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Heart exam

The heart exam section covers physical exam and diagnostics about the patient's heart. For best results, findings should characterize the condition of the heart during the initial forty-eight hours of hospitalization.

Blocked arteries

Enter the number of blocked coronary arteries, usually determined by a cardiac catheterization (coronary angiogram), in the appropriate box. For reference, the four coronary arteries are called (1) circumflex; (2) left anterior descending; (3) left main, and (4) right coronary. For example, if the circumflex and right coronary arteries are both blocked, enter the number 2. If no coronary arteries are blocked, or if no exam or blockage test was performed within forty-eight hours of admission, leave zero as the default. If a cath or angiogram was performed after forty-eight hours of admission, you may wish to see the possible impact of this information by calculating "what if" results with both the default zero value and the later test result value. Remember, however, that including test results after forty-eight hours may yield unreliable calculations.

Ejection fraction

Enter the patient's ejection fraction as a percent in the appropriate box. For example, if the ejection fraction was 50%, you would enter the number 50. The ejection fraction is usually determined by (1) cardiac catheterization (coronary angiogram); (2) cardiac ultrasound or (3) MUGA. If no ejection fraction value is available or if none of the above tests was performed within the first forty-eight hours of admission, leave the default value of 70. In general, ejection fraction values from tests performed after forty-eight hours of admission are not reliable for use in this survival calculator.

Congestive heart failure

After ejection fraction, the heart exam contains a group of four check boxes covering the current condition of the patient's heart. Check these boxes only if the patient had positive findings on a specific exam (or exams). If the patient has a finding of congestive heart failure (CHF) on a chest x-ray (CXR) taken during the first forty-eight hours of admission, mark the appropriate box. Other terms for CHF include interstitial fluid, cardiac or ventricular decompensation, interstitial edema, lung edema, pulmonary interstitial edema, and kerley b-lines.

Hypertrophy

If the patient has a finding of cardiac hypertrophy diagnosed during the first forty-eight hours of admission, then mark the appropriate box. Cardiac hypertrophy is usually found on the following diagnostic exams: (1) cardiac catheterization (coronary angiogram); (2) cardiac doppler/ultrasound; (3) echocardiogram; (4) MUGA or (5) a wall motion study. Another description of hypertrophy is increased cardiac thickness.

Acute MI

If the patient has a finding of acute myocardial infarction (MI) positively diagnosed by an EKG test during the first forty-eight hours of admission, then mark the appropriate box. Other terms for acute MI include acute or subacute infarct and acute necrosis.

Unspecified MI

If the patient has a finding of MI, diagnosed by an EKG test during the first forty-eight hours of admission, but the original onset of the MI occurred at an unspecified (that is, unknown) age, then mark the appropriate box. Another notation for MI of unspecified age is the term evolving infarct. Do not check this box if the EKG report lists an MI with modifiers like "old", "remote", "sub-acute", or "within 4 weeks prior to admission".

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