ACC Heart Failure Guideline

ACC Heart Failure Guideline
Prepared by:
Hitinder S. Gurm, MBBS, FACC
Kim Eagle, MD, FACC

Twenty Points to Remember from the
2007 UA/NSTEMI Guideline Update

Based on the ACC/AHA Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction

A Report of the ACC/AHA Task Force on Practice Guidelines Writing Committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction

ACC Heart Failure Guideline

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Heart Rhythm Abnormalities video(Part 2)

Heart Rhythm Abnormalities video(Part 2)

Millions of people have irregular heart rhythms, also called arrhythmias. Their hearts either beat too fast or too slow. These problems can be benign or they can also signal a life-threatening condition--sudden cardiac death-which is the number-one cause of death in the U.S. This program covers different kinds of heart rhythm problems and treatments.

Part Two:
Medical treatments for arrhythmias
Cardiac ablation-how it works
Different types of ablation
PET/CT cardiac imaging
Many are unaware of arrhythmias

Guest:
Dr. Stephen Shorofsky, a cardiologist and director of cardiac electrophysiology at the University of Maryland Medical Center. Dr. Shorofsky is also a professor of medicine at the University of Maryland School of Medicine.

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Heart Rhythm Abnormalities video(Part 1)

Heart Rhythm Abnormalities video(Part 1)

Millions of people have irregular heart rhythms, also called arrhythmias. Their hearts either beat too fast or too slow. These problems can be benign or they can also signal a life-threatening condition--sudden cardiac death-which is the number-one cause of death in the U.S. This program covers different kinds of heart rhythm problems and treatments.

Part One:
Irregular heart rhythms
Causes of arrhythmias
Symptoms of arrhythmia
Testing for arrhythmia - ECG/EKG
Sudden cardiac death
Implanted defibrillators
Pacemakers

Guest:
Dr. Stephen Shorofsky, a cardiologist and director of cardiac electrophysiology at the University of Maryland Medical Center. Dr. Shorofsky is also a professor of medicine at the University of Maryland School of Medicine.

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Heart Failure Advances video(Part 2)

Heart Failure Advances video(Part 2)

About 5 million Americans are living with heart failure, a chronic condition that is the leading cause of hospitalization for people over age 65. There has been a lot of progress in understanding and treating heart failure in recent years, and the latest advances are discussed in this interview.

Part Two:
Range of heart failure severity
Fluid retention/weight monitoring
Beta Blocker medications
Ace Inhibitor medicines
Diuretics
Heart pumps

Guest:
Dr. Mandeep Mehra, the head of cardiology at the University of Maryland Medical Center. Dr. Mehra is also a professor of medicine and head of the division of cardiology at the University of Maryland School of Medicine

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Heart Failure Advances video(Part 1)

Heart Failure Advances video(Part 1)

About 5 million Americans are living with heart failure, a chronic condition that is the leading cause of hospitalization for people over age 65. There has been a lot of progress in understanding and treating heart failure in recent years, and the latest advances are discussed in this interview.

Part One:
Definition of heart failure
Symptoms
Diagnosis
Risk factors

Guest:
Dr. Mandeep Mehra, the head of cardiology at the University of Maryland Medical Center. Dr. Mehra is also a professor of medicine and head of the division of cardiology at the University of Maryland School of Medicine

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Acute Coronary Syndrome

Acute Coronary Syndrome
By:Rich Derby, Lt Col, USAF
MGMC Family Practice Program

Objectives

* Define & delineate acute coronary syndrome
* Review Management Guidelines
* Review secondary prevention initiatives

Scope of Problem
Expanding Risk Factors
* Smoking
* Hypertension
* Diabetes Mellitus
* Dyslipidemia
* Family History—event in first degree relative >55 male/65 female
* Age-- > 45 for male/55 for female
* Chronic Kidney Disease
* Lack of regular physical activity
* Obesity
* Lack of Etoh intake
* Lack of diet rich in fruit, veggies, fiber

Acute Coronary Syndromes
Similar pathophysiology
Similar presentation and early management rules
STEMI requires evaluation for acute reperfusion intervention
* Unstable Angina
* Non-ST-Segment Elevation MI
* ST-Segment Elevation MI

Diagnosis of Acute MI
STEMI / NSTEMI
Diagnosis of Angina
* Typical angina
* Atypical angina
* Noncardiac chest pain

Diagnosis of Unstable Angina
* Patients with typical angina - An episode of angina
* Patients not known to have typical angina
Unstable Angina
Acute Management
Evaluation
Time Sensitive
Chest pain suggestive of ischemia
Immediate assessment within 10 Minutes
Initial labs and tests
Emergent care
History & Physical
Focused History
Targeted Physical
ECG assessment
Normal or non-diagnostic EKG3
Cardiac markers
Prognosis with Troponin
Mortality at 42 Days
Risk Stratification
Cardiac Care Goals
STEMI cardiac care
Fibrinolysis indications
Absolute contraindications for fibrinolysis therapy in patients with acute STEMI
Relative contraindications for fibrinolysis therapy in patients with acute STEMI
STEMI cardiac care
Comparing outcomes
Medical Therapy
Additional medication therapy
STEMI care CCU
Unstable angina/NSTEMI cardiac care
Probable ischemic symptoms
TIMI Risk Score
ACS risk criteria
Moderate to high likelihood of CAD
High Risk ACS
Invasive therapy option UA/NSTEMI
Conservative Therapy for UA/NSTEMI
Secondary prevention behavioral intervention
Secondary prevention cognitive
Medication Checklist after ACS
Summary

Acute Coronary Syndrome.ppt

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Dental Management of Patients with Cardiac Arrhythmias

Dental Management of Patients with Cardiac Arrhythmias
Presentation by:Donald Falace, DMD
Oral Diagnosis and Oral Medicine
UK College of Dentistry

Conduction System of the Heart
* Begins with depolarization of the SA (sinus) node
* Impulse then spreads to the atria resulting in..
* Contraction of atria with blood being pumped out of the atria
* Then the AV node depolarizes and…
* Impulse spreads to the bundle of His and then to right and left bundle branches resulting in…
* Contraction of ventricles and blood being pumped out of the ventricles

Electrocardiogram
* P wave = atrial depolarization
* QRS wave = ventricular depolarization
* T wave = ventricular depolarization
* Atrial depolarization is masked by the QRS wave

Terminology

* Sinus rhythm: normal heart rhythm originating in the SA (sinus) node; 60-100 beats/minute
o Tachycardia: rapid heart rate greater than 100 beats per minute
o Bradycardia: slow heart rate less that 60 beats per minute
* Supraventricular arrhythmias: arrhythmias originating in areas other than the normal ventricular pathways (such as from the atria, AV node, or an accessory pathway)
* Premature ventricular contraction (PVC): a ventricular contraction (QRS wave) not preceded by an atrial contraction (P wave) due to an abnormal electrical focus in the ventricles; found in normal and abnormal patients
* Heart block: an interruption in the normal electrical conduction between the atria and ventricles so that the atria and ventricles beat independently
* Ectopic pacemaker: appearance of a new and abnormal pacemaker
* Fibrillation: a chaotic heart beat

Classification of Arrhythmias
Classified by Site of Origin

o Supraventricular: arrhythmias that arise above the bifurcation of the His bundle (atria) and broadly categorized into
+ Tachyarrhythmias (too fast)
+ Bradyarrhythmias (too slow)
o Ventricular: arise below the bifurcation of the His bundle (ventricles)

Supraventricular Arrhythmias
* Sinus nodal disturbances
o Sinus arrhythmia (resp)
o Sinus tachycardia (>100)
o Sinus bradycardia (<60)
* Disturbances of atrial rhythm
o Premature atrial complexes (ectopic foci)
o Atrial flutter (250-350)
o Atrial fibrillation (350-600)
o Atrial tachycardias (150-200)
* Tachycardias involving the atrioventricular (AV) junction (accessory AV pathways)
o Pre-excitation syndrome (Wolff-Parkinson-White)
* Heart block (conduction impairment)
o First degree
o Second degree
+ Mobitz type I (Wennckebach)
+ Mobitz type II
o Third degree

Ventricular Arrhythmias
* Premature ventricular complexes (PVC’s; very common)
o Occur alone
o Every other (bigeminy)
o Every third (trigeminy)
o Two consecutive (couplet)
o Three consecutive (ventricular tachycardia)
* Ventricular tachycardia
o Three or more PVC’s in a row
* Ventricular fibrillation

Atrial Fibrillation

* Most common sustained arrhythmia
* Rapid, chaotic atrial activity; 350-600 beats per minute
* Disagreeable palpitations or discomfort, weakness, faintness, breathlessness; stroke
* Usually associated with RHD, HBP, IHD, thyrotoxicosis
* May be found in otherwise healthy individuals
* Prone to thromboembolism, therefore, will often be on warfarin

Significance and Risk of Arrhythmias

* ACC/AHA Guideline Update for Perioperative Cardiovascular Risk Evaluation for Non-Cardiac Surgery (Circulation 2002;105:1257-1267)
* Major Risk:
o High grade A-V block
o Symptomatic ventricular arrhythmias in the presence of underlying heart disease
o Supraventricular arrhythmias with uncontrolled ventricular rate
* Intermediate Risk:
o Abnormal Q waves (marker of previous MI)
* Minor Risk:
o Abnormal ECG (LVH, L-BBB, St-T abnormalities)
o Rhythm other than sinus


Diagnosis of Arrhythmias
Pulse
Physical exam
Electrocardiogram
Stress test
Echocardiogram
Holter monitor
Event recorder
Arrhythmias
* Signs
* Symptoms

Medical Management of Arrhythmias
Antiarrhythmic Drugs
Potential Drug Concerns
Implanted Pacemaker
Placement/Functioning of Pacemaker
Implanted Defibrillator
Pacemakers/Defibrillators
Cardioversion
Surgical Ablation
Dental Management Considerations for Patients With Arrhythmias

* ID patients with significant arrhythmias; must rely on medical history; obtain medical consult if any question
* Consult with physician if patient is symptomatic (frequent palpitations, chest pain, dizziness, shortness of breath)
* Avoid elective care in patients with significant arrhythmias or with uncontrolled or poorly controlled arrhythmias
* Avoid epinephrine in uncontrolled or poorly controlled patients and in patients taking digitalis
* Avoid lidocaine in patients taking amiodarone
* With stable (controlled) arrhythmia, may use vasoconstrictor in modest amounts if needed; treat as normal patient
* Implement stress management protocol as needed
* Be mindful of anticoagulant therapy; most treatment permissible if INR is within the therapeutic range)
* Watch for digitalis toxicity (increased salivation)
* Avoid electrical interference with pacemaker

Dental Management of Patients with Cardiac Arrhythmias.ppt

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Hybrid Pulmonary Artery Stent video

Hybrid Pulmonary Artery Stent

Fontan Procedure with Hybrid Pulmonary Artery Stent - Hypoplastic Left Heart Syndrome (HLHS) - Pediatric Heart Surgery

App. 10 minutes video

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Atherosclerotic Heart Disease: Treatment video

UCSF's Osher Lifelong Learning Institute presents this series exploring the latest science about the treatment and managment of Cardiovascular disease. Join Andrew Michaels, MD, Co-director, Adult Cardiac Catheterization Laboratory, UCSF for a look at the use of drugs, stents and surgery in the treatment of Atherosclerotic Heart Disease.

Approximately 1 hour 30 minutes

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Cardiac Examination

Cardiac Examination
Lecture Notes & Video

The Cardiac Exam
Introduction
Learning Objectives
Sections of Cardiac Exam
CardiacExamVideo
Inspection: Jugular VenousPulse
Phases of Jugular Venous Pulse
Measuring the Jugular Venous Pulse
Estimating Central Venous Pressure
Diagnosing Complete Heart Block
Locations
Location of Heart in the Chest
Location of Point of Maximum Impulse
The Four Cardiac Listening Areas
Methods and Tools
Palpation of Parasternal Area and Base
Qustion 1
Question 2
Auscultation of the Heart
Auscultation: What Makes Noises in the Heart
S1 and S2
S1
Question 3
S2
S2 Splitting
Rhythm
Gallops: S3 and S4
S3
S4
Question 4
Heart Murmurs
How to Describe Heart Murmur
Heart Murmur Intencity
Heart Murmur Timing
Heart Murmur Quality
Finding the Areas to Auscultate
Common Systolic Murmur
Innocent Flow Murmur
Mitral Regurgitation
Aortic Stenosis
Mitral Valve Prolapse
Evidence Based Lesson
Question 5
Comon Diastolic Murmur: Aortic Insufficiency
Friction Rub
Final Test

http://www.med-ed.virginia.edu/courses/pom1/pexams/CardioExam/

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Coronary Artery Disease and Acute Myocardial Infarction

Coronary Artery Disease and Acute Myocardial Infarction
Presentation by: Joyce Smith RN, BSN

Coronary Artery Disease
Signs and Symptoms
Medical Treatment
Myocardial Infarction
Complications of an MI
Risk Factors
Causes
Assessment for Chest Pain
EKG Changes of an MI
Medical Treatment
Angioplasty
Nursing Interventions For MI
Cardiopulmonary Arrest
Objective Symptoms
Diagnostic Tests

* History
* Physical
* EKG
* Enzymes after emergency treatment
Implementation

* CPR
* ABC’s
* IV for administration of drugs
* ABG’s frequently
* Give Lidocaine, etc.
* Watch for hypoxia, arrythmias, acidosis, and hypokalemia
* Monitor labs
* Assess LOC, skin color, temp, pulses, seizures, pupil changes
* Observe for complications (rib fractures, tamponade, pneumothorax)
* Give emotional support to the family

Coronary Artery Disease and Acute Myocardial Infarction.ppt

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Prevention of Sudden Cardiac Death in Young Athletes

Prevention of Sudden Cardiac Death in Young Athletes
Topics covered in this presentation

SCD Incidence and Overview
Drezner, Jonathan A., M.D.
Duration: 8:00

Hypertrophic Cardiomyopathy
Towbin, Jeffrey, MD
Duration: 27:42

AVRC and Coronary Artery Anomalies
Corrado, Domenico, MD, PhD
Duration: 20:00

Channelopathies
Campbell, Robert, MD
Duration: 22:34

Commotio Cordis
Link, Mark, MD
Duration: 15:54

ECG Screening: The Italian Experience
Corrado, Domenico, MD, PhD
Duration: 28:49

PPE History & Physical
Campbell, Robert, MD
Duration: 21:26

ECG Screening in the US - Con
Page, Richard L., M.D.
Duration: 19:56

ECG Screening in the US - Pro
Vetter, Victoria, MD
Duration: 33:50

Echocardiography
Lewin, Mark B., M.D.
Duration: 17:35

Athletic Heart Syndrome
Salerno, Jack C., M.D.
Duration: 12:45

Genetic Testing - Is There a Role in Screening?
Towbin, Jeffrey, MD
Duration: 16:40

Natriuretic Peptides
Maisel, Alan, MD
Duration: 24:53

Pediatric & Age Specific ECG Differences
Salerno, Jack C., M.D.
Duration: 12:34

Activity Recommendations in the Young with Conditions that Lead to Sudden Cardiac Arrest
Vetter, Victoria, MD
Duration: 19:43

AED Programs & Emergency Planning in Athletics
Drezner, Jonathan A., M.D.
Duration: 22:05

Prevention of Commotio Cordis
Lewin, Mark B., M.D.
Duration: 11:46

Rapid Cooling After SCA
Kim, Francis, M.D.
Duration: 15:05

View it here

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Evaluation of Heart Failure in the Internal Medicine Clinic

Evaluation of Heart Failure in the Internal Medicine Clinic
Presentation by
Natohya Henry, Pharm.D.
Kristin Campbell, Pharm.D., Jennifer Campbell, Pharm.D., CDE; Christa George Pharm.D., BCPS, CDE; Kristie Ramser, Pharm.D., CDE, Laura Sprabery, MD, FACP,
Craig Dorko, MD, FACP


Heart Failure
NYHA Classification
Stages of Heart Failure
ACC/AHA 2005 Guidelines
Stages in the development of HF/recommended therapy by stage
CMS Core Measures
Routine Assessment
Evidence-Based Therapies
Symptomatic benefits
Loop Diuretics
Beta Blockers
Evaluation of HF in the Internal Medicine Clinic
Methods
Pre-Intervention
Medical Record Review
Physicians

* Symptoms/ ER visits
* Smoking and smoking cessation
* Diet and daily weights
* Review of results
* Review of ACC/ AHA guidelines
* Review of CMS core measures

Medical Record Review
Baseline Characteristics
Use of Heart Failure Medications in All Patients
Use of Evidence-Based Medications
Conclusions
References

Evaluation of Heart Failure in the Internal Medicine

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50 Years of Clinical Cardiology Experience

50 Years of Clinical Personal Experience

a personal experience
by
Prof. Dr. Fayez Fayek Botros
National Heart Institute

Topics covered:

Heart failure
Hypertension
Drugs
Lumbo -dorsal sympathectomy
Medical sympathectomy
Development of antihypertensive therapies
Ischemic heart disease
Cardiac infarction
Investigations
Ballistoca rdiograpgy
Cardiac catheterization
Cardiac pacing

50 Years of Clinical Personal Experience ppt

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Cardiovascular disease videos

Cardiovascular disease videos from North East Valley Division of General Practice, Australia.

You need RealPlayer to view these videos. If you dont have Realplayer get it from here.

							Cardiovascular disease - introduction
							- Heart attack & diseased coronary arteries (plaque)
							- Major risk factors
							- Persons at risk
							Preventing disease
							- reducing cholesterol
							- heart protection study
							- exercise and the heart
							- summary of goals to reduce heart disease
							Other therapies
							( HRT, antioxidants, CRP, homocysteine, stress & anti-smoking medications )

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41 Cardiology Video Lectures

41 Cardiology videos are available from University of Wisconsin School of Medicine and Public Health. You can view them online or there is a download link if you wish to download them.

Date		Presentation
03/19/2009		Chemotherapy-Related Cardiomyopathy: An Update S. Ewer
01/15/2009		Mutations in Sodium Channel Interacting Proteins (ChIPs) Causing Inherited Arrhythmia J. Makielski
12/18/2008		Cardiac Dyssynchrony P. Rahko
11/20/2008		Ablation of Supraventricular Tachycardias C. Alberte
11/06/2008		Nkx2.5 and the Genetic Origins of Pediatric Heart Disease D. Benson, Jr.
10/23/2008		Bicuspid Aortic Valve and Aortic Aneurysm–Surgical Implications N. De Oliveira
09/25/2008		Is Alzheimer’s Disease a Vascular Disorder? C. Carlsson
08/21/2008		Cardiovascular Disease and Diabetes: What Does the Future Hold for Wisconisn's Children? P. Hughes
08/07/2008		Cardiocerebral Resuscitation: The Best Approach to Cardiac Arrest G. Ewy
07/31/2008		Hyponatremia in Heart Failure: Current Concepts and Future Directions M. Gheorghiade
07/24/2008		Delayed Myocardial Infarction Contrast-Enhancement with Cardiac MRI C. Francois
07/17/2008		Steps Toward Making Complicated Catheter Procedures More Complicated…But Better! A. Raval
06/26/2008		Laminopathies M. Wolff
06/19/2008		Cardiac Surgery Outcomes at the University of Wisconsin N. Edwards
05/12/2008		The Sleep Heart Health Study: 10 Year Cardiovascular Disease Incidence and Mortality S. Redline
05/08/2008		The Genetics of Cardiomyopathy J. Towbin
04/24/2008		The Intersection of Acute Coronary Syndromes and Oral Antiplatelet Therapy D. Bhatt
02/28/2008		Cardiovascular Prescription Development and Pitfalls R. Harrington
02/14/2008		Energy Metabolism in the Failing Heart: Should We Intervene? J. Ralphe
01/23/2008		Blunt Carotid Injury - Literature Review M. Nawalany
01/17/2008		Myocardial Imaging with Fatty Acid Tracers C. Stone
12/20/2007		Renal Artery Stenosis G. Gimelli
11/29/2007		Transcatheter Valve Therapies L. Lozonschi
11/15/2007		Molecules Governing Cardiac Hypertrophy E. Kaji
10/25/2007		Carotid Stenting - A Stroke of Genius? K. Moncher
10/18/2007		Targeting the Renin Angiotensin System to Prevent and Treat Heart Failure B. Greenberg
09/27/2007		Revascularization Strategies in Patients with Multi-Vessel Coronary Artery Disease J. Resar
08/30/2007		After 40 Years of Clinical Heart Transplantation, Where Are We Today? D. Taylor View description David O. Taylor, MD, speaks about the past, present and future of clinical heart transplant at the Health Sciences Learning Center on August 16, 2007.
08/16/2007		Big Blue Babies F. Ballantyne, III View description Ford Ballantyne, MD, speaks on "Big Blue Babies" at the Health Sciences Learning Center on August 16, 2007.
07/26/2007		Mechanistic Insight into a Rare Cardiovascular Disease: Congenital Long QT Syndrome B. Delisle View description Brian Delisle, PhD, speaks on "Mechanistic Insight into a Rare Cardiovascular Disease: Congenital Long QT Syndrome" at the Health Sciences Learning Center on July 26, 2007.
07/19/2007		Heart Disease in the Female Population: Prevalence, Presentation and Pathophysiology M. Zasadil View description Mary Zasadil, MD, faculty at the University of Wisconsin-Madison, speaks on "CT Angiography" at the Health Sciences Learning Center on July 19, 2007.
06/28/2007		What is New in the Treatment of Type B Aortic Dissection? G. Tefera
06/21/2007		Arterial Stiffening and Cardiovascular Disease N. Sweitzer View description Nancy Sweitzer, MD, PhD, assistant professor in the Department of Cardiovascular Medicine at the University of Wisconsin-Madison, speaks on "Arterial Stiffening and Cardiovascular Disease" at the Health Sciences Learning Center on June 21, 2007.
05/17/2007		Location, Location, Location: Why Neighborhood Matters to an Ion Channel and for Arrhythmias T. Kamp View description Timothy J. Kamp, MD, PhD, an associate professor of medicine and the associate director of the Medical Scientist Training Program at the University of Wisconsin-Madison speaks on "Location, Location, Location: Why Neighborhood Matters to an Ion Channel and for Arrhythmias" at the Health Sciences Learning Center.
04/25/2007		Vascular Trauma: Endovascular Approaches T. Bayer
03/22/2007		Myocarditis E. Winkel View description Dr. Winkel an associate professor of medicine at the University of Wisconsin department of medicine spoke on Myocarditis at the Health Sciences Learning Center on March 22, 2007.
02/28/2007		Race Differences in Function and Quality of Life After Stroke D. Farrar Edwards View description Ethnic disparities in stroke incidence and mortality are well established. However, there are relatively few studies of disparities in post-stroke functional status and long-term outcome. Health related quality of life (HRQOL) is particularly understudied in diverse populations, and is emerging as important indicator of stroke recovery. Dr. Dorothy Edwards presents on a study focused on black-white differences in recovery from ischemic stroke and the identification predictors of diminished quality of life.
02/22/2007		Vascular Biology of Atherosclerosis and Beneficial Effects of Grape Flavonoids: Is It Really True? J. Folts View description John Folts, PhD speaks on "Vascular Biology of Atherosclerosis and Beneficial Effects of Grape Flavonoids" at the Cardiovascular Medicine Grand Rounds on February 22, 2007 at the Health Sciences Learning Center.
02/15/2007		Evolution of Ablation of Atrial Fibrillation at the University of Wisconsin D. Kopp View description By viewing this presentation, you should be able to: 1. Review revised guidelines for treatment of Atrial fibrillation (AF). 2. List indications for AF ablation. 3. Recognize the pros and cons of various AF treatments, including minimally invasive surgical options. 4. Discuss future technologies on the horizon at the University of Wisconsin Hospital and Clinics.
01/18/2007		CT Angiography J. Keevil View description Jon Keevil, MD speaks on "CT Angiography" at the Cardiovascular Medicine Grand Rounds on January 18, 2007 at the Health Sciences Learning Center.
08/24/2006		PCI, Drug-Eluting Stents, and Adjunctive Medical Therapy for Patients with CVD S. King, III View description

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