IMACS Users' Guide – Version 1.0 - The International Society for ...
IMACS Users' Guide – Version 1.0 - The International Society for ...
IMACS Users' Guide – Version 1.0 - The International Society for ...
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<strong>IMACS</strong> Users’ <strong>Guide</strong> <strong>–</strong> <strong>Version</strong> <strong>1.0</strong><br />
12/21/2012<br />
Page 32 of 56<br />
1 Month Follow-up<br />
Mark whether the medications listed are used at the follow-up time period: Yes, No or<br />
Other<br />
List of medications<br />
Hydralazine (at 1 month only)<br />
Calcium channel blockers (at 1 month only)<br />
Nesiritide<br />
Angiotensin receptor blocker drug<br />
Amiodarone<br />
ACE inhibitors<br />
Beta-blockers<br />
Aldosterone antagonist<br />
Lovenox<br />
Warfarin (coumadin)<br />
Antiplatelet therapy drug <strong>–</strong> additionally, check all that apply.<br />
If Other, specify is selected, type in the specification in the block<br />
provided.<br />
Nitric oxide<br />
Phospodiesterase Inhibitor<br />
Digoxin<br />
Loop diuretics<br />
MEDICAL CONDITION<br />
NYHA Class: New York Heart Association Class <strong>for</strong> heart failure:<br />
Class I: No limitation of physical activity; physical activity does not cause fatigue,<br />
palpitation or shortness of breath.<br />
Class II: Slight limitation of physical activity; com<strong>for</strong>table at rest, but ordinary physical<br />
activity results in fatigue, palpitations or shortness of breath.<br />
Class III: Marked limitation of physical activity; com<strong>for</strong>table at rest, but less than<br />
ordinary activity causes fatigue, palpitation or shortness of breath.<br />
Class IV: Unable to carry on minimal physical activity without discom<strong>for</strong>t; symptoms<br />
may be present at rest.<br />
Unknown
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