Journal of Urgent Care Medicine

Smartwatches Are Trustworthy AFib Screening Devices

Smartwatches do a good job of identifying atrial fibrillation, according to a meta-analysis in JACC. The authors considered data from 26 studies that included 17,349 participants and found that smartwatches detect atrial fibrillation with high accuracy. Overall sensitivity was 94.8%, and specificity was 96.4%. The accuracy of the results varied when comparing each individual device, however. According to the authors, Amazfit (99% sensitivity; 99% specificity) and Samsung (97% sensitivity; 96% specificity) models performed at the …

Long Daytime Naps Associated With Atrial Fibrillation

A prospective cohort study of 20,827 Spanish adults found an association between daytime and nighttime sleep patterns and the risk of atrial fibrillation (AF), as published in the European Journal of Preventive Cardiology. Over a median follow-up of 15.1 years, a total of 163 incident atrial fibrillation cases were confirmed by medical record. Compared to individuals who took short daytime naps (less than 30 minutes a day), those in the study who took long naps …

An 83-Year-Old Female with CHF, A-Fib, and New-Onset Confusion and Syncope

An 83-year-old female with past medical history of congestive heart failure and atrial fibrillation presents to urgent care with confusion and syncope. She reports intermittent dizziness, but denies chest pain or shortness of breath. There is no evidence of trauma on exam. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Jonathan Giordano, DO, MEd, McGovern …

An 82-Year-Old Man with Palpitations

An 82-year-old man presents with complaints of palpitations. He denies chest pain, shortness of breath, dizziness, fever, vomiting, or confusion. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

A 26-Year-Old Man with Palpitations

The patient is a 26-year-old man who presents after 3 days of palpitations. He denies any chest pain, shortness of breath, diaphoresis, fever, or dizziness. He does use home oxygen (2 L/min), but denies any new shortness of breath. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain …

Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation

Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients. Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …

Clinical Challenge 2: October 2017

A 42-year-old woman with a history of anxiety presents, complaining of intermittent palpitations over the past 2 weeks. She says she has not taken any medication and denies chest pain, shortness of breath, diaphoresis, fever, or dizziness. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain or swelling, …

Abstracts in Urgent Care: December, 2010

Nahum Kovalski, BSc, MDCM Each month, Dr. Nahum Kovalski reviews a handful of abstracts from, or relevant to, urgent care practices and practitioners. For the full reports, go to the source cited under each title. New Guidelines for Prevention of Stroke in Patients with Stoke or TIA Key point: New, evidence-based recommendations aim at reducing risk of ischemic stroke in patients who have had a stroke or transient ischemic attack. Citation: Furie KL, Kasner SE, …

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