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Continuing Medical Education
School of Medicine, UAB |
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Online CME Courses
Course Catalog > Online Courses |
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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
The 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, clinicians should be able to: |
- Know
the initial evaluation of patients with newly diagnosed
atrial fibrillation and to identify secondary causes
of atrial fibrillation.
- Know
the indications and management strategies for rate control
vs. rhythm in patients with atrial fibrillation.
- Understand
how to stratify, know anti-thrombolic indications and
management in patients with atrial fibrillation.
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| SOURCE: |
| FACULTY: |
Carlos
Estrada, MD
Associate Professor of Medicine
University of Alabama at Birmingham |
| DISCLOSURE: |
| Dr.
Estrada has no commercial affiliations to disclose. |
| CME
PARTICIPATION: |
| To
participate in this program for CME credit, please review
the objectives before beginning the program. Take the course,
complete the case questions and evaluation before March
5, 2010 to receive CME credit. Your certificate will then
be available online. This process should take approximately
60 minutes. |
| ACCREDITATION: |
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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 online course 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. |
| 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 –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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