• The goal of exercise testing in the setting of acute chest pain is typically to evaluate for coronary ischemia and not for exercise capacity per se. (medscape.com)
  • Acute coronary syndromes (ACS) is an umbrella term for conditions caused by sudden blockage of the blood supply to the heart. (biomerieuxindia.in)
  • Acute statin withdrawal does not interfere with the improvements of a session of exercise in postprandial metabolism. (medscape.com)
  • hs-CRP can be ordered for patients with some established risk factors of coronary heart disease to determine strategy for prevention of cardiovascular events and for follow-up of patients with acute coronary syndromes. (medscape.com)
  • Conversely, an incorrect diagnosis of an athlete's heart may put a young life in harm's way and waive further risk stratification and evaluation of family members for this genetic condition. (acc.org)
  • Clearly, further risk-stratification of the pool of patients considered eligible for ICDs would have broad implications for the healthcare system. (uscjournal.com)
  • We examined the end points of all-cause mortality, cardiac mortality and sudden cardiac death. (bmj.com)
  • There was no significant reduction in cardiac mortality or sudden death (OR 0.78, p=0.85, and OR 0.34, p=0.25, respectively). (bmj.com)
  • Conclusions Although there was a trend towards reduced overall mortality when comparing early AVR in patients with asymptomatic, severe AS to a symptom-driven AVR approach, there was no significant difference in cardiac mortality or sudden death. (bmj.com)
  • An individual approach focusing on individual risk stratification and operative mortality is required until more robust, randomised trial data are available. (bmj.com)
  • Although syncope is associated with serious risks, short-term mortality is low (i.e., 0.7% at 10 days and 1.6% at 30 days). (aafp.org)
  • PICO 3.1a: Which risk tool(s) best predict(s) perioperative CV risk and mortality? (ccs.ca)
  • Sudden cardiac death (SCD) is the leading cause of mortality in patients with ischemic heart disease and left ventricular dysfunction. (uscjournal.com)
  • Reflecting these interests, the three broad foci of the survey are (1) socioeconomic status and mortality, (2) associates between risk factors and mortality, and (3) health care sought and provided in the last year of life. (cdc.gov)
  • It has long been associated with ventricular arrhythmias and sudden death. (wikipedia.org)
  • The family history of cardiovascular diseases is considered positive in athletes when close relatives had experienced a premature heart attack or sudden death (below 55 years of age in males and 65 years in females), or suffered from cardiomyopathy, Marfan syndrome, long QT syndrome, Brugada syndrome, severe arrhythmias, coronary artery disease, or other disabling cardiovascular diseases. (escardio.org)
  • The majority of sudden cardiac death events in athletes are due to ventricular arrhythmias as a result of underlying molecular and/or structural level pathologic substrate. (scienceopen.com)
  • In this article, we will review the physiologic cardiac adaptations to exercise along with arrhythmias seen in athletes with a focus on those commonly associated with sudden cardiac death. (scienceopen.com)
  • Non-compaction cardiomyopathy is a congenital disorder of the myocardium causing cardiomyopathy, a variety of arrhythmias, conduction disorders, and increased risk of sudden death. (msdmanuals.com)
  • Overview of Arrhythmias The normal heart beats in a regular, coordinated way because electrical impulses generated and spread by myocytes with unique electrical properties trigger a sequence of organized myocardial. (msdmanuals.com)
  • Her research is focused on developing risk stratifying tools for life threatening ventricular arrhythmias and sudden cardiac death. (ous-research.no)
  • Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. (jamanetwork.com)
  • Depending on which disorder you are looking to identify, Holter monitoring, exercise testing and cross-sectional imaging can be invaluable in reaching a diagnosis. (escardio.org)
  • A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to under an exercise echocardiography. (bvsalud.org)
  • Diagnosis includes ECG, cardiac imaging, and genetic testing. (msdmanuals.com)
  • Diagnosis, Risk Stratification, And Management Of Pulmonary Hypertension Of Sickle Cell Disease. (guidelinecentral.com)
  • As of 2006, the thickness, commonly referred to as is not yet an agreed Testing and diagnosis for anomalous aortic origin of a coronary artery Because AAOCA us the precise volume of the inside plus the central layers of about 25 mm (1 in) of artery length. (ddtpsod.com)
  • Overview of Stroke Strokes are a heterogeneous group of disorders involving sudden, focal interruption of cerebral blood flow that causes neurologic deficit. (msdmanuals.com)
  • The second large ARB randomised controlled trial (RCT) published this year evaluated whether irbesartan would reduce the risk of cardiovascular events in patients with AF.3 Patients with a history of risk factors for stroke and a systolic blood pressure of at least 110 mm Hg were randomly assigned to receive either irbesartan (target dose of 300 mg once daily) or placebo. (romanianjournalcardiology.ro)
  • These materials that stress can increase blood pressure caused by eating a heart attack relies on this hardness starts the fruit and Sodium intake every day might want you have one can also been diagnosed with Postpartum blood flow to help his situation you take antihypertensive agent and stroke starts again after PS stratification. (tantrakamala.com)
  • In controlled trials, patients experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL [see WARNINGS AND PRECAUTIONS ]. (rxlist.com)
  • A myocardial perfusion SPECT (single photon emission computed tomography) test is a procedure that demonstrates the function of the myocardium. (medscape.com)
  • Transient ischemic dilation (TID) in the setting of abnormal stress-rest cardiac SPECT myocardial perfusion imaging (MPI) has been linked with increased cardiovascular risk. (snmjournals.org)
  • In this study, cardiac CT was used to evaluate the prevalence of atherosclerotic lesions and the severity of coronary artery stenosis in patients with TID of the left ventricle with or without associated myocardial perfusion defects on SPECT MPI. (snmjournals.org)
  • Transient ischemic dilation (TID) on stress SPECT myocardial perfusion imaging (MPI) is defined as the apparent presence of left ventricular (LV) dilation on poststress relative to rest images. (snmjournals.org)
  • Previous studies have suggested that TID in the context of reversible myocardial perfusion defects is associated with increased risk of severe, extensive multivessel coronary artery disease (CAD) ( 1 , 6 , 7 ). (snmjournals.org)
  • It is most often used in patients who have had myocardial infarctions (heart attacks) or other heart damage to see if they are at high risk of developing a potentially lethal cardiac arrhythmia. (wikipedia.org)
  • The presence of TID with an otherwise normal SPECT MPI study does not translate into a greater extent of coronary artery disease as assessed by cardiac CT or increased risk for future major adverse cardiac events. (snmjournals.org)
  • TID in the setting of an abnormal SPECT MPI study has also been linked with increased cardiovascular risk and poor cardiovascular outcomes ( 8 - 11 ). (snmjournals.org)
  • This can present with palpitations or syncope from an atrioventricular reciprocating tachycardia or rarely sudden death secondary to ventricular fibrillation from rapid conduction of atrial fibrillation across the accessory pathway. (escardio.org)
  • Most modern references to TWA refer to microvolt T wave alternans (MTWA), a non-invasive heart test that can identify patients who are at increased risk of sudden cardiac death. (wikipedia.org)
  • Otherwise, positive and indeterminate results are often lumped together when making clinical judgments about the likelihood of sudden cardiac death. (wikipedia.org)
  • In patients who have a negative (normal) MTWA test the risk of sudden cardiac death is very low. (wikipedia.org)
  • competitive sport activity enhances by 2.5 the risk of sudden death in adolescents and young athletes (1). (escardio.org)
  • 7 In those with a family history of sudden death, HCM or a clinical exam with a resting/provocable systolic ejection murmur, a heightened suspicion and pointed discussion will be helpful. (acc.org)
  • Sudden cardiac death related to athletic competition is a rare but tragic event. (scienceopen.com)
  • The occurrence of sudden cardiac death (SCD) in an athlete is a tragic event that deeply affects family members, teammates, and at times, an entire community. (scienceopen.com)
  • Observational studies have shown the annual risk of sudden death is about 1% per year. (bmj.com)
  • and to ventricular tachyarrhythmias, cardiac arrest, and sudden death. (msdmanuals.com)
  • Brugada syndrome is a disorder characterized by sudden death associated with one of several ECG patterns characterized by incomplete right bundle-branch block and ST-segment elevations in the anterior precordial leads. (medscape.com)
  • To date, the only treatment that has proven effective in treating ventricular tachycardia and fibrillation and preventing sudden death in patients with Brugada syndrome is implantation of an automatic implantable cardiac defibrillator (ICD). (medscape.com)
  • Erosion or rupture of the plaque leads to the formation of a blood clot (thrombus) that blocks the flow of blood to the heart, starving it of oxygen and ultimately leading to myocardial necrosis (tissue death in the heart muscle). (biomerieuxindia.in)
  • Several comparable clinical decision rules can be used to assess the short-term risk of death and the need for hospital admission. (aafp.org)
  • Patients with syncope and evidence of congestive heart failure or structural heart disease, abnormal electrocardiographic findings, or a family history of sudden death should be admitted to the hospital for emergent evaluation. (aafp.org)
  • Patients with syncope who are at low risk of adverse events (e.g., those with symptoms consistent with vasovagal or orthostatic hypotension syncope, no history of heart disease, no family history of sudden cardiac death, and normal electrocardiographic findings) may be safely followed without further intervention or treatment. (aafp.org)
  • Your doctor may ask you to attend more closely to changes in your heart rhythms if your family has a history of heart disease or sudden death. (hopkinsmedicine.org)
  • Together with Thor Edvardsen, the center director, Haugaa is a principal investigator for center workpackage focusing on risk assessment for sudden cardiac death (SCD) and myocardial function. (ous-research.no)
  • Long QT syndrome (LQTS) is a congenital disorder characterized by a prolongation of the QT interval on electrocardiograms (ECGs) and a propensity to ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death. (medscape.com)
  • Genetic Variations Within METTL16 and Susceptibility to Sudden Cardiac Death in Chinese Populations With Coronary Artery Disease. (cdc.gov)
  • Sudden cardiac death in athletes. (jamanetwork.com)
  • Despite its legal Buy Nifedipine Over Internet success in treatments and use since the 1880s, the mechanism of nitroglycerine is still incompletely and are not at risk of bleeding may want but does not reduce the risk of death, future diverse etiologies, in particular, the role of CE. (ddtpsod.com)
  • Bifascicular block or LBBB in young individuals should prompt screening of siblings and consideration of genetic testing to exclude a genetically determined progressive conduction abnormality (e.g. (escardio.org)
  • The positive familial history can be especially helpful in athletes without any clinical symptoms of disease and should encourage a doctor to perform further necessary examinations (resting ECG, echocardiography, ECG Holter monitoring or eventually genetic tests). (escardio.org)
  • Replacing device-measured sedentary time with physical activity is associated with lower risk of coronary heart disease regardless of genetic risk. (cdc.gov)
  • Cardiopulmonary exercise (CPX) testing is useful in differentiating athlete's heart from HCM. (acc.org)
  • Investigations include CMR, cardiopulmonary exercise test, stress echocardiography, signal-averaged electrocardiogram, 24-h electrocardiogram monitoring, laboratory tests and patient-reported outcome measures. (biomedcentral.com)
  • Laboratory testing and neuroimaging have a low diagnostic yield and should be ordered only if clinically indicated. (aafp.org)
  • In non-compaction cardiomyopathy, the disordered myocardial architecture and associated microvascular abnormalities lead to myocardial fibrosis. (msdmanuals.com)
  • Subclinical reduction in LV strain before mitral repair predicts a fall in LV ejection fraction following surgery and is thought to reflect the development of myocardial fibrosis in response to chronic volume overload. (biomedcentral.com)
  • Myocardial fibrosis can be detected non-invasively using cardiac magnetic resonance (CMR) imaging techniques as an expansion of the extracellular volume (ECV). (biomedcentral.com)
  • Establishing the link between myocardial fibrosis (measured on CMR and validated through histology), with early ventricular dysfunction, will offer physicians a novel non-invasive biomarker that can further inform the timing of surgery. (biomedcentral.com)
  • ACS is suspected when a person presents with symptoms, particularly chest pain, and especially when they also have known risk factors like high blood pressure, being overweight or a family history. (biomerieuxindia.in)
  • In patients whose symptoms and condition have become stable after initial treatment, this assessment should include stress testing. (bmj.com)
  • Your symptoms are sudden and abnormal. (hopkinsmedicine.org)
  • Previous studies have identified that the need for a permanent ventricular pacing system (PPMv) may be associated with additional adverse long-term outcomes.OBJECTIVES: The goal of this study was to quantify the attributable risk of PPMv in patients with SV, and to identify modifiable risk factors.METHODS: This international study was sponsored by the Pediatric and Congenital Electrophysiology Society. (stanfordchildrens.org)
  • Patients who test MTWA positive or indeterminate for heart rate or dense ectopy (abnormal) should be referred to an electrophysiologist for further evaluation. (wikipedia.org)
  • With the MMA method, risk is defined by the peak MTWA level, with cutpoints of 47μV and 60 μV for abnormal and severely abnormal risk, respectively. (wikipedia.org)
  • High-risk patients with cardiovascular or structural heart disease, history concerning for arrhythmia, abnormal electrocardiographic findings, or severe comorbidities should be admitted to the hospital for further evaluation. (aafp.org)
  • Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). (bvsalud.org)
  • Sensitive and specific cardiac marker tests with a rapid turnaround time are essential to global risk assessment and treatment of all patients presenting with ACS. (biomerieuxindia.in)
  • Risk assessment with stress testing should be performed unless contraindicated, preferably before discharge from hospital. (bmj.com)
  • stress testing for risk assessment is unnecessary if the patient is already in a high risk category for which coronary angiography is indicated. (bmj.com)
  • Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease CG67. (guiasalud.es)
  • Since the publication of the 2017 CCS guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery, [90] new evidence has emerged for evaluating clinical risk indices specific to patients who undergo peripheral vascular surgery. (ccs.ca)
  • The scope of this section includes the evaluation of available evidence for preoperative assessment and risk stratification of patients who undergo nonurgent vascular surgery for PAD along the following themes: clinical risk indices, cardiac biomarkers, and noninvasive testing. (ccs.ca)
  • Patients who require emergency lower extremity arterial revascularization should not have their surgery delayed by a preoperative risk assessment. (ccs.ca)
  • Conversely, patients who undergo scheduled, nonemergency lower extremity arterial revascularization surgery should undergo cardiac risk assessment. (ccs.ca)
  • Physicians or surgeons with training and competency in cardiac risk assessment should perform preoperative assessments. (ccs.ca)
  • In some cases, the test is equivalent to a more invasive electrophysiology (EP) study. (wikipedia.org)
  • 8-10 Earlier studies have suggested that MTWA may be a useful, non-invasive method for discriminating between patients with ischemic cardiomyopathy who are at low and high risk for SCD. (uscjournal.com)
  • The MMA method uses routine, symptom-limited exercise stress testing or ambulatory ECG monitoring and standard electrodes and requires that chronic medications be retained. (wikipedia.org)
  • As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). (natap.org)
  • These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. (natap.org)
  • They may be sudden and brief, persistent or chronic, lasting for seconds, hours, to days or weeks (chronic). (rjmatthewsmd.com)
  • Antiadrenergic therapeutic measures (eg, use of beta-blockers, left cervicothoracic stellectomy) and device therapy (eg, use of pacemakers, implantable cardioverter-defibrillators) aim to decrease the risk and lethality of cardiac events. (medscape.com)
  • To decrease these risks, as well as the risk of serious cardiovascular and thromboembolic reactions, use the lowest dose needed to avoid RBC transfusions [see DOSAGE AND ADMINISTRATION ]. (rxlist.com)
  • [3] Treating people who have strep throat with antibiotics can decrease the risk of rheumatic heart disease. (wikipedia.org)
  • Increasingly, due to changes in the clinical practice environment, emergency healthcare providers are ordering these tests and using the results for clinical decision making. (medscape.com)
  • A clinical history of syncope or presyncope is common although milder presentations with fatigue or dyspnoea, reduced exercise capacity, or cognitive impairment are also possible. (escardio.org)
  • Multiple prospective clinical trials indicate that patients from broad groups of at risk populations who test MTWA negative will likely live ventricular event-free for 12 to 24 months after their initial MTWA test. (wikipedia.org)
  • The Negative Predictive Value of MTWA testing has been shown to be 98% accurate for follow-up periods of 12-24 months in various clinical studies. (wikipedia.org)
  • Risk estimation and the prevention of cardiovascular disease: a national clinical guideline. (guiasalud.es)
  • The summary of the findings and GRADE Evidence Profile for the 3 clinical risk scores are available on ccs.ca. (ccs.ca)
  • 11,12 While provocative, these studies were primarily limited in their ability to adjust for baseline differences in clinical characteristics (such as age and LVEF) between patients who tested MTWA-negative and non-negative (positive and indeterminate). (uscjournal.com)
  • All MTWA tests were interpreted according to standard criteria by an expert reader blinded to patient characteristics and clinical outcomes. (uscjournal.com)
  • Other doses of oral conjugated estrogens with medroxyprogesterone acetate, and other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials and, in the absence of comparable data, these risks should be assumed to be similar. (nih.gov)
  • ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in clinical studies of patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers [see WARNINGS AND PRECAUTIONS ]. (rxlist.com)
  • However, other cardiovascular abnormalities such as anomalies of coronary vessels, arrhythmogenic dysplasia of right ventricle (ADRV), mitral valve prolapse, myocarditis, coronary vessel bridge, Marfan Syndrome, bicuspid aortic valve, pulmonary thrombo-embolism and channelopathies also significantly contribute to cardiovascular risk in athletes. (escardio.org)
  • Prevention of ACS starts with healthy living and sometimes medication to lower risk factors . (biomerieuxindia.in)
  • 5) Evans A, Tolonen H, Hense HW, Ferrario M, Sans S, Kuulasmaa K. Trends in coronary risk factors in the WHO MONICA project. (guiasalud.es)
  • A prostaglandin E1 (Alprostadil) are the balance in the same age, which is essential, therefore, be treated with substantial health and a risk factors Proinflammatory cytokines and in pregnancy are outsourced from varying doses, the likelihood of patients who experience complications are both men to having a paradigm is through an increased bleeding from fluid accumulated within 48 hours using aspirin. (tantrakamala.com)
  • Metabolites as Risk Factors for Diabetic Retinopathy in Patients with Type 2 Diabetes: a 12-year Follow-up Study. (medscape.com)
  • 11. Risk factors for development of atrial fibrillation. (prime-cardiology.com)
  • [3] It is estimated that dietary risk factors are associated with 53% of CVD deaths. (wikipedia.org)
  • [3] Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial. (wikipedia.org)
  • Sustained efforts in improving risk factors should further benefit the cardiovascular health of people with diabetes. (cdc.gov)
  • Therefore, controlling the risk factors for cardiovascular disease is of the utmost importance in reducing the risk for developing cardiovascular disease in the diabetic population. (cdc.gov)
  • In the U.S., important strides have been made in reducing the impact of several key risk factors for cardiovascular disease. (cdc.gov)
  • The TWA test uses an electrocardiogram (ECG) measurement of the heart's electrical conduction using electrodes attached to one's torso. (wikipedia.org)
  • these patients are also in a category at high risk of further cardiac events. (bmj.com)
  • However, operative risks must be explained to the patient and their family. (ccs.ca)
  • No trial has identified a hemoglobin target level, ESA dose, or dosing strategy that does not increase these risks [see DOSAGE AND ADMINISTRATION ]. (rxlist.com)
  • Pharmacologic stress testing, established after exercise testing, is a diagnostic procedure in which cardiovascular stress is induced by pharmacologic agents in patients with decreased functional capacity or in patients who cannot exercise. (medscape.com)
  • Further testing may be indicated to exclude other diagnostic possibilities. (medscape.com)
  • In cases of unexplained syncope, provocative testing and prolonged electrocardiographic monitoring strategies can be diagnostic. (aafp.org)
  • An increased corrected QT (QTc) interval in response to standing up ("response to standing" test), which is associated with increased sympathetic tone, can provide more diagnostic information in patients with LQTS. (medscape.com)
  • Aortic stenosis is typically diagnosed through a combination of physical exams, medical history review, and diagnostic testing. (prime-cardiology.com)
  • Exercise is performed using a treadmill or a bicycle ergometer. (medscape.com)
  • If a treadmill is used, images are obtained prior to exercise and then within 60-90 seconds of completing exercise. (medscape.com)
  • Many clinicians who see athletes often prefer a CPX to standard treadmill exercise testing (TMET). (acc.org)
  • Patients were enrolled between March 2001 and June 2004 and underwent baseline MTWA testing by treadmill exercise (Heartwave system, Cambridge Heart, Inc., Bedford, Massachusetts). (uscjournal.com)
  • citation needed] Microvolt T wave alternans testing acts as a risk stratifier between patients who need implantable cardiac defibrillators (ICDs) and those who do not. (wikipedia.org)
  • If the risk is high, medications to thin the it can lead to coronary artery rupture and cardiac. (ddtpsod.com)
  • Low-risk patients with a single episode of syncope can often be reassured with no further investigation. (aafp.org)
  • Syncope is a sudden, brief, and transient loss of consciousness caused by cerebral hypoperfusion. (aafp.org)
  • Your risk of developing atherosclerosis is significantly increased if about this ingredient that stops heart attacks in only. (ddtpsod.com)
  • The estimated 10-year risk for CHD among adults with diabetes has improved significantly from 1999-2000 to 2007-2008. (cdc.gov)
  • 4 Current guidelines do not recommend intervention in asymptomatic patients unless they are in certain high-risk groups such as those with very severe asymptomatic AS or those with haemodynamic changes on exercise. (bmj.com)
  • Regarding cardiovascular risk stratification, both the intervention (26 %) and the control (6 %) groups shifted to the lower-risk class. (bvsalud.org)
  • The first of these trials, published in 2009, tested the hypothesis that the ARB valsartan could reduce the recurrence of AF in patients with underlying cardiovascular disease, diabetes or left atrial enlargement and a history of documented AF, in addition to established treatments.2 A total of 1442 patients were enrolled into the study-722 assigned to the valsartan group (target dose 320 mg) and 720 to the placebo group. (romanianjournalcardiology.ro)
  • As a result, physiologic adaptations related to training such as increased myocardial thickness may occur. (acc.org)
  • Physiologic adaptation to exercise is dependent on the type of exercise being performed and the degree with which it is performed. (scienceopen.com)
  • Two of the major goals in the treatment of this condition include reducing progression or recurrence of the arrhythmia and decreasing the risk of cardiovascular events, thereby improving quality of life and decreasing morbidity. (romanianjournalcardiology.ro)
  • The study by the Ministry of Health in Israel, a country with one of the highest vaccination rates in the world, assesses the risk of myocarditis after receiving the 2nd vaccine dose to be between 1 in 3000 to 1 in 6000 in men of age 16-24 and 1 in 120,000 in men under 30 11 , 12 , 13 . (nature.com)
  • The CDC has recently posted a warning regarding a vaccine-related risk of myocarditis, but still maintained their recommendation to vaccinate young individuals and children over 12 7 . (nature.com)
  • Non-compaction cardiomyopathy is a rare (1 in 7000) cardiomyopathy resulting from failure of the embryonic ventricular myocardial compaction process, such that the ventricular myocardium consists of an outer layer of normally compact myocardium and an inner non-compacted layer that has retained embryonal characteristics. (msdmanuals.com)
  • These noninvasive tests can be performed in an outpatient setting, in a physician's office, in a hospital, or in an observation unit, as well as for admitted inpatients. (medscape.com)