Download CARDIOLOGY

SIERRA NEVADA MEDICAL ASSOCIATES, INC. (IPA)
UTILIZATION GUIDELINES
PRIMARY CARE MANAGEMENT GUIDELINES
CARDIOLOGY
The Primary Care Physician should:
1. Evaluate chest pain, murmurs, and palpitations, and recognize significant heart
disease by history, examination, EKG, echocardiogram, and stress EKG.
2. Evaluate and treat coronary risk factors including smoking, hyperlipidemia, diabetes,
and hypertension.
3. Treat hypertension and non life-threatening ventricular arrhythmias.
4. Evaluate patients with CHF for degree of LV dysfunction and for etiology of CHF.
Treat CHF patients with diuretics, beta blockers, aldactone, digoxin, and afterload
reduction as appropriate.
5. Treat atrial fibrillation, usually with a rate-slowing drug plus coumadin.
6. Evaluate patients with stable angina non-invasively for severity of CAD. Treat
angina medically with nitrates, beta-blockers, calcium-channel blockers, and aspirin
(or Plavix) as appropriate.
7. Attempt to determine whether syncope is cardiac by history, examination, EKG,
ambulatory monitoring, echocardiogram, and where appropriate, stress testing.
8. In general, consult for:
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acute myocardial infarction
unstable angina requiring hospitalization or post-infarction angina
angina despite aggressive medical therapy
noninvasive evaluation that suggests moderate to severe CAD
CHF not responding to medical therapy
syncope discovered to be on a cardiac basis or if etiology of syncope remains
unclear
recurrent PSVT
ventricular tachycardia
other arrhythmias refractory to initial medical treatment
significant pericardial effusion
moderate to severe valvular disease
congenital heart disease
PC MGMT - CARDIOLOGY
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compromised LV systolic function
CHF plus angina
Pericarditis (and not responding to NSAIDs)
suspected Myocarditis
Endocarditis (also obtain I.M. consult)
CHF with SOB of unknown origin
hypertension refractory to treatment
hyperlipidemia refractory to treatment
sudden death in young first degree relative
PC MGMT - CARDIOLOGY
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