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Lesson 279: PreAnesthetic Assessment of
the Patient With Cardiomyopathy |
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Course Author:
Prashan H. Thiagarajah, MD
Research associate, Department of Cardiology, Beth Israel Medical
Center, New York, New York
Reviewed By:
Somasundaram Thiagarajah, MD, FRCA
Clinical professor of anesthesiology, Albert Einstein College of
Medicine, Bronx, New York; anesthesiologist, Beth Israel Medical
Center, New York, New York
Review Date: December, 2008
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Registration Fee: $15.00
2.0 AMA PRA Category 1 CreditsTM
available until April 30, 2010
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REGISTRATION INFORMATION:
Participants who do not possess a copy of Anesthesiology News
can download and print the course material in an easy to read
convenient format. Participants must reflect on the information
presented, and then register to complete the exam and course evaluation
online before the availability date listed above. (CME credit is not valid past this
date).
Click on the link below to download and print the course material
and post-test exam.
Register for the exam to enter your responses to receive CME credit. There are ten questions in the examination and you must achieve
a score of 80% or better to earn CME credit. Following successful
completion, your certificate will be immediately available online.
In addition, a historical record of completed CME courses is
maintained online in an individualized profile. This includes
copies of course certificates which can be printed at any time.
The registration fee for this course is $15.00
Physicians are provided with two opportunities to successfully complete the
exam presented here.
Software Requirements: Adobe Acrobat Reader and any standard
Internet Browser.
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NEEDS STATEMENT
Cardiomyopathic disorders are being diagnosed increasingly as the
result of both improvements in the means of detection and aging of
the population. Consequently, more patients with cardiomyopathy as
an underlying condition undergo anesthesia. It is essential that
anesthesiologists understand the fundamental pathologies of these
cases to improve their management.
CASE HISTORY
To improve the cardiac function of a 78-year-old man with an
ejection fraction (EF) of 20%, an operation was scheduled in which
his single-chamber, ventricular-inhibited pacemaker would be
upgraded to a biventricular pacer. The patient’s current medications
included furosemide, warfarin (which was discontinued a week before
surgery), and losartan (an angiotensin II–receptor antagonist).
Electrocardiography (ECG) revealed left bundle branch block. Chest
x-ray revealed cardiomegaly and lung congestion. The patient’s vital
signs were as follows: blood pressure (BP), 90/65 mm Hg; heart rate,
92 beats/min; respiratory rate, 22 breaths/min; hemoglobin, 14 g/100
mL. His potassium, magnesium, and creatinine levels were all within
normal range.
LEARNING OBJECTIVES
At the end of this activity, the participant should be able to:
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Identify the types of cardiomyopathy.
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List the symptoms of cardiomyopathy.
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Differentiate between ischemic and
nonischemic cardiomyopathy, by cause.
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Discuss the basic medical and
surgical management of the patient with cardiomyopathy.
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Outline the application of an
automatic implantable cardioverter defibrillator (ICD).
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Describe biventricular pacing.
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Outline the appropriate preparation
for surgery of patients with cardiomyopathy.
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Manage patients requiring anesthesia
who have an automatic ICD.
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Manage patients with a low ejection
fraction due to cardiomyopathy.
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Present an anesthetic plan for
patients with cardiomyopathy.
TARGET AUDIENCE: Anesthesiologists
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Accreditation Statement
Mount Sinai School of Medicine is accredited by the Accreditation
Council for Continuing Medical Education (ACCME) to provide continuing
medical education for physicians.
Credit Designation: The Mount Sinai School of Medicine designates
each educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM.
Physicians should only claim credit commensurate with the extent of
their participation in the activity.
It is the policy of Mount Sinai School of Medicine to ensure objectivity,
balance, independence, and scientific rigor in all CME-sponsored educational
activities. All faculty participating in the planning or implementation
of a sponsored activity are expected to disclose to the audience any
relevant financial relationships and to assist in resolving any conflict
of interest that may arise from the relationship. Presenters must
also make a meaningful disclosure to the audience of their discussions
of unlabeled or unapproved drugs or devices.
Disclosures
The author, reviewer, and editor have no relationships with
pharmaceutical companies or manufacturers of products to disclose.
This educational activity may contain discussion of published
and/or investigational uses of agents for the treatment of
disease. Some uses of these agents have not been approved by the
FDA. Please refer to the official prescribing information for each
product for approved indications, contraindications, and warnings.
CONTACT INFORMATION
Questions regarding course content may be directed to Dr. Elizabeth
Frost: ElzFrost@aol.com.
If you require technical assistance with completing this
course, please contact Continuing Education Online Customer Service
at 718-648-8080 or send e-mail to
ceo.contact7@proceo.com.
CALL FOR WRITERS
If you would like to write a CME lesson in Anesthesiology News,
please send an e-mail to Elizabeth A.M. Frost, MD, at
ElzFrost@aol.com
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