DVT complete diagnostic approach resident survival guide

Probability of infective endocaritis	Characteristics
Definite diagnosis by pathological criteria	❑ Microorganisms demonstrated by culture or histological examination of a vegetation, OR ❑ Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Definite diagnosis by clinical criteria	❑ 2 major criteria; OR ❑ 1 major criterion and 3 minor criteria; OR ❑ 5 minor criteria
Possible diagnosis	❑ 1 major criterion and 1 minor criterion; OR ❑ 3 minor criteria
Rejected diagnosis	❑ Firm alternative diagnosis explaining evidence of IE, OR ❑ Resolution of IE syndrome with antibiotic therapy for 4 days, OR ❑ No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days, OR ❑ Does not meet criteria for possible IE as above

Criteria	Definite Infective Endocarditis According to Modified Duke Criteria
Pathological Criteria	Microorganisms demonstrated by culture or histological examination of a vegetation Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Clinical Criteria	2 major criteria; or 1 major criterion and 3 minor criteria; or 5 minor criteria
Possible IE	1 major criterion and 1 minor criterion; or 3 minor criteria
Rejected	Firm alternative diagnosis explaining evidence of IE; or Resolution of IE syndrome with antibiotic therapy for 4 days; or No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or Does not meet criteria for possible IE as above

Table

Management of focal atrial tachycardia Acute treatment Conversion in hemodynamically unstable patient ▸ DC cardioversion (Class I, level of evidence B) Conversion in hemodynamically stable patient ▸ Adenosine (Class IIa, level of evidence C) OR ▸ Verapamil (Class IIa, level of evidence C) OR ▸ Diltiazem (Class IIa, level of evidence C) OR ▸ Beta blocker (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Procainamide (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) Rate control ▸ Verapamil (Class I, level of evidence C) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Beta blocker (Class I, level of evidence C) OR ▸ Digoxin (Class IIb, level of evidence C) Prophylactic therapy Recurrent symptomatic atrial tachycardia ▸ Catheter ablation (Class I, level of evidence B) OR ▸ Beta blockers (Class I, level of evidence C) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Verapamil (Class I, level of evidence C) OR ▸ Disopyramide (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) Asymptomatic or symptomatic incessent atrial tachycardia ▸ Catheter ablation (Class I, level of evidence B) Asymptomatic and non-sustained atrial tachycardia ▸ No therapy (Class I, level of evidence C) OR ▸ Catheter ablation (Class III, level of evidence C) Management of focal and nonparoxysmal junctional tachycardia Focal junctional tachycardia ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) OR ▸ Catheter ablation (Class IIa, level of evidence C) Non paroxysmal junctional tachycardia ▸ Reverse digitalis toxicity (Class I, level of evidence C) AND ▸ Correct hypokalemia (Class I, level of evidence C) AND ▸ Treat myocardial ischemia (Class I, level of evidence C) OR ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Calcium channel blockers (Class IIa, level of evidence C) Management of recurrent AVNRT AVNRT with hemodynamic intolerance ▸ Catheter ablation (Class I, level of evidence B) OR ▸ Verapamil (Class IIa, level of evidence C) OR ▸ Diltiazem (Class IIa, level of evidence C) OR ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Amiodarone (Class IIa, level of evidence C) OR ▸ Sotalol (Class IIa, level of evidence C) OR ▸ Flecainide (Class IIa, level of evidence C) OR ▸ Propafenone (Class IIa, level of evidence C) Recurrent symptomatic AVNRT ▸ Catheter ablation (Class I, level of evidence B) OR ▸ Verapamil (Class I, level of evidence B) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Beta blockers (Class IIa, level of evidence C) OR ▸ Digoxin (Class IIb, level of evidence C) Recurrent AVNRT unresponsive to beta blockers and calcium channel blockers, patient not desiring radiofrequency ablation ▸ Flecainide (Class IIa, level of evidence B) OR ▸ Propafenone (Class IIa, level of evidence B) OR ▸ Sotalol (Class IIa, level of evidence B) OR ▸ Amiodarone (Class IIb, level of evidence C) Single episode of AVNRT or infrequent AVNRT in patients desiring complete control of arrhythmia ▸ Catheter ablation (Class I, level of evidence B) Documented PSVT with only dual AV nodal pathways OR single echo beats documented during electrophysiological study AND no other cause of arrhythmia identified ▸ Verapamil (Class I, level of evidence C) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Beta blockers (Class I, level of evidence C) OR ▸ Flecainide (Class I, level of evidence C) OR ▸ Propafenone (Class I, level of evidence C) OR ▸ Catheter ablation (Class I, level of evidence B) Infrequent, well tolerated AVNRT ▸ No therapy (Class I, level of evidence C) OR ▸ Vagal maneuvers (Class I, level of evidence B) OR ▸ Pill in the pocket (Class I, level of evidence B) OR ▸ Verapamil (Class I, level of evidence B) OR ▸ Diltiazem (Class I, level of evidence B) OR ▸ Beta blockers (Class I, level of evidence B) OR ▸ Catheter ablation (Class I, level of evidence B) Management of inappropriate sinus tachycardia ▸ Beta blockers (Class I, level of evidence C) OR ▸ Verapamil (Class I, level of evidence C) OR ▸ Diltiazem (Class I, level of evidence C) OR ▸ Catheter ablation (Class I, level of evidence B)