Contents:

TABLE OF CONTENTS: INTRODUCTION CARDIOLOGY – GUIDELINES (refer to Cardiothoracic Surgery & Vascular Laboratory sections) Acoustic Heart Scans/Recordings (New 8-04, 6-07) Ambulatory blood pressure monitoring (Added 1-01, updated 04-04, 4-05, 11-05, 6-06, 4-07) Ambulatory electrocardiography (Holter)/Cardiac Event Monitors – Also refer to the following EKC section: - Medicare coverage framework (update 8-04) - Cardiac Event Monitors/Real Time Cardiac Surveillance System – Loop Recorders (updated 12-01, 8-04, 10-05, 7-07, 12-08) - Holter Monitors/Dynamic Electrocardiograms (New 3-06, 12-06, 4-07) - Implanted Loop Recorders (Added 09-02, update 8-04, 6-07) - Mobile Cardiac Outpatient Telemetry (MCOT) (New 3-06) Angioplasty – refer to PTCA in this chapter and Angioplasty in the Cardiovascular Surgery chapter Brachytherapy, Coronary – refer to Radiation Therapy chapter Cardiology Consultation or Referral for Care (added 04-03, update 6-05, 3-06) Chest pain – acute myocardial ischemia/infarct (AMI), admission criteria, evaluation & management guideline resources (updated 10-01, 3-05, 5-05, 8-05, 8-06) CARDIAC CATHETERIZATION - Cardiac catheterization, right; Central venous access & pressure monitoring (updated 10-01, 11-04, 5-06, 9-07) - Cardiac Catheterization, left; Coronary arteriography; Angiography and Ventriculography (rev 12-00, update 8-04, 1-06, 5-06, 12-06, 7-07) Cardiac catheter or operative ablation of arrythmogenic foci (New 12-04, update 3-05, 5-05) Cardiac output and related hemodynamic measurements - Cardiac output Doppler monitoring (New 5-07) - Electrical Bioimpedance, Thoracic – Cardiac output and related hemodynamic measurements (updated 08-03, 12-04, 3-05, 4-07) - Inert gas re-breathing techniques to measure cardiac output (New 10-05, update 7-07) Cardiovascular Nuclear Medicine Studies – refer to Nuclear Medicine chapter Central venous catheter placement (New 1-09) CHF/Heart Failure – admission, discharge criteria (updated 9-04, 12-04, 5-05, 8-05, 11-05, 2-06, 7-07) CT, CARDIAC - CT screens for coronary artery calcifications (update 4-04, 10-05, 7-06, 1-07, 7-07, 5-08) - Cardiac Computed Tomography, Computed Tomography Coronary Angiography (New 7-06, updated 1-07, 4-07, 3-08, 7-08, 11-08, 3-09) Coronary artery revascularization procedures (New 1-09) - Refer to the PTCA and CABG guidelines in this chapter and the Cardio-thoracic Surgical chapter respectively Defibrillator devices, external/wearable and automatic implantable cardioverter (ICDs, AICDs) (updated 09-04, 12-04, 3-05, 5-05, 11-05, 1-06, 8-06, 10-07, 2-09) - Defibrillators for home use (New 10-05, 7-07) Direct current cardioversion (Update 4-05, 7-07) also refer to Atrial fibrillation ablative procedures in the CV Surgery chapter that follows. Directional coronary atherectomy (DCA)/Percutaneous transluminal rotational atherectomy (update 4-05, 7-07) Displacement cardiography/cardiokymography and photokymography (New 5-07) ECHOCARDIOGRAMS - Adult and pediatric, transthoracic, transesophageal (updated 6-04, 7-05, 10-06, 7-07, 2-09) - Doppler Echocardiography (updated 01-03, 3-05, 2-07) - Stress Echocardiography (New 10-06) ELECTROCARDIOGRAMS – refer to the preceding Ambulatory Electrocardiography section - EKG criteria (update 7-04, 12-04, 3-05, 5-07, 7-07) - Cardiointegram (CIG) (New 4-05, update 4-07) - Body Surface Potential Mapping (New 7-05) Electrophysiology testing (ET)/Electrophysiologic Studies (EPS) (update 5-05, 1-07, 5-07) - His bundle studies (New 5-07) - T-Wave Alternans (TWA) testing (added 10-01, updates 9-04, 12-04, 3-05, 10-05, 3-06, 5-07, 5-08) External Counterpulsation, Enhanced (EECP) Therapy (update 1-04, 12-04, 3-05, 10-05, 3-06, 7-07) Exercise Treadmill Test (ETT)/ ‘stress test’, (update 4-04, 3-05, 5-05, 3-06, 3-09) - Exercise Treadmill Test with Thallium imaging/Stress Test (update 06-01, 11-04, 6-07) - BNP and NT-proBNP TES Testing with Stress Exercise Tests (New 3-09) - Pediatric stress testing guideline link (New 4-06) Holter Monitor – refer to ambulatory electrocardiography/event monitors sections Left Ventricular End Diastolic Pressure (LVEDP) Measurement in the Outpatient Setting (New 10-05) MRI/MRA (MR Angiography) – Cardiovascular studies – refer to Radiology chapter Pacemakers - Permanent cardiac pacemakers/Resynchronization therapy (update 07-04, update 3-05, 10-05, 7-06, 5-07) - Pacemaker monitors; Monitoring frequency (update 4-07) - Pacemakers/External manually activated devices to terminate tachyarrhythmias (update 5-04) - Pacemaker reference list (update 5-04, 3-05, 5-05, 7-05, 7-07) Percutaneous Transluminal Coronary Angioplasty (PTCA) (update 6-03, 5-05, 11-05, 5-06, 10-06, 7-07, 11-07, 1-09) - Vascular cryoplasty (New 5-08) Pulmonary artery catheters – refer to the preceding cardiac catheterization section & the Central venous catheter placement guideline Pulmonary Artery Hypertension – Iloprost therapy (New 3-07) - Prostacyclin infusion therapy for pulmonary hypertension – refer to the Pharmacy chapter Pulmonary vein stenosis, infants (New 1-09) Radiofrequency Catheter Ablation Procedures – Cardiac (update 5-01, 8-04, 12-04, 5-05, 4-06, 4-07) Resynchronization therapy – refer to the preceding ‘Permanent cardiac pacemakers’ guideline Revascularization procedures – refer to coronary artery revascularization procedures as well as the individual procedures listed in this and the following chapter Stents, coronary (update 10-03, 5-05, 10-05) Stress tests – refer to the preceding Exercise Treadmill Test sections Syncope, evaluation of – guideline link (New 8-06) Thoracic electrical bioimpedance (TEB) – refer to the preceding guideline: ‘Electrical bioimpedence, thoracic’ Tilt table testing (Updated 10-01, 12-04, 10-05, 7-07) Thrombolysis for acute myocardial infarction (update 05-02, 5-05) Cardiac Rehabilitation - Cardiac Rehabilitation Program Guidelines (update 5-01, 8-04, 3-05, revision 3-06, update 3-07, 5-08) - Cardiac Rehabilitation Services – CMS policy (added 11-00, updated 5-05, 3-06, 5-06, 10-06, 2-08) Phonocardiography and Vectorcardiography (added 8-04) Screening for ischemic cardiac disease (new 4-04) Length of stay benchmarks/targets for cardiology diagnoses (update 6-05, 2-08) - Acute Myocardial Infarction LOS – reference list - Pulmonary embolus (New 11-08) Cardiology Guideline Resources – web links (New 8-04, update 8-06, 7-08) NY Heart Association Classification (New 2-07) Ultrafiltration therapy for heart failure – refer to the Nephrology chapter for guideline Cardiology Notes (update 12-06, 5-07, 11-08) CARDIOVASCULAR/THORACIC & PERIPHERAL VASCULAR SURGERY AND/OR INTERVENTIONAL VASCULAR RADIOLOGY –GUIDELINES (also refer to Cardiology, Radiology and Vascular Laboratory sections) Alcohol-induced septal ablation for hypertrophic obstructive cardiomyopathy/Non-surgical ablation (new 2-04, update 2-05, 5-06, 7-07) Angioplasty, Percutaneous Transluminal (PTA) and/or Atherectomy; peripheral, renal, dialysis fistulae –[refer to guidelines for coronary arteries (PTCA) in the Cardiology chapter; while aortic, carotid, renal, intracranial and vertebral arteries follow in this chapter] (update 5-05, 2-06, 2-07, 7-07, 2-09) - Cryoplasty, peripheral arterial (New 5-08) Angioplasty Aorta (for aortic stenosis) (New 7-07) Angioplasty, coronary – refer to the Percutaneous Coronary Angioplasty (PTCA) guideline Aortic Aneurysm Repair – indications, options (open, endovascular stent-grafts); (New 06-02, update 10-04, 10-05, 3-06, 4-07, 4-08, 12-08, 2-09) Refer to AAA ultrasound screening coverage in the Radiology chapter - Abdominal aorta aneurysms - Thoracic aorta aneurysms (update 3-08, 12-08) - Aneurysm reference/resource list (update 7-07) Aortic valve replacement/repair – refer to the following Valve replacement and/or repair guideline Arterial elasticity as a screening tool for CV disease (New 3-07) Artificial hearts and related devices (New 4-07, update 7-07, 5-08) – also refer to the ‘Heart Transplant’ and Ventricular Assist Devices guidelines in this chapter. Atrial fibrillation – ablative procedures (New 5-05, update 7-06, 11-08, 1-09) - Maze Procedure for atrial fibrillation/flutter (new 3-02, update 4-05, 7-07) - Pulmonary vein isolation for atrial fibrillation (new 3-02, update 5-05, 7-07, 11-08) Atrial Septal Defect, repair (update 3-05, 10-05, 1-07, 6-07) – Also refer to Ventricular Septal guidelines Autologous cell transplant therapy for damaged myocardium (New 7-07, update 12-08) Carotid body tumor resection (Glomectomy) (New 4-00, update 5-05, 4-07) Carotid sinus nerve stimulation (New 4-07) Carotid Endarterectomy (CEA) – Indications, LOS (update 9-04, 2-06, 9-06, 7-07) Carotid and Vertebral Artery Percutaneous Transluminal Angioplasty (PTA) and Stenting Procedures (update 9-04, 3-05, 5-05, 11-05, 3-06, 1-07, 7-07, 4-08, 5-08, 4-09) Carotid, noninvasive tests – refer to the vascular lab chapter in this manual Coronary artery bypass graft(s) surgery (CABG)/Off-pump CAB; Indications, LOS (updates 10-04, 10-05, 10-06, 7-07, 1-09) Dynamic Cardiomyoplasty (New 4-07) Extracranial-Intracranial arterial bypass surgery (update 5-05, 11-05, 5-07) – refer to PTA stents in the preceding guideline Heart/Cardiac and Heart-Lung Transplants (New 5-05, 8-05, 10-05, 2-07, 12-08) - Heartsbreath test for rejection (New 12-08, 2-09) Impedance plethysmography – refer to Plethysmodgraphy guideline in the Vascular Laboratory chapter Intraoperative Ventricular Mapping (new 4-00, update 5-05, 5-07) Maze Procedure for atrial fibrillation/flutter (new 3-02, update 4-05, 7-07) Microsurgical lymphaticovenous anastomosis operation for lymphedema (new 1-01, update 5-05, 4-07) Microvascular arterial bypass surgery for impotence (New 5-05, update 10-05, 4-07) Mitral valve replacement/repair – refer to the following Valve replacement and/or repair guideline Pain – Post-thoracotomy or post-mastectomy – Intercostal nerve lesion excision (new 4-00, update 9-06, 7-07) Patent ductus arteriosus closure (New 5-05, update 10-05, 7-07, 1-09) Patent foramen ovale – closure indication (New 3-05, update 10-05, 7-07, 1-09) Pectus excavatum and pectus carinatum – Surgical correction (updated 3-02, 5-05, 7-07) Percutaneous Transluminal Coronary Angioplasty (PTCA) – refer to the cardiology chapter Peripheral vascular disease - Cryoplasty (New 4-07) - Peripheral vascular percutaneous interventional procedures (PTA, other) (New 3-07, update 9-07) - Peripheral vascular rehabilitation programs (New 12-04, update 6-06, 1-07, 7–07) Photopheresis, extracorporeal – Therapy for heart transplant rejection (New 4-00, update 5-05, revised 3-07) Pulmonary embolectomy, transvenous (New 5-07) Pulmonary valve replacement/repair – refer to the following ‘Valve replacement and/or repair’ Pulmonary vein isolation for atrial fibrillation (added 3-02, update 5-05, 7-07, 11-08) Renal Artery Stenosis – Angioplasty, Stent placement (New 11-04, 7-07, 11-07) Robotically-assisted cardiac surgery (New 4-05, 7-07) Thoracoscopy (New 7-08) - Thoracoscopic aortopexy for tracheomalacia (New 11-08) - Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation – refer to atrial fibrillation, ablative procedures Thrombectomy, arterial or venous (New 7-07) Total Artificial Heart Replacement – refer to the preceding ‘Artificial heart’ guideline Tracheo-bronchial stents – refer to the Pulmonary chapter Transjugular Intrahepatic Portosystemic Shunt (TIPS) (New 11-04, update 5-05, 7-07) Transmyocardial laser revascularization (update 1-04, 5-05, 10-05, 5-07) Transplantation – refer to the preceding Heart/Cardiac and Heart-Lung Transplants in this chapter Tricuspid valve replacement/repair – refer to the following ‘Valve replacement and/or repair’ guideline Valve Replacement and/or Repair: Aortic/Mitral/Tricuspid/Pulmonary (update 5-05, 8-06, 2-07, 7-07, 12-07, 6-08) Varicose Vein/Perforator Vein Therapies – including sclerotherapy, endovenous radiofrequency or laser ablation (refer to the Vascular Lab chapter for related guidelines) (update 5-04, 4-05, 10-05, 8-06, 5-07, 5-08) 8 Venous stents (New 1-07) Ventricular Assist Devices (New 10-03, rev 4-07, update 12-08) – also refer to Artificial Heart, Heart transplant guidelines Ventricular Reduction/Remodeling or Partial Left Ventriculectomy (PLV) (New 12-00, update 4-05, 3-06, 10-06) Ventricular Septal Region Procedures - Ventricular Septal Defect (VSD) – closure (New 10-05, update 5-06, 1-09) - Transcoronary ablation of septal hypertrophy (TASH) (Added 3-02, update 3-05) Cardiovascular/Peripheral Vascular Surgery – additional resources, risk calculator Cardiovascular surgery notes/links: General resource; Bloodless surgery – links (update 12-06, 7-07) VASCULAR LABORATORY – Clinical Review Guidelines; refer to the ‘Cardiovascular/Thoracic/Peripheral Vascular Surgery’, Urology and ‘Radiology’ chapters for related criteria Noninvasive cerebrovascular studies of extracranial arteries/Carotid function (new 12-01, update 10-03, 11-04, 2-05, 5-06, 5-07) - Ocular Plethysmography (OPG) and Ophthalmodynamometry - Ultrasonographic measurement of carotid intimal-medial thickness as an assessment of subclinical atherosclerosis (New 4-06) - Penile doppler and corpora cavernosonography studies for impotence (update 3-06) Peripheral arterial non-invasive studies (section updates 11-04, 6-05, 3-06) - Segmental Doppler Pressures and Pulse Volume Recording - Ankle/Brachial Index (ABI) (New 7-06) - Exercise (Stress) Doppler Test - Digital Arterial Evaluation Hemorheograph (New 5-04, update 5-07) Visceral arterial duplex imaging Plethysmography (update 12-04, 6-05) Peripheral venous non-invasive studies/ultrasonography (update 06-02, 11-04, 2-05, 4-05, 5-06) Scintigraphic Imaging for Detection/Localization of Lower Limb Deep Vein Thrombosis (DVT) (added 2-01, update 4-07) Thermography and Temperature Gradient Studies – refer to Radiology chapter Hemodialysis Access Shunts – refer to Nephrology chapter Vascular Laboratory Notes WEB SITES for Cardiology and Cardiovascular Surgery ‘Famous Last Words’ APOLLO’S PUBLICATION LIST