#19 Cardiology

Guest: Adam Ware, MD, FAAP

July 2020

 

SUBSCRIBE:

Listen on Google Play Music

Show Notes

Disclosures

No commercial support is associated with this CME activity.

Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities

The AAP CME/CPD program develops, maintains, and improves the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice.  The AAP CME/CPD program strives to meet the educational needs of pediatricians and pediatric healthcare professionals and support their lifelong learning with a goal of improving care for children and families.  (AAP CME/CPD Program Mission Statement, May 2015)

 The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.

All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.

The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.

DISCLOSURE OF FINANCIAL RELATIONSHIPS

All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities.  Listed below are the disclosures provided by individuals in a position to influence and/or control CME activity content.  

* A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.   

Disclosure of Commercial Support for AAP CME Activities

No commercial support is associated with this CME activity.

Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities

The AAP CME/CPD program develops, maintains, and improves the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice.  The AAP CME/CPD program strives to meet the educational needs of pediatricians and pediatric healthcare professionals and support their lifelong learning with a goal of improving care for children and families.  (AAP CME/CPD Program Mission Statement, May 2015)

 The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.

All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.

The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.

DISCLOSURE OF FINANCIAL RELATIONSHIPS

All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities.  Listed below are the disclosures provided by individuals in a position to influence and/or control CME activity content.  

* A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.   

 

Name Role

Relevant Financial Relationship

(Please indicate Yes or No)

Name of Commercial Interest(s)*

Please list name(s) of entity

AND

Nature of Relevant Financial Relationship(s)

(Please list: Research Grant, Speaker’s Bureau, Stock/Bonds excluding mutual funds, Consultant, Other – identify)

Disclosure of Off-Label (Unapproved)/Investigational Uses of Products
AAP CME faculty are required to disclose to the AAP and to learners when they plan to discuss or demonstrate pharmaceuticals and/or medical devices that are not approved by the FDA and/or medical or surgical procedures that involve an unapproved or “off-label” use of an approved device or pharmaceutical.

(Do intend to discuss or Do not intend to discuss)

Paul Wirkus Planner/Moderator NO NONE Do not intend to discuss
Adam Ware Faculty NO NONE Do intend to discuss
Carolyn Reynolds Planner NO NONE Do not intend to discuss
Alisa Stoddard UTAAP Staff/COI Reviewer-Resolver NO NONE Do not intend to discuss

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Academy of Pediatrics (AAP) and the Utah Chapter of the AAP.  The American Academy of Pediatrics is accredited by the ACCME to provide continuing medical education for physicians.

The AAP designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity is acceptable for a maximum of 1.0 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.

PAs may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

 This program is accredited for 1.0 NAPNAP CE contact hours of which 0 contain pharmacology (Rx) content, (0 related to psychopharmacology) (0 related to controlled substances), per the National Association of Pediatric Nurse Practitioners (NAPNAP) Continuing Education Guidelines.

 MOC Statement:

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 1.0 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.

 If you do not successfully complete all components of the activity and evaluation assessment ABP MOC Part 2 Points will not be awarded.

 Please note: your completion data will be shared with the ABP through the ACCME PARS system within 30 days of successful completion.  This will include the name of the activity and provider; participant name; participant’s ABP ID number; participant’s DOB; date of completion of the activity; the PARS activity identifier; ABP MOC Part 2 credit statement and number of MOC points awarded.  If any questions or concerns please contact the activity manager alisa@aaputah.org.

Learning Objectives

After listening to these episodes listeners will…

  • Understand benign causes of syncope and initial recommendations
  • Recognize dyslipidemia as a cardiovascular risk factor and understand how to interpret a lipid panel
  • Know features of a benign murmur

Time Stamps Episode 19-1

Intro
4:18 Dizziness, lightheadedness, and fainting
8:07 Physiology of lightheadedness
9:43 Dehydration
11:55 Not eating & salt
13:27 Mechanics
15:44 Taking detailed histories, family histories
17:54 Physical exam
19:21 Who needs an ECG? Holter?
22:18 Common themes
23:45 Lifestyle or Medicate?

Time Stamps Episode 19-2

Intro
5:20 Bogalusa heart study
6:19 Effect of lipids on blood vessels
8:21 Acquired lipid disorders
9:45 Familial lipid disorders
12:11 NHBLI 2011 guidelines
15:00 What do we do with results?
17:37 Level threshold?
21:20 When to refer?
22:40 Other interventions?
23:45 Starting statins

Time Stamps Episode 19-3

Intro
3:33 Cardiac auscultation physical exam
5:18 History & physical findings
8:12 Normal sound
9:43 Physiologic split
11:05 Fixed split second heart sound
12:30 Mid systolic click
13:40 Murmurs
22:45 Phase of the cardiac cycle
24:32 Innocent murmurs
26:38 Stills murmur
27:35 Flow murmur
31:06 Venous hum
35:19 VSD murmur
40:08 Diastolic murmur
42:05 PDA

Links from the Show

Bogalusa Heart Study

NHBLI 2011 guidelines

Heart Sounds Library  Open.Michigan, Regents of the University of Michigan, https://open.umich.edu/find/open-educational-resources/medical/heart-sound-murmur-library; (Accessed 20, July 2020). License: Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/).

Acknowledgements

Written and Hosted by: Paul Wirkus, MD, FAAP
Administrator/Producer/Photographer: Alisa Stoddard, UTAAP Executive Director
Audio Engineer: Phil Wirkus
Music by: Phil Wirkus
Guest: Adam Ware, MD, FAAP

Questions?  Send us an email.