UCLA Family Medicine Department IMG Program Carlos Yoo A 66 year-old man comes t

UCLA Family Medicine Department IMG Program Carlos Yoo A 66 year-old man comes t www.phwiki.com

UCLA Family Medicine Department IMG Program Carlos Yoo A 66 year-old man comes t

Mitchell, Ralph, On-Air Personality has reference to this Academic Journal, PHwiki organized this Journal UCLA Family Medicine Department IMG Program Carlos Yoo A 66 year-old man comes to the emergency department complaining of a several-day history of an intermittent sensation of fluttering in the chest. He feels weak when the episodes occur but denies chest pain or shortness of breath. He has had hypertension as long as 20 years, controlled well with enalapril, in addition to he takes albuterol as long as asthma. He denies any alcohol use. UCLA Family Medicine Department IMG Program Carlos Yoo VS: Temperature 36.8C (98.3F), Blood pressure 140/80, pulse 140/min, respirations 12/min PE: supple neck, no jugular vein distension or thyromegaly. CV: irregularly irregular rhythm with no rubs or gallops. Chest: clear sounds Abd: Benign Extremities: no edema UCLA Family Medicine Department IMG Program Carlos Yoo

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Atrial Fibrillation Multifocal atrial tachycardia Supraventricular tachycardia Pulmonary Embolism Thyrotoxicosis UCLA Family Medicine Department IMG Program Carlos Yoo EKG Thyroid Function tests Cardiac enzymes Echocardiogram ABGA UCLA Family Medicine Department IMG Program Carlos Yoo Elderly patient Palpitation Fatigue/weakness Long term hypertension Tachycardia Irregularly irregular rhythm EKG: atrial fibrillation waves, inconsistent R-R intervals, absence P waves. UCLA Family Medicine Department IMG Program Carlos Yoo ATRIAL FIBRILLATION

GOALS Hemodynamic stabilization Ventricular rate control Prevention of embolic complication UCLA Family Medicine Department IMG Program Carlos Yoo Patient with diagnosis of atrial fibrillation Hemodynamically stable Control ventricular rate: Diltiazem Cardioversion Yes No Spontaneous conversion to sinus rhythm Assess cause of atrial fibrillation Yes No Contraindication to cardioversion Cont’ Beta Blockers Calcium Channel blockers Digoxin Amiodarone Unstable Hypotension Confusion Angina . UCLA Family Medicine Department IMG Program Carlos Yoo Consider long-term anticoagulation Cardiversion Yes No >48hs <48hs Start Heparin IV Immediate medical or electrical cardioversion Later elective cardioversion after 3weeks of warfarin Early TEE-guided cardioversion Atrial fibrillation persist Assess cause of atrial fibrillation Yes No Cont’ Warfarin Aspirin http://www.chestjournal.org/content/135/3/849.full.html http://www.aafp.org/afp/20020715/249.html http://www.aafp.org/afp/20020715/261.html http://www.americanheart.org/downloadable/heart/222-ja20017993p-1.pdf UCLA Family Medicine Department IMG Program Carlos Yoo Mitchell, Ralph WBHY-AM On-Air Personality www.phwiki.com

Mitchell, Ralph On-Air Personality

Mitchell, Ralph is from United States and they belong to WBHY-AM and they are from  Spanish Fort, United States got related to this Particular Journal. and Mitchell, Ralph deal with the subjects like Religious/Gospel

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This Particular Journal got reviewed and rated by Politeknik Negeri Malang and short form of this particular Institution is ID and gave this Journal an Excellent Rating.