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Advice from the BP Measurement Experts

5 Tips for Preparing for a Cardiac Stress Test

For accuracy purposes, some diagnostic tests require a little preparation on your part. So, what do you need to do before you have a cardiac stress test? According to a recent publication by the Heart and Vascular Team at the Cleveland Clinic, the following tips are good to know before you step on the treadmill:

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Cardiac Stress Tests Help Predict the Future

Picture of Heart in a Crystal Ball being held by a hand.

Let’s be honest, a cardiac stress test can be just that – stressful! So how do physicians know when it’s appropriate to use this as a way to evaluate how well a patient’s heart is handling its workload? Well, it’s actually by considering a few different factors. Is the patient healthy enough to walk on a treadmill or bike on an ergometer? What if the patient presents healthy, yet there is a family history of heart disease? After evaluating those parameters, the question then becomes which type of stress test [see previous blog] should the patient actually undergo? The good news - there may now be further guidance for physicians when it comes to making this decision, specifically for males who are at risk.

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When Physicians Should Be Present for Stress Testing

Picture of young woman on a treadmill performing a stress test under the supervision of a doctor.

When it comes to patient safety in stress labs, opinions run the gamut as to which clinicians actually need to be in the room during a cardiac stress test. Historically, it has been considered best practice to always have a physician present as those being tested are typically thought to be at risk of having some type of potential cardiovascular disease. And let’s face it – wouldn’t you want your doctor in the room in case something went wrong? But in today’s struggling economy, even stress labs are looking for ways to cut costs, and having a non-physician supervise a stress test if the patient is considered lower risk has become common practice.

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HAIs Are On The Outs With Outpatient Facilities

Picture of a Doctor holding a chalkboard that says Stop HAIs

With all of the attention being given to the need for hospitals to reduce the occurrence of healthcare-associated infections (HAIs) in their facilities, should we be equally concerned about the outpatient facilities that work in conjunction with these health systems? The answer is a resounding “yes,” and these outpatient facilities find themselves working with the same diligence to find products that will help lower their incidence of these unwanted, costly, and often, dangerous infections.

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Healthcare Associated Infections Reduced Under Pressure

7 Reasons to Use Disposable BP Cuffs Infographic

We all know it’s necessary, often put it off, sometimes dread it, but eventually – we give in…and schedule our annual physical. After we have been properly weighed and measured, so to speak, we are left to await the arrival of our physician. Following the staccato knock indicating the doctor is entering, he dutifully washes his hands and offers a friendly hello. Long after the disposable protector is removed from the thermometer and forgotten in the trash, he reviews the chart for any obvious issues. Dutifully applying the disposable protector to his otoscope, our ears, eyes and nose are all given a sufficient look. Stethoscope wiped with the appropriate sanitizer, our hearts get a good listen. Hopefully, we soon go home with a clean bill of health and the intention of shedding a few pounds before next year’s appointment.

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Relax...Tips for Accurate Cardiac Stress BP Measurement

Audio Series by SunTech MedicalWhen most people have their blood pressure (BP) taken, it’s typically done by a clinician in a physician’s office. A past blog post - 10 Factors That Can Affect Your BP Reading– discusses several factors which may influence your BP reading during these visits, which are usually conducted under routine or “normal” conditions. But what if you are having your BP taken under different circumstances such as during a cardiac stress test or ABPM study? Do these same factors still apply?


Well, yes and no. Accurate cuff size and placement are still critical; however, as a result of the motion and noise introduced during these tests, not all of the 10 factors still apply. For example, during a cardiac stress test, your body will be ‘stressed’ on purpose. It will be necessary for you to talk to your clinician about how you feel throughout the course of the assessment. Additionally, you will not have any support other than the bar of the treadmill or the Ergometer and there are not any significant ‘rest times’ between measurements. So, how do you collect an accurate BP in an environment such as this?

Follow these simple tips:

  • Relax the arm on which the BP cuff has been placed
  • Do not grip the bar of the treadmill or Ergometer
  • Stand up straight – no leaning on the rail
  • Follow instructions carefully for when cuff inflates

To request a free, digital copy with a complete list of tips, simply click the button below to get one today! (Available in English, French, Italian, German, Spanish, Czech, Polish, Dutch, Brazilian Portuguese, Turkish, Chinese, and Japanese)

 

 

 

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You Want to do What with That?

You Want to do What with That?Have you ever read the instructions for use for a product that you purchased? Let’s be honest, a majority of us simply do not take the time to read the instructions that come with a product; especially if it is something we believe we are familiar with already. I mean, who has the time, or patience, to sift through all of the warnings and the over simplified step-by-step description of how to use something in order to find that one little nugget of information that might actual improve your user experience? And besides, aren’t we supposed to be saving trees?


But wait. What if we told you that the instructions are there because not all products are created equal? Take the omnipresent blood pressure cuff for example. You’ve used one you’ve used them all, right? Wrong. Not every cuff is identical. There are many varieties, sizes, and shapes and each of those has specific, appropriate applications.

We appreciate the value of even five minutes gained in a day by tossing the instructions aside and charging forward. But in the case of blood pressure cuffs, the instructions for fitting are even more important, no matter how simple they may seem. Having the right sized cuff and placing that cuff properly on the patient’s arm are integral to the accuracy of any blood pressure measurement. And for automated blood pressure measurement devices, the cuff is the sensor which collects the necessary data to derive the blood pressure values. Applying an unsuitable cuff to your patient can generate erroneous results, and therefore affect a patient’s diagnosis and/or treatment.

Reading the instructions for use will help you learn to select the appropriate cuff size for your patient as well as how to apply it properly, thus ensuring the data you collect is accurate and useful. But, for all you visual learners, we have created five new videos to help with placement of some of the cuffs we offer at SunTech Medical: Orbit Cuffs for use with our Oscar 2 ABPM system, and for the Tango stress monitors Orbit-K Cuffs for everyday use, and Single Patient Use Kits as a Disposable Cuff option for the Stress Lab.

 

 

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ABPM Makes a Lot of Cents

ABPM ReimbursementAmbulatory Blood Pressure Monitoring (ABPM) is a commonly-used tool for the identification and treatment of hypertension with a variety of clinical applications including identification of white-coat hypertension, diagnosis of masked hypertension, monitoring the efficacy of anti-hypertensive treatment, and identification of resistant hypertension. One common question from both those preparing to implement ABPM in their practice, and current ABPM users alike, is whether or not it is a reimbursable procedure.

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3 Types of Stress Tests: Part 2 of 2 - The ECHO and Nuc

ECHO and Nuc Stress TestingIn my previous blog I talked about one of the three types of stress tests, how your doctor will calculate your maximum heart rate, and what types of parameters they may be looking for during a stress test. In the second portion of the blog I will go over the other two types of stress testing, what parameters are looked for during these tests and why one may be used over the other.

 

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3 Types of Stress Tests: Part 1 of 2 - The ETT

Exercise Stress Test Running ManHave you ever been to your doctor’s office and wondered why one type of test was ordered over another? And, if they are all important, what makes a doctor ask for that particular type of test? Well when it comes to stress testing there are many different types of tests but generally they all come down to 3 different types. If your doctor orders you to have a stress test this can mean that you are having a cardiac or exercise stress test (often called an ETT or an exercise treadmill test), an echocardiogram stress test (often called Stress ECHO), or a nuclear stress test (often called a Walking Nuc or Nuc Test).

We have found that the type of test ordered is determined by your heart’s health or by your physical condition. In our 2 part blog series we will try to answer these questions about why one test can be used over another, what your doctor may be looking for during this test, and what parameters they look at during the test.

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World’s Leading ABPM Experts Publish Position Paper

ESH logoJust two months ago the European Society of Hypertension (ESH) released its new guidelines for the management and treatment of arterial hypertension at its annual meeting. ESH remains active in publishing guidance documents and has now released its latest position paper. The topic is Ambulatory Blood Pressure Monitoring (ABPM).

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Get Out of the Office for Better BP Measurement

Out of Office BPThough we state it often, we at SunTech Medical aren't the only ones touting the utility of monitoring BP outside of a clinical setting. A recent article published by a northeastern regional news website advocates for the use of home BP (HBPM) and ambulatory BP monitoring (ABPM) to diagnose and monitor hypertension. An estimated 50% of patients experience either white coat hypertension or masked hypertension. Therefore, as Dr. David Landers is quoted in the article, "'One blood pressure reading in the office is not useful. What you need is more data points.'"

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ESH Releases New Guidelines on Hypertension and BP Measurement

ESH and ESC Guidelines 2013This year marked the 23rd scientific meeting of the European Society of Hypertension (ESH) on "Hypertension and Cardiovascular Protection". While the ESH annual meeting is always filled with the latest in hypertension research, this year's highlight was the presentation of the newest edition of the ESH/ESC (European Society of Cardiology) Guidelines for the management of arterial hypertension.

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Beet High Blood Pressure

 beetrootjuiceMy mother was recently diagnosed with high Blood Pressure (BP). She talked to her doctor about the best ways to help control her high BP. The doctor prescribed a blood pressure medication and recommended she should eat more fruits and vegetables in addition to adding 30 minutes of exercise to her daily routine.

I was happy that the doctor recommended a healthy lifestyle to her in addition to the medication. I wouldn't call myself a health nut, maybe an enthusiast – which is why I liked the idea of alternatives for her. Recently, I read a study in the American Heart Association journal Hypertension, about how drinking a cup (250ml) of beetroot juice a day could help lower High BP.

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Striving for Interoperability of BP Devices and Vital Signs Data at HIMSS 2013

Healthcare InteroperabilityWhen thinking about the healthcare industry it is easy to become overwhelmed due to the sheer volume of what it encompasses and its ever-evolving nature. One continuing focus and challenge that cuts across the entire industry is the management of healthcare information, including BP measurement and other vital signs data. I had the opportunity earlier this month to attend the 2013 Healthcare Information and Management Systems Society (HIMSS) conference and exhibition held in New Orleans, LA which is entirely dedicated to this topic. Specifically, the HIMSS show brings together professionals from the healthcare industry with a goal of leveraging information technology (IT) and management systems for the improvement of healthcare delivery.

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Don't Break a Hip: How ABPM Can Help

As we have all heard time and time again hypertension is a prevalent public health issue, but it affects the elderly at a much higher rate. A newly published study now warns that "caution" is needed when initiating new antihypertensive drugs to treat elderly patients. The findings, published last month in the Archives of Internal Medicine (AIM), showed that elderly patients had a 43% increased risk of having a hip fracture within the first 45 days following the start of new antihypertensive treatment.1 It is reportedly "'the first study to demonstrate an immediate increased risk of hip fracture on initiation of antihypertensive drug therapy in community-dwelling hypertensive elderly patients'". The researchers also hypothesized that the most likely cause of the hip fractures were falls related to orthostatic hypotension, which can have symptoms such as dizziness and fainting.2


The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), the American Society of Hypertension (ASH) and the National Institute for Clinical Excellence (NICE) recommend regular monitoring for patients who start antihypertensive therapy. So how can we best monitor these patients? JNC and NICE both recommend the use of in-office measurement.3,4 ASH encourages the use of Ambulatory or Home BP monitoring.5
"elderly patients had a 43% increased risk of having a hip fracture within the first 45 days following the start of new antihypertensive treatment"

Ambulatory BP monitoring (ABPM) is widely recognized as a tool for diagnosing hypertension. But it is also a useful tool for monitoring the efficacy of antihypertensive treatment, evaluating optimal BP control in patients with postural hypotension, and aiding in the assessment of patients with hypotensive symptoms that occur with antihypertensive medication.4,6

Clearly, as the AIM study has shown, monitoring could be beneficial for some patients at the onset of antihypertensive treatment and ABPM would be an ideal candidate given its proven value for this specific application. But we want to hear your thoughts. How do you monitor elderly patients starting antihypertensive drug treatments in order to monitor for orthostatic hypotension?

Sources

  1. Archives of Internal Medicine: The Risk of Hip Fracture After Initiating Antihypertensive Drugs in the Elderly, http://archinte.jamanetwork.com/article.aspx?articleid=1392493#METHODS
  2. Heart Wire: Starting BP meds ups risk of hip fracture in elderly, http://www.theheart.org/article/1477231.do?utm_medium=email&utm_source=20121121_EN_Heartwire&utm_campaign=newsletter
  3. NICE Quick Reference Guide: Hypertension, http://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf
  4. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, http://hyper.ahajournals.org/content/42/6/1206.long
  5. ASH Position Paper: When and how to use self (home) and ambulatory blood pressure monitoring, http://www.ashjournal.com/article/S1933-1711(08)00047-8/abstract
  6. New England Journal of Medicine: Ambulatory Blood-Pressure Monitoring, http://www.nejm.org/doi/full/10.1056/NEJMra060433
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Our Blood Pressure is Rising Over Pediatric Studies

Pediatric Hypertension ScreeningAt Blog@SunTech, monitoring blood pressure on a regular basis is a common point of discussion especially as it relates to hypertension. Blood pressure measurement is an important part of overall health assessment and is typically the first piece of data collected for any office visit...with the exception of one rather important field of practice.

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Silent Killer Ravages US Population

Silent KillerHypertension, often called "the silent killer", is a medical condition that does not strike fear into the hearts of many people. Why? It often presents no noticeable symptoms.

Many people (myself included) don't feel the need to go to the doctor until they have (unbearable) symptoms of something being "wrong". It is a fair assumption then that if they are not going for regular check-ups with a healthcare provider, they are probably not monitoring blood pressure levels on their own either. It is also likely that some are even unaware that their blood pressure is at an unhealthy level.

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Interval Exercise: A New Approach to Lowering BP

Breaking Up Your Exercise May lower BP more EffectivelyExercise has long been recommended to patients wanting a non-pharmaceutical approach to achieving lower blood pressure (BP). The American Heart Association (AHA) specifically recommends:

  • At least 150 minutes of moderate intensity aerobic physical activity (2 hours and 30 minutes) each week.
  • Incorporate your weekly physical activity with 30 minutes a day, at least 5 days a week.
  • Physical activity should be performed in episodes of at least 10 minutes, and preferably, should be spread throughout the week.
  • Include flexibility and stretching exercises.
  • Include muscle strengthening activity at least 2 days each week.1
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Cardiologists, Choose Your Weapons Wisely!

heart wrenchWhen all else fails, keep it simple. Isn’t this what we have been told since childhood? It seems that some cardiologists have gone back to this basic philosophy when it comes to diagnosing heart disease. Dr Martha Gulati, a cardiologist at the Ohio State Wexner Medical Center where she specializes in women’s heart disease, says that it is “simple stuff” like an exercise stress test that can “catch blockages and predict hypertension” that other more high-tech tests sometimes miss. She says that using an exercise stress test in a recent case allowed her to “find significant disease” that other tests like an MRI completely missed.

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