Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:

  1. Read the article by Poliac et al.  entitled “Hypertrophic cardiomyopathy” on page 183 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.

The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The American Society of Anesthesiologists designates this continuing medical education program for a maximum of 1 hour of Category 1 credit toward the AMA’s Physician Recognition Award. Each physician should claim only those hours of credit actually spent in the activity.

Purpose:  The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.

Target Audience:  Physicians and other medical professionals whose medical specialty is the practice of anesthesia.

Learning Objectives:  After reading this article, participants should have a better understanding of the pathophysiology of hypertrophic cardiomyopathy and the anesthetic management of patients with this condition.

Authors –Liviu C. Poliac, M.D., Michael E. Barron, M.D., and Barry J. Maron, M.D. Grants or research support:  None Consultantships or honoraria:  None The article authored by Drs. Poliac, Barron, and Maron was supported solely from institutional and/or departmental sources.

Question Writer –Peter L. Bailey, M.D. Dr. Bailey has no grants, research support, or consultant positions, nor does he receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.

Based on the article by Poliac et al.  entitled “Hypertrophic cardiomyopathy” the January issue of Anesthesiology, choose the one correct answer for each question:

1. Which of the following statements concerning hypertrophic cardiomyopathy (HCM) is most  likely true?

A. It is a rare (< 1:5,000) disorder.

B. It is usually transmitted as an autosomal dominant trait.

C. Its diagnosis requires left ventricular outflow obstruction.

D. It is always associated with a high risk for sudden death.

2. Which of the following methods is most  definitive in establishing a diagnosis of HCM?

A. Echocardiography

B. Family history

C. DNA analysis

D. Electrocardiography

3. Which of the following statements concerning the morphological features of HCM is most  likely true?

A. It is usually symmetric.

B. Mitral valve malformation is usually secondary to outflow tract obstruction.

C. Involvement of the anterior ventricular septum is usually predominant.

D. Histopathological changes are restricted to hypertrophied areas of myocardium.

4. Which of the following hemodynamic aberrations is least  likely to be associated with HCM?

A. Midsystolic left ventricular outflow tract obstruction

B. Mitral regurgitation

C. Impaired ventricular relaxation and diastolic dysfunction

D. Increased peak velocity of early ventricular filling

5. Which of the following is least  likely to increase outflow tract obstruction in patients with HCM?

A. Hypertension

B. Tachycardia

C. Increased contractility

D. Hypotension

6. Anesthetized patients with unrecognized HCM may experience sudden hypotension and seemingly paradoxical responses to vasoactive drugs. In such circumstances, where HCM is suspected, which of the following interventions is least  likely to be appropriate?

A. β-adrenergic therapy

B. α1-agonist therapy

C. Epinephrine

D. Fluid volume loading