Lesson 295: PreAnesthetic Assessment of the Patient With Systolic or Diastolic Heart Failure

Written By:

Megan Lanigan, MD, Resident, Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois; and Richa Dhawan, MD, Assistant professor, Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois

Registration Fee: $15.00
2.0 AMA PRA Category 1 CreditsTM
available until December 31, 2012

Reviewed By:

Mark Chaney, MD, Professor, Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois

Review Date: November, 2011
REGISTRATION INFORMATION:

Participants who do not possess a copy of Anesthesiology News can download and print the course material in an easy to read printer-friendly 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. 

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CLICK HERE TO VIEW / PRINT COURSE MATERIAL

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NEEDS STATEMENT

Diagnosing congestive heart failure (CHF) may be difficult in the elderly or obese patient. Complications during anesthesia can lead to increased morbidity and mortality. Recognizing this common condition has been identified by committee as required knowledge for anesthesiologists.

CASE HISTORY

A 13-year-old girl was brought to the emergency department by her parents after developing progressive swelling of the face, lips, and tongue. Her parents explained that over the course of the afternoon, the child’s voice had become increasingly hoarse, and she began to complain of difficulty in swallowing. Earlier that day, she had been to the dentist for routine dental cleaning. She had been well at the time, and the visit itself was uneventful. On physical examination, there was marked edema of the perioral region. Her tongue was severely enlarged such that she had difficulty keeping her mouth closed and controlling her saliva. She resisted lying down, preferring to sit in a forward-leaning position. No other constitutional symptoms, including rash or urticaria, were apparent. Vital signs included blood pressure, 100/60 mm Hg; heart rate, 88 beats per minute; oxygen saturation, 96%; and temperature, 97.2°F.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

    1. List the diagnostic criteria for CHF with preserved ejection fraction (EF).
    2. Differentiate the diagnostic criteria between CHF with, and without, preserved EF.
    3. Define the American College of Cardiology/American Heart Association and New York Heart Association classifications for CHF.
    4. Identify differences in ventricular structural abnormalities in CHF with and without preserved EF.
    5. Quote the prevalence and demographics of CHF.
    6. Outline the pathophysiology leading to CHF.
    7. Discuss the treatment options for patients with CHF.
    8. Evaluate the patient with acute decompensated heart failure.
    9. Explain the anesthetic implications for CHF.
    10. Establish hemodynamic goals for patients with CHF.

TARGET AUDIENCE:  Anesthesiologists

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, the reviewer, and the editor have no relation-ships 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