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===Clinical Clues to the Diagnosis of RAS===
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{{familytree | | | | | | | | | | A01 | |A01=<div style="float: left; text-align: left; height: 30em; width: 20em; padding:1em;">'''Determine if one or more of the following is present:''' <br> ❑ Onset of hypertension before the age of 30 years or severe hypertension after the age of 55<br> Accelerated, resistant, or [[malignant hypertension]]<br> ❑ Development of new [[azotemia]] or worsening renal function after administration of an [[ACE inhibitor]] or [[ARB]] agent<br> ❑ Unexplained [[atrophic kidney]] or size discrepancy between kidneys >1.5 cm<br> ❑ Sudden, unexplained pulmonary edema<br> ❑ Unexplained renal dysfunction, including individuals starting renal replacement therapy<br>❑ Multi-vessel [[CAD]]<br> ❑ Unexplained [[CHF]]<br> ❑ Refractory [[angina]] </div>}}
{{familytree | | | | | | | A01 | | | | | | | | A01='''High risk criteria:''' <br><div style="float: left; text-align: left;"> Severe structural or [[CAD]]<br>❑ Clinical or [[ECG]] features suggesting arrhythmic syncope: <br> -syncope during exertion or supine <br> -palpitations at the time of syncope <br> -family history of[[SCD]] <br> -non- sustained [[VT]] <br> -conduction abnormalities with QRS >120 ms <br> -[[sinus bradycardia]] <br> -pre-exited QRS complex <br> -prolonged or short QR interval <br> -brugada pattern <br> -[[ARVC]] <br> ❑ Important comorbidities: <br> -Severe anemia <br> -Electrolyte intolerance </div> }}
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{{familytree | | | | C01 | | | | | | | | C02 | C01=<div style="height: 5em; width: 10em; padding:1em;">'''If one of the above are present, proceed with Non- invasive imaging'''</div>| C02= <div style="height: 7em; width: 10em; padding:1em;">'''If there are no clinical clues, proceed with invasive renal arteriography'''</div>}}
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{{familytree | | | | D01 | | | | | | | | |!| | D01=<div style="height: 1em; width: 10em; padding:1em;">'''Is patient allergic to contrast'''</div>}}
{{familytree | | |,|-|^|-|.| | | | | | | |!| | }}
{{familytree | | E01 | | E02 | | | | | | E03 | E01= <div style="float: left; text-align: center; height: 1em; width: 10em; padding:1em;">If yes proceed with US </div>| E02=<div style="float: left; text-align: left; height: 12em; width: 10em;">If no check for:
❑ Implanted devices:
*Pacemakers
*Defibrillators
*Cochlear implants
*Spinal cord stimulators
❑ Claustrophobic patient </div>| E03= <div style="height: 3em; width: 25em;">❑ [[Abdominal aortography]] to assess the renal arteries during coronary and peripheral[[angiography]]</div>}}
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{{familytree | | |!| F01 | | F02 | | | | |!| | | | F01=<div style="height: 1em; width: 10em; padding:1em;">If none of the above proceed with [[MRA]]
</div>| F02= <div style="height: 1em; width: 10em; padding:1em;">If yes to any of the above, proceed with [[CT]]</div>}}
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{{familytree | | | G01 | | G02 | | | | | G03 | G01= <div style="height: 5em; width: 10em;">Negative noninvasive test but with high clinical suspicion </div>| G02= <div style="height: 3em; width: 10em;">Evidence of RAS </div>| G03= <div style="height: 3em; width: 10em;">Evidence of RAS </div>}}
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{{familytree | | | H01 | | |!| | | | | | |!| H01= <div style="height: 2em; width: 10em; padding:1em;">Go to invasive imaging</div>}}
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{{familytree | | | | | | | |`|-|-| I01 |-|'| I01= <div style="height: 7.5em; width: 10em; padding:1em;">'''Confirmed RAS:
❑Proceed to medical therapy
❑Consider revascularization'''</div>}}
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Latest revision as of 21:25, 10 January 2014

 
 
 
 
 
 
High risk criteria:
❑ Severe structural or CAD
❑ Clinical or ECG features suggesting arrhythmic syncope:
-syncope during exertion or supine
-palpitations at the time of syncope
-family history ofSCD
-non- sustained VT
-conduction abnormalities with QRS >120 ms
-sinus bradycardia
-pre-exited QRS complex
-prolonged or short QR interval
-brugada pattern
-ARVC
❑ Important comorbidities:
-Severe anemia
-Electrolyte intolerance