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Outpatient
Evaluation and Management of
Atrial Fibrillation, Part I
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Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by
the
University
of
Alabama
School
of
Medicine
Division of Continuing Medical Education
and
Alabama Quality Assurance Foundation
| Release
Date: February 5, 2007 |
Expiration
Date: February 5, 2010
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| TARGET
AUDIENCE: |
| Primary
care physicians |
| OBJECTIVES: |
| Upon
completion of this CME activity,
physicians and other healthcare professionals
should be able to: |
- Recognize
that hypertension remains a large
public health issue in part because
of under diagnosis and poor control.
- Understand
lifestyle and pharmacologic treatment
approaches for control of hypertension.
- Appreciate
controversies regarding initial
drug choices for treating hypertension.
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| SOURCE: |
| FACULTY: |
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Carlos
Estrada, MD
Associate Professor of Medicine
University of Alabama at Birmingham
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| DISCLOSURE: |
The
faculty discloses grants/research
support from the NIH: NHLBI and
honoraria from ACP Medicine - Institute
for Healthcare Education.
Because of the nature of preliminary
studies, some products mentioned are
unlabeled and investigational. Dosages,
indications, and methods of use of
drugs mentioned in this publication
may reflect the experience of the authors,
clinical literature, or other resources.
Therefore, please see the full prescribing
information before using any licensed
product mentioned. |
| CME
PARTICIPATION: |
| To
participate in this online course
for CME credit, please review the
objectives before beginning the program.
Complete the course and the self-assessment
test before February 5, 2010 to receive
CME credit. Your certificate will
then be available online. This process
should take approximately 1 hour. |
| ACCREDITATION: |
|
The
University of Alabama School of
Medicine is accredited by the Accreditation
Council for Continuing Medical
Education to provide continuing
medical education for physicians.
The
University of Alabama School of
Medicine designates this educational
activity for a maximum of 1 AMA
PRA Category 1 Credit™.
Physicians should only claim credit
commensurate with the extent of
their participation in the activity.
The
boards of nursing in many states,
including Alabama, recognize Category
1 continuing medical education
courses as acceptable activities
for the renewal of license to practice
nursing.
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| DISCLAIMER: |
| Dosages,
indications, and methods of use of
any drug referred to in this publication
may reflect the clinical experience
of the authors, clinical literature,
or other clinical resources. Therefore,
please see the full prescribing information
before using any product mentioned.
UAB is an equal opportunity/affirmative
action institution. |
| INTRODUCTION: |
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This
online course represents the first
part of a series of two courses
on the evaluation and management
of Atrial Fibrillation.
Atrial
fibrillation (AF) is a supraventricular
arrhythmia characterized by uncoordinated
atrial activation. The p wave is
absent on EKG and the rhythm on
the physical exam is usually irregular-irregular.
The prevalence of atrial fibrillation
increases with age. In apidemiological
studies, the mortality is increased
in patients with AF.[1]
Atrial
fibrillation lasting more than
30 seconds can be:
- Paroxysmal
(recurrent episodes lasting 1-7
days)
- Persistent
(episodes lasting > 7 days, can
be terminated by cardioversion)
- Recurrent
(>= 2 episodes)
- Permanent
(lasts > 1 year)
- "Lone"
(age < 60 years, no cardiac or
pulmonary disease)
The
above categories are not mutually
exclusive, i.e.: a patient may
have more than one category.[1]
The
level of evidence indicated in
the answers were reported in the
ACC/AHA/ESC 2006 Guidelines for
the Management of Patients with
Atrial Fibrillation (highest to
lowest):
- Level
of Evidence A: Data from
multiple randomized cliical
trials or meta-analyses.
- Level
of Evidence B: Data from
a single randomized trial,
or non-randomized studies.
- Level
of Evidence C: Only consensus
opinion of experts, case studies,
or standard-of-care.
Similarly,
recommendations were classified[1] as:
- Class
I: Evidence available and/or
general agreement that approach
is beneficial.
- Class
II: Conflicting evidence and/or
lack of agreement that approach
is beneficial.
- Class
III: Evidence available and/or
general agreement that approach
is NOT beneficial.
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| Case
1: |
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A
46-year-old woman sees you because
of anxiety. Over the past 2-3 months
she feel anxious all of the time,
has lost 10 lbs (unintentional)
and has experienced palpitations.
She is otherwise healthy and takes
no medications. She is married
and has 2 young children. She does
not smoke.
On
physical examination, her blood
pressure if 144/80mmHg, her pulse
if 124/min (irregular-irregular),
and her temperature is normal.
She has a mild tremor, mild exophtalmus,
terse skin, mild pre-tibial non-pitting
edema, and brisk deep tendon reflexes.
She also has a mildly enlarged
non-tender thyroid with a bruit.
Her cardiovascular exam shows normal
neck veins, a non-enlarged heart,
normal heart sounds and a soft
flow murmur. Her electrocardiogram
shows atrial fibrillation.
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