you can do to prevent a stroke 9 What to
More informationSession 21: Heart Health
Session 21: Heart Health Heart disease and stroke are the leading causes of death in the world for both men and women. People with pre-diabetes, diabetes, and/or the metabolic syndrome are at higher risk
More informationPAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only)
PAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only) 1. What is the main problem that you are having? (If additional space is required, please use the back of this
More informationEDUCATION. Peripheral Artery Disease
EDUCATION Peripheral Artery Disease Peripheral Artery Disease You may have circulation problems that have to do with your blood vessels. You may feel aches, pains, cramps, numbness or muscle fatigue when
More informationOur Commitment to Quality and Patient Safety Core Measures
Calvert Memorial Hospital is committed to our community, with a focus on patient-centered care. High quality and safe patient care is not our goal, it is our priority. That means delivering the best possible
More informationFrom the desk of the: THE VIRTUAL NEPHROLOGIST
Hypertension, also referred to as high blood pressure or HTN, is a medical condition in which the blood pressure is chronically elevated. It is a very common illness. One out of three American adults has
More informationSPECIAL EDITION: Men s Health
SPECIAL EDITION: Men s Health 1 Heart Health If you re like most Americans, heart health might be something you don t think about very often. You should. The risk of heart disease increases with age and
More informationElements for a Public Summary
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Generalised anxiety disorder Generalised anxiety disorder (GAD) is an umbrella term that covers a wide range of anxiety disorders
More informationCardiovascular Disease
Cardiovascular Disease Controlling your risk factors WE RECOMMEND THAT YOU Monitor your blood pressure on a regular basis If you have high blood pressure, reduce your intake of salt, tea and coffee Drink
More informationHypertension and Heart Disease. Weldon James, MD, Mercy Clinic Family Medicine, Union
Hypertension and Heart Disease Weldon James, MD, Mercy Clinic Family Medicine, Union The Silent Killer High blood pressure, also known as HBP or hypertension, is a widely misunderstood medical condition
More informationCirculation and Cardiac Emergencies. Emergency Medical Response
Circulation and Cardiac Emergencies Lesson 19: The Circulatory System and Cardiac Emergencies You Are the Emergency Medical Responder You are called to the home of a 50-year-old man whose wife called 9-1-1
More informationWhy do we care? 20.8 million people. 70% of people with diabetes will die of cardiovascular disease. What is Diabetes?
What is Diabetes? Diabetes 101 Ginny Burns RN MEd CDE Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action
More informationObjectives / Learning Targets: The learner who successfully completes this course will be able to demonstrate understanding of the following concepts:
Objectives / Learning Targets: The learner who successfully completes this course will be able to demonstrate understanding of the following concepts: Insulin s function in the body. The basics of diabetes
More informationCardiovascular Disease
Cardiovascular Disease Chapter 15 Introduction Cardiovascular disease (CVD) is the leading cause of death in the U.S. One American dies from CVD every 33 seconds Nearly half of all Americans will die from
More informationSECONDARY HYPERTENSION
HYPERTENSION Hypertension is the clinical term used to describe a high blood pressure of 140/90 mmhg or higher (National Institute of Health 1997). It is such a health risk the World Health Organisation
More information