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Outpatient
Evaluation and Management of
Atrial Fibrillation, Part II
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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: March 5, 2007 |
Expiration
Date: March 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 March 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 second
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
3: |
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A 77-year-old man returns to your office for routine follow-up without any complaints. He has a history of hypertension, diabetes, and hyperlipidemia. His medications include hydrochlorothiazide, enalapril, glucophage, and a statin. His health maintenance is up-to-date. On physical examination, his blood pressure is 138/88 mmHg and his pulse is 76/min. You notice that his pulse is irregular. The rest of his physical examination is normal. He has not had palpitations, dyspnea, or lightheadedness. He performs his daily activities without difficulties. His electrocardiogram reveals atrial fibrillation (rate 80/min) and left ventricular hyperthrophy. The laboratory examination, including blood count, liver profile, cholesterol, urinalysis, electrolytes, and creatinine are normal.
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