![]() Progressive Diagnostics, Llc is registered as an entity type code: 2. This address may contain the same information as the provider location address. The mailing address of the provider being identified. This address cannot include a Post Office box. For providers with more than one physical location, this is the primary location. The location address of the provider being identified. The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider. What is the National Provider Indentifier (NPI)? Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. If concurrent LV dysfunction is detected (ejection fraction less than 50%), these patients may have clinically significant “low-flow” aortic stenosis.(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. 21 – 23 However, stenosis severity may be more difficult to assess in some patients who have only a moderately elevated transaortic velocity (3.0 to 4.0 m per second) but an aortic valve area less than 1.0 cm 2. 20 Patients typically remain asymptomatic until maximum transvalvular velocity is more than four times the normal velocity or at least 4.0 m per second. 20 The primary indices of stenosis severity are maximum transaortic velocity and the Doppler-derived mean pressure gradient ( Table 1). 18 – 20 Transthoracic echocardiography, the recommended initial test for patients with suspected aortic stenosis, allows reliable identification of the number of valve leaflets and assessment of valve motion, leaflet calcification, and LV function. Medical management of concurrent hypertension, atrial fibrillation, and coronary artery disease will lead to optimal outcomes.Įchocardiography is indicated in patients with a loud unexplained systolic murmur, a single second heart sound, a history of a bicuspid aortic valve, or symptoms that may be caused by aortic stenosis. Cardiology referral is recommended for all patients with symptomatic moderate and severe aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular systolic dysfunction. In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. Patients should be educated about the importance of promptly reporting symptoms to their physicians. Transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk. Surgical valve replacement is the standard of care for patients at low to moderate surgical risk. However, select patients may also benefit from aortic valve replacement before the onset of symptoms. Watchful waiting is recommended for most asymptomatic patients. Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in after-load caused by aortic stenosis. ![]() Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it decreases rapidly after symptoms appear. ![]() ![]() Aortic stenosis affects 3% of persons older than 65 years. ![]()
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