Phys Clinical Cases · cardiovascular
Arrhythmias and Conduction Disease — DCE Clinical Case
DCE short-case station: the irregular pulse — examination technique, the AF workup discussion, anticoagulation and rate/rhythm reasoning, with presentation template and probing questions.
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FRACP DCEMRCP PACES
Prompt
DCE short-case station: the irregular pulse — examination technique, the AF workup discussion, anticoagulation and rate/rhythm reasoning, with presentation template and probing questions.
The station frame
This is a short case with a long case hiding inside it. The examination takes five minutes; the examiner's real interest is whether you can move from a physical sign — the irregularly irregular pulse — to a complete management framework: confirm the rhythm, find the cause, assess the stroke risk, and decide rate, rhythm and anticoagulation [1].
References6ShowHide
- [1]Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation Chest, 2010.PMID 19762550
- [2]Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey Chest, 2010.PMID 20299623
- [3]Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation N Engl J Med, 2011.PMID 21870978
- [4]Kirchhof P, Camm AJ, Goette A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation N Engl J Med, 2020.PMID 32865375
- [5]Van Gelder IC, Groenveld HF, Crijns HJ, et al. Lenient versus strict rate control in patients with atrial fibrillation N Engl J Med, 2010.PMID 20231232
- [6]Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society Circulation, 2019.PMID 30586771