Just don’t stopmy achy, breaky heart …

The case A 13-year-old girl with a history of congestive heart failure underwent device closure of her atrial septal defect (ASD) about 3 months ago. Now she presents with worsening cardiac function, and the cardiologist thinks she might have myocarditis. She presents today for a diagnostic cardiac catheterization. “She's very nervous, doctor. She can't lay still for 10 minutes, there's no way she's going to be able to lay still for 1 hour,” her mother explains. “She definitely needs general anesthesia – and that's what she wants.” The patient is sitting quietly next to her mother with her head down and won't look at you when you address her. As you go through the preop questionnaire, you learn that she can only go up one flight of stairs before she “looks like she's gonna faint!” Yesterday's echocardiogram showed a whopping ejection fraction (EF) of 20%. “The cardiologist assured us that she would be totally asleep for this.” Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families. Here we have a very nervous teenager and her equally, if not more, nervous mother – who has been told by another physician (a nonanesthesiologist) how you are going to perform this anesthetic. Nice.