K. Congruent Conditions: This judgment considers the fact that the organ system and or etiology of the conditions are similar to that of another condition treatment pair elsewhere on the List or that the outcomes of the condition treatment pairs are congruent. L. Public Health Risk: This judgment reflected the fact that prevention of communicable diseases is a high priority for the state and federal government. An example is the treatment of syphilis.
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Table 4. Summary Results of Efficacy Studies, Clinical Response for the Microbiologically Evaluable Population at the Test-of-Cure Visit.
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The growing population of patients with coronary artery disease includes an increasing number who do not obtain acceptable relief of anginal symptoms with conventional therapy. Enhanced external counterpulsation EECP ; is one of the recent novel approaches including transmyocardial laser revascularization, therapeutic angiogenesis, percutaneous coronary artery bypass, and spinal cord stimulation ; being evaluated for the relief of chronic angina. Typically these treatment methods are considered for patients in whom medical management does not adequately control symptoms, or because of previous procedures, unsuitable anatomy, or comorbid conditions, they are not good candidates for interventional or surgical treatment. EECP has been used in the treatment of angina for the past 2 decades, with a record of safety and a more recent body of literature supporting the technique's efficacy. "It augments diastolic pressure, increases coronary perfusion pressure, and provides left ventricular unloading in a manner analogous to the intra-aortic balloon pump, " says Gregory W. Barsness, MD, an interventional cardiologist from the Chest Pain and Coronary Physiology Clinic at Mayo Clinic in Rochester. "It is approved by the Food and Drug Administration for the treatment of chronic or unstable angina and is being evaluated for use in patients with congestive heart failure." Patients typically receive 35 EECP treatments of 1 hour each over a 7-week period. The device produces an acute hemodynamic effect via 3 sets of cuffs on the upper thigh, lower thigh, and calf of each leg Figure 1 ; . These cuffs are inflated sequentially with compressed air during diastole and deflated in early systole, raising diastolic aortic pressure, increasing perfusion pressure in the coronary and other arterial beds, and providing mild afterload reduction and increased venous return with a subsequent increase in cardiac output Figure 2 ; . Although the mechanism of benefit is unclear, EECP may produce both peripheral and central cardiovascular effects. "Small studies have demonstrated increased levels of growth factors and nitric oxide, as well as improved endothelial function after treatment, " says Dr Barsness. "Other potential mechanisms include develop and flomax.
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Reference guide therapeutic agents mentioned in this article acetaminophen amitriptyline aspirin atenolol carbamazepine tegretol ; carvedilol coreg ; chlordiazepoxide librium ; cimetidine tagamet ; clofibrate clonidine catapres ; codeine diazepam valium ; dicyclomine bentyl ; digoxin lanoxin ; dipyridamole disopyramide norpace ; doxazosin cardura ; doxepin sinequan ; erythromycin famotidine pepcid ; fluconazole diflucan ; flurazepam dalmane ; fluoxetine prozac, sarafem ; guanethidine ismelin ; hydralazine apresoline ; hyoscyamine levsin, anaspaz, cystospaz ; ketoconazole nizoral ; lidocaine xylocaine ; lithium eskalith, lithobid ; meperidine demerol ; meprobamate equanil, miltown ; metformin glucophage ; methyldopa methylphenidate ritalin ; metoprolol lopressor, toprol ; nitrofurantoin macrodantin ; nizatidine axid ; oxycodone oxycontin ; pentazocine talwin ; phenytoin dilantin ; prazosin minipress ; procainamide pronestyl, procan-sr, procanbid ; propranolol inderal ; propoxyphene darvon, darvocet ; ranitidine zantac ; reserpine terazosin hytrin ; terfenadine seldane ; theophylline theodur ; thyroxine ticlopidine ticlid ; trimethobenzamide tigan ; valproic acid depakene ; warfarin coumadin ; brand names are listed in parentheses only if a drug is not available generically and is marketed as no more than two trademarked or registered products.
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