Persius/hicric huggingface dataset:
Class III recommendations in guidelines for cardiovascular medicine organized by guideline keywords

# Overview
There are 584 class III recommendations in guidelines published by American cardiology societies. Class III recommendations may be classified either by guideline name/year of publication or by recommendation level of evidence.

# Organized by Guideline Keywords
The table shown below is a list of class III recommendations obtained from American guidelines for cardiovascular medicine. The list is organized by guideline name/keywords in alphabetical order. Alternatively, to view the same list organized by year of guideline publication, click here.
L-transposition of the great arteries or congenitally corrected transposition of the great arteries

# Overview

# Classification

# Pathophysiology

# Causes

# Differentiating Levo-transposition of the great arteries from other Diseases

# Epidemiology and Demographics

# Natural History, Complications and Prognosis

# Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings |  Electrocardiogram | Chest X Ray | Echocardiography or Ultrasound | Cardiac catheterization

# Treatment
L-transposition of the great arteries ACC/AHA guidelines | ACC/AHA recommendations for surgical intervention | Post-operative care | ACC/AHA recommendations for reproduction

# Case Study
Case #1

# Acknowledgements and Initial Contributors to Page
Leida Perez, M.D.
The Living Guidelines: Patients with Pulmonary Hypertension: Polling Results for CLASS I Guidelines

# Class I Guidelines
1. Correction of hypoxemia and acidosis is the recommended primary therapeutic measure for patients who develop AF during an acute pulmonary illness or exacerbation of chronic pulmonary disease. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 1 for patients with pulmonary hypertension should be:
2. A non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with obstructive pulmonary disease who develop AF. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 2 for patients with pulmonary hypertension should be:
3. Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of AF. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 3 for patients with pulmonary hypertension should be:
ACC/AHA guidelines-recommendations for permanent pacing in patients with congenital heart disease
ACC / AHA Guidelines-Recommendations for Permanent Pacing in Children, Adolescents, and Patients With Congenital(DO NOT EDIT) ==
-   Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 28202840. PMID 18483207
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CME Category::Cardiology
Duplex Ultrasonography to Evaluate Asymptomatic Patients With Known or Suspected Carotid Stenosis

# Diagnostic Testing Guidelines

## 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease (DO NOT EDIT)

### Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease (DO NOT EDIT)

### Duplex Ultrasonography to Evaluate Asymptomatic Patients With Known or Suspected Carotid Stenosis (DO NOT EDIT)

### In revascularization candidates

### Carotid Artery Evaluation and Revascularization Before Cardiac Surgery (DO NOT EDIT)
-  Jump up to: 1.0 1.1 1.2 1.3 Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL;  et al. (2011). "2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery". Circulation. 124 (4): 489532. doi:10.1161/CIR.0b013e31820d8d78. PMID 21282505.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) .mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
The Living Guidelines: Maintenance of sinus rhythm: Suggest Revisions to the CLASS IIa Guidelines

# Class IIa Guidelines
- Pharmacological therapy can be useful in patients with AF to maintain sinus rhythm and prevent tachycardia induced cardiomyopathy. (Level of Evidence: C) 
- Infrequent, well-tolerated recurrence of AF is reasonable as a successful outcome of antiarrhythmic drug therapy. (Level of Evidence: C) 
- Outpatient initiation of antiarrhythmic drug therapy is reasonable in patients with AF who have no associated heart disease when the agent is well tolerated. (Level of Evidence: C) 
- In patients with lone AF without structural heart disease, initiation of propafenone or flecainide can be beneficial on an outpatient basis in patients with paroxysmal AF who are in sinus rhythm at the time of drug initiation. (Level of Evidence: B) 
- Sotalol can be beneficial in outpatients in sinus rhythm with little or no heart disease, prone to paroxysmal AF, if the baseline uncorrected QT interval is less than 460 ms, serum electrolytes are normal, and risk factors associated with class III drugrelated pro-arrhythmia are not present. (Level of Evidence: C) 
- Catheter ablation is a reasonable alternative to pharmacological therapy to prevent recurrent AF in symptomatic patients with little or no LA enlargement. (Level of Evidence: C)
The Living Guidelines: Patients with hyperthyroidism: Suggest Revisions to the CLASS I Guidelines

# Class I Guidelines
- Administration of a beta blocker is recommended to control the rate of ventricular response in patients with AF complicating thyrotoxicosis, unless contraindicated. (Level of Evidence: B) 
- In circumstances when a beta blocker cannot be used, administration of a non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with AF and thyrotoxicosis. (Level of Evidence: B) 
- In patients with AF associated with thyrotoxicosis, oral anticoagulation (INR 2.0 to 3.0) is recommended to prevent thromboembolism, as recommended for AF patients with other risk factors for stroke. (Level of Evidence: C) 
- Once a euthyroid state is restored, recommendations for antithrombotic prophylaxis are the same as for patients without hyperthyroidism. (Level of Evidence: C)
The Living Guidelines: Preventing Thromboembolism Suggest Revisions to the CLASS IIa Guidelines

# Class IIa Guidelines
- For primary prevention of thromboembolism in patients with non valvular AF who have just 1 of the following validated risk factors, antithrombotic therapy with either aspirin or a vitamin K antagonist is reasonable, based upon an assessment of the risk of bleeding complications, ability to safely sustain adjusted chronic anticoagulation, and patient preferences: age greater than or equal to 75 y (especially in female patients), hypertension, HF, impaired LV function, or diabetes mellitus. (Level of Evidence: A) 
- For patients with non valvular AF who have 1 or more of the following less well-validated risk factors, antithrombotic therapy with either aspirin or a vitamin K antagonist is reasonable for prevention of thromboembolism: age 65 to 74 y, female gender, or CAD. The choice of agent should be based upon the risk of bleeding complications, ability to safely sustain adjusted chronic anticoagulation, and patient preferences. (Level of Evidence: B) 
- It is reasonable to select antithrombotic therapy using the same criteria irrespective of the pattern (i.e., paroxysmal, persistent, or permanent) of AF. (Level of Evidence: B) 
- In patients with AF who do not have mechanical prosthetic heart valves, it is reasonable to interrupt anticoagulation for up to 1 week without substituting heparin for surgical or diagnostic procedures that carry a risk of bleeding. (Level of Evidence: C) 
- It is reasonable to reevaluate the need for anticoagulation at regular intervals. (Level of Evidence: C)
The Living Guidelines: Preventing Thromboembolism Suggest Revisions to the CLASS IIb Guidelines

# Class IIb Guidelines
- In patients 75 y of age and older at increased risk of bleeding but without frank contraindications to oral anticoagulant therapy, and in other patients with moderate risk factors for thromboembolism who are unable to safely tolerate anticoagulation at the standard intensity of INR 2.0 to 3.0, a lower INR target of 2.0 (range 1.6 to 2.5) may be considered for primary prevention of ischemic stroke and systemic embolism. (Level of Evidence: C) 
- When surgical procedures require interruption of oral anticoagulant therapy for longer than 1 week in high-risk patients, unfractionated heparin may be administered or low molecular weight heparin given by subcutaneous injection, although the efficacy of these alternatives in this situation is uncertain. (Level of Evidence: C) 
- Following percutaneous coronary intervention or revascularization surgery in patients with AF, low dose aspirin (less than 100 mg per d) and/or clopidogrel (75 mg per d) may be given concurrently with anticoagulation to prevent myocardial ischemic events, but these strategies have not been thoroughly evaluated and are associated with an increased risk of bleeding. (Level of Evidence: C) 
- In patients undergoing percutaneous coronary intervention, anticoagulation may be interrupted to prevent bleeding at the site of peripheral arterial puncture, but the vitamin K antagonist should be resumed as soon as possible after the procedure and the dose adjusted to achieve an INR in the therapeutic range. Aspirin may be given temporarily during the hiatus, but the maintenance regimen should then consist of the combination of clopidogrel, 75 mg daily, plus warfarin (INR 2.0 to 3.0). Clopidogrel should be given for a minimum of 1 month after implantation of a bare metal stent, at least 3 months for a sirolimus-eluting stent, at least 6 months for a paclitaxel-eluting stent, and 12 months or longer in selected patients, following which warfarin may be continued as monotherapy in the absence of a subsequent coronary event. When warfarin is given in combination with clopidogrel or low-dose aspirin, the dose intensity must be carefully regulated. (Level of Evidence: C) 
- In patients with AF younger than 60 y without heart disease or risk factors for thromboembolism (lone AF), the risk of thromboembolism is low without treatment and the effectiveness of aspirin for primary prevention of stroke relative to the risk of bleeding has not been established. (Level of Evidence: C) 
- In patients with AF who sustain ischemic stroke or systemic embolism during treatment with low intensity anticoagulation (INR 2.0 to 3.0), rather than add an antiplatelet agent, it may be reasonable to raise the intensity of anticoagulation to a maximum target INR of 3.0 to 3.5. (Level of Evidence: C)
The Living Guidelines: Preventing Thromboembolism Suggest Revisions to the CLASS I Guidelines

# Class I Guidelines
- Antithrombotic therapy to prevent thromboembolism is recommended for all patients with AF, except those with lone AF or contraindications. (Level of Evidence: A) 
- The selection of the antithrombotic agent should be based upon the absolute risks of stroke and bleeding and the relative risk and benefit for a given patient. (Level of Evidence: A) 
- For patients without mechanical heart valves at high risk of stroke, chronic oral anticoagulant therapy with a vitamin K antagonist is recommended in a dose adjusted to achieve the target intensity INR of 2.0 to 3.0, unless contraindicated. Factors associated with highest risk for stroke in patients with AF are prior thromboembolism (stroke, TIA, or 
- Anticoagulation with a vitamin K antagonist is recommended for patients with more than 1 moderate risk factor. Such factors include age 75 y or greater, hypertension, HF, impaired LV systolic function (ejection fraction 35% or less or fractional shortening less than 25%), and diabetes mellitus. (Level of Evidence: A) 
- INR should be determined at least weekly during initiation of therapy and monthly when anticoagulation is stable. (Level of Evidence: A) 
- Aspirin, 81325 mg daily, is recommended as an alternative to vitamin K antagonists in low-risk patients or in those with contraindications to oral anticoagulation. (Level of Evidence: A) 
- For patients with AF who have mechanical heart valves, the target intensity of anticoagulation should be based on the type of prosthesis, maintaining an INR of at least 2.5. (Level of Evidence: B) 
- Antithrombotic therapy is recommended for patients with atrial flutter as for those with AF. (Level of Evidence: C)
Management of Patients With Occlusive Disease of the Subclavian and Brachiocephalic Arteries

# Management of Patients With Occlusive Disease of the Subclavian and Brachiocephalic Arteries

## 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS: Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease (DO NOT EDIT)

### Management of Patients With Occlusive Disease of the Subclavian and Brachiocephalic Arteries (DO NOT EDIT)
The Living Guidelines: Maintenance of sinus rhythm: Polling Results for CLASS IIa Guidelines

# Class IIa Guidelines
1. Pharmacological therapy can be useful in patients with AF to maintain sinus rhythm and prevent tachycardia induced cardiomyopathy. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 1 for maintenance of sinus rhythm should be:
2. Infrequent, well-tolerated recurrence of AF is reasonable as a successful outcome of antiarrhythmic drug therapy. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2 for maintenance of sinus rhythm should be:
3. Outpatient initiation of antiarrhythmic drug therapy is reasonable in patients with AF who have no associated heart disease when the agent is well tolerated. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 3 for maintenance of sinus rhythm should be:
4. In patients with lone AF without structural heart disease, initiation of propafenone or flecainide can be beneficial on an outpatient basis in patients with paroxysmal AF who are in sinus rhythm at the time of drug initiation. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 4 for maintenance of sinus rhythm should be:
5. Sotalol can be beneficial in outpatients in sinus rhythm with little or no heart disease, prone to paroxysmal AF, if the baseline uncorrected 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 5 for maintenance of sinus rhythm should be:
6. Catheter ablation is a reasonable alternative to pharmacological therapy to prevent recurrent AF in symptomatic patients with little or no LA enlargement. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 6 for maintenance of sinus rhythm should be:
The Living Guidelines: Patients with hyperthyroidism: Polling Results for CLASS I Guidelines

# Class I Guidelines
1. Administration of a beta blocker is recommended to control the rate of ventricular response in patients with AF complicating thyrotoxicosis, unless contraindicated. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 1 for patients with hyperthyroidism should be:
2. In circumstances when a beta blocker cannot be used, administration of a non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with AF and thyrotoxicosis. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 2 for patients with hyperthyroidism should be:
3. In patients with AF associated with thyrotoxicosis, oral anticoagulation (INR 2.0 to 3.0) is recommended to prevent thromboembolism, as recommended for AF patients with other risk factors for stroke. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 3 for patients with hyperthyroidism should be:
4. Once a euthyroid state is restored, recommendations for antithrombotic prophylaxis are the same as for patients without hyperthyroidism. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 4 for patients with hyperthyroidism should be:
ACC/AHA recommendations for evaluation of patients with unoperated patent ductus arteriosus

# Overview
The ACC/AHA has given recommendations for evaluation of unoperated patient with patent ductus arteriosus

# 2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)

## Recommendations for evaluation of the unoperated patient (DO NOT EDIT)
For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme
Platelet monitoring can improve outcomes following PCI among clopidogrel resistant patients
March 29, 2008 By Lauren Ciaglo
SCAI-ACCi2 08-Chicago, IL: Investigators from France demonstrate that platelet monitoring of clopidogrel response using VASP phosphorylation index decreases the rate of major adverse cardiovascular events in patients with clopidogrel resistance.
This study was presented by Dr. Laurent Bonello at the SCAI-i2 summit Annual Scientific Sessions in Chicago today.
Clopidogrel resistance is an important factor to take into account among patients undergoing percutaneous coronary intervention (PCI) particularly those who receive drug eluting stents. Previous studies demonstrated that a poor response to clopidogrel is associated with an increased risk of complications such as in-stent restenosis and stent thrombosis.
The investigators from France studied patients with clopidogrel resistance (defined as more than 50% platelet activity after the standard 600mg loading dose). This study was a multicenter, randomized, prospective study. The outcome measures consisted of myocardial infarction (MI), needed repeat PCI or coronary artery bypass grafting surgery (CABG), or death
This study consisted of 162 patients who were clopidogrel resistant and in need of stenting for treatment of unstable angina. Patients were randomized to one of the two groups: control (n=84) or individually tailored therapy (n=78).  The individually tailored therapy consisted of increasing the clopidogrel dose in 600mg increments up to 2,400mg until platelet activity reduced to 50% or less.
The tailored therapy was effective 86% of patients and patients received 1,620 mg of clopidogrel prior to PCI.  The platelet activity reduced from 69.3% (after the first loading dose) to 37.6% with tailored therapy assessed by platelet monitoring. In the control group compared with the tailored therapy group the incidence of cardiovascular death was 2% vs. 0%, acute & subacute stent thrombosis was 5% vs. 0% (p=0.059), and revascularization was 2% vs. 0%.  There was a significant difference in the composite 30 day outcome between the control group and the tailored therapy group (10% vs. 0% p=0.007 respectively) with no difference in bleeding (5% vs. 4%).
This study demonstrates that tailoring the clopidogrel loading dose according to platelet activity can improve prognosis after PCI. In addition, it is evident from this study that on occasion, a loading dose of clopidogrel several times higher than usual is required in some patients to ensure its effectiveness.  Tailored therapy is associated with better cardiovascular outcome following PCI.

# Source
- Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 29-April 1, 2008 Chicago
- SCAI-ACC i2 press release

# Reference