Phys Vivas · cardiovascular
Arrhythmias and Conduction Disease — Viva Defence
Structured DCE viva for arrhythmias: long-case defence of an elderly patient with persistent AF, CKD and fall risk — anticoagulation, rate/rhythm strategy, and monitoring — with probing questions and model answers.
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Opening statement (SASPOP, delivered aloud)
"Mrs Ford is an 82-year-old retired teacher with persistent atrial fibrillation on a background of hypertension and stage 3 chronic kidney disease, presenting with worsening exertional breathlessness. Her main problems are: persistent AF with inadequate rate control and high stroke risk — her CHA₂DS₂-VASc is at least 4; anticoagulation complicated by CKD and a falls history; hypertensive heart disease as a likely driver; and her goals — remaining independent at home. I would like to reassess her rate control, defend her anticoagulation choice against her renal function and falls, and address her breathlessness systematically." [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]Kotecha D, Bunting KV, Gill SK, et al. Effect of Digoxin vs Bisoprolol for Heart Rate Control in Atrial Fibrillation on Patient-Reported Quality of Life: The RATE-AF Randomized Clinical Trial JAMA, 2020.PMID 33351042