ARC: A Review Course
ARC: A Review Course

ARC: A Review Course

ARC: A Review Course, is the SCA's review course for the Adult Cardiac Anesthesia Board Examination that will be administered by the American Board of Anesthesiology for the first time in December 2023. Our review course embraces the intersection of technology and education and hosts a series of 36 interactive modules that will walk you through the content outline of the ACA exam. These modules contain images, videos, tables, and text from a variety of sources, but have been arranged for members in easy-to-navigate modules. Work through our modules that are rigorously cited and peer reviewed.


This course contains modules that correlate to the Adult Cardiac Anesthesia Board Exam Content Outline. While not completely inclusive, this will cover the majority of the content outline.

Topics that are covered:

  • Aortic stenosis
  • Cardiac catheterization 1
  • Cardiac catheterization 2
  • Cardiac output
  • Cardiac tamponade
  • Cardiomyopathy 1
  • Cardiopulmonary Bypass (hematologic effects)
  • Cardiopulmonary Bypass (myocardial preservation, cardiothoracic and respiratory effects)
  • Cardiopulmonary Bypass (Neurologic, Metabolic and Endocrine Effects)
  • Cardiopulmonary Bypass (pharmacokinetics and pharmacodynamics)
  • Cardiopulmonary Bypass (renal effects)
  • Cardiopulmonary Bypass (thermoregulatory effects)
  • Coagulation
  • Conduction system
  • Congenital 1
  • Congenital 2
  • CSF drains and SSEPS
  • ECMO
  • Embryology
  • Heart Transplant
  • Hypertrophic cardiomyopathy
  • IABP
  • Infiltrative Storage Disease
  • Ischemic heart disease
  • Lung isolation
  • LVAD
  • Mitral regurgitation
  • Mitral stenosis
  • Neoplastic disease
  • Pacemakers & AICDs
  • Pericardial surgery
  • Post-operative left ventricular failure & inotropes
  • Post-operative right ventricular failure and vasodilators
  • Pulmonary artery catheter
  • Pulmonary regurgitation and stenosis
  • Right ventricular assist device
  • TAAA
  • Tricuspid regurgitation and stenosis
  • Type A dissection
  • Vasoplegia

Regina Linganna, MD

Bola Faloya, MD, FASE, FASA

Albert Tsai, MD

Editor: Vivien Wong, MD

Curriculum content

  •
    From risk factors and pathophysiology to surgical and interventional repair and replacement this module takes you through aortic stenosis. Ali Salehi, M.D., F.A.S.A. Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA.

    • Lesson Aortic Stenosis

  • Cath lab procedures provide a minimally invasive way to diagnose, treat and dictate management for CAD, valvular heart disease, congenital heart disease, cardiomyopathies, pericardial disease. Heather Hayanga, MD, MPH West Virginia University Megan P. Kostibas, MD Johns Hopkins School of Medicine

  • Cath lab procedures provide a minimally invasive way to diagnose, treat and dictate management for CAD, valvular heart disease, congenital heart disease, cardiomyopathies, pericardial disease. Heather Hayanga, MD, MPH West Virginia University Megan P. Kostibas, MD Johns Hopkins School of Medicine

  • This module will discuss different modalities to determine cardiac output​. Jordan Goldhammer, M.D. Thomas Jefferson University Hospital

  • This module reviews the etiology of cardiac tamponade, how cardiac tamponade is diagnosed, anesthetic management and goals, and treatment for cardiac tamponade. Francis M Chang, M.D. University of Rochester 

  • Cardiopulmonary Bypass is essential to the majority of cardiac operations. It is a complex technique that makes cardiac surgery possible but has profound multisystem effects, especially on blood physiology and temperature regulation. An understanding of these fundamentals is crucial to optimal anesthetic management of patients requiring CPB. * Unless otherwise noted , most of this module references portions of relevant chapters in the highly recommended text below, which will be well worth the reader’s time. (New edition awaited in 2023).  Gravlee, Glenn P., Richard F. Davis, John Hammon, and Barry Kussman. Cardiopulmonary bypass and mechanical support: principles and practice. 4th Ed. Lippincott Williams & Wilkins, 2015: Chapter 17. “Hematological Effects and Coagulopathy". Andreas Pape and Kai Zacharowski. (Pages 433-447) & Chapter 8. “Temperature management in cardiac surgery”. Laurie Davies and Heather Reed. (Pages157-173) Mohammed Iqbal Ahmed, MBBS, FRCA University of Texas Southwestern Medical Center

  • Optimizing myocardial preservation during CPB is essential to reducing post-CPB ventricular dysfunction.  CPB can lead to systemic inflammation and ischemia which can manifest as end organ damage in the heart as well as in the lungs.  Kayla Knuf, MD San Antonio Military Medical Center

  • This module will discuss the evaluation of the preoperative risk of cardiac surgery-associated acute kidney injury (CSA-AKI) and the intraoperative and early postoperative strategies in decreasing the incidence of CSA-AKI. Reney Henderson, M.D. University of Maryland School of Medicine

  • Cardiopulmonary Bypass is essential to the majority of cardiac operations. It is a complex technique that makes cardiac surgery possible but has profound multisystem effects, especially on blood physiology and temperature regulation. An understanding of these fundamentals is crucial to optimal anesthetic management of patients requiring CPB. * Unless otherwise noted , most of this module references portions of relevant chapters in the highly recommended text below, which will be well worth the reader’s time. (New edition awaited in 2023).  Gravlee, Glenn P., Richard F. Davis, John Hammon, and Barry Kussman. Cardiopulmonary bypass and mechanical support: principles and practice. 4th Ed. Lippincott Williams & Wilkins, 2015. Chapter 8. “Temperature management in cardiac surgery”. Laurie Davies and Heather Reed. (Pages157-173) Mohammed Iqbal Ahmed, MBBS, FRCA University of Texas Southwestern Medical Center

  • This module will discuss heparin, other anticoagulants, and their reversal agents. This module will also discuss Thromboelastography™ (TEG™); Rotational Thromboelastometry™ (ROTEM™); and Quantra™. It will discuss how they work as well as Viscoelastic testing (VET)- based algorithms. Further it will discuss coagulation/anticoagulation before, during, and after bypass. Lastly, it will discuss post-anesthetic diagnosis and management of post-op hemorrhage. Nadia B. Hensley, M.D. Johns Hopkins University School of Medicine Jacob Raphael, M.D. Thomas Jefferson University Hospital Nabil K. Thalji, M.D. Ph.D. Hospital of the University of Pennsylvania Disclosures: NBH and JR have served as consultants for the scientific advisory of Octapharma, USA. NHB receives author royalties for Wolters Kluwer, www.uptodate.com

  • This module summarizes the cardiac conduction anatomy, mechanism of arrhythmia, and diagnostic tools.  Saga Navare, M.D. Department of Anesthesiology, Weill Cornell Medical Center

  • This module present an overview of congenital valvular diseases focusing on understanding of pertinent concerns for adult patients with history congenital heart disease.   *We recommend completing the embryology module prior to Congenital Heart Disease 1 and 2. Anna Jankowska, MD, FASA Jennie Ngai, MD, FASA New York University School of Medicine Edited by Tal Mandelbaum, MD

  • This module present an overview of congenital valvular diseases focusing on understanding of pertinent concerns for adult patients with history congenital heart disease.   Anna Jankowska, MD, FASA Jennie Ngai, MD, FASA New York University School of Medicine Edited by Tal Mandelbaum, MD

  • This module will cover principles of spinal cord monitoring and protection during open and endovascular aortic surgery.   Igor Feinstein, M.D., Ph.D. Stanford University School of Medicine

  • This module will discuss the indications, cannulation configurations, management of both VV and VA ECMO. Bhoumesh Patel, M.D. Yale School of Medicine Peer Review: Asad Usman, M.D. Hospital of the University of Pennsylvania

  • This module will cover the risk factors, clinical presentation, and evaluation of ischemic heart disease, including perioperative and silent ischemia. The module will also discuss the determinants of myocardial oxygen supply and demand. Paul Frank, M.D. University of California Davis School of Medicine

  • This module will take through etiology, pathophysiology, diagnosis and management of patients with hypertrophic cardiomyopathy. Liliya Pospishil, M.D. NYU Langone Health

  • This module will take you through the physiologic effects of an intra-aortic balloon pump, its mechanism of action, indications, and contraindications for use​. Lida Shaygan, D.O.​ UT Southwestern Medical Center​

  • This module will discuss the perioperative considerations, management, and essential imaging of left ventricular assist devices.  It will also explore device anatomy, common alarms, and associated complications. Heather Lander, M.D. University of Rochester Medical Center

  • From evaluating a patient for lung isolation, describing the physiology of one-lung ventilation to describing the techniques for safe and effective lung isolation, this module will take you through lung isolation and one-lung ventilation. Stephanie Ibekwe, MD, MPH, MS Baylor College of Medicine

  • From evaluating a valve for repair to contributing to the surgical plan to evaluation after CPB, this module will discuss mitral regurgitation. Regina Linganna, M.D. Hospital of the University of Pennsylvania

  • This module will identify the prevalence and etiology of mitral stenosis, discuss mitral stenosis pathophysiology, describe its pharmacologic, interventional, and surgical management, and explore the potential complications of untreated mitral stenosis. Lida Shaygan, D.O. UT Southwestern Medical Center

  • This module will review the types of cardiac neoplastic disease, imaging modalities, surgical and anesthetic considerations for this patient population. David Carroll, D.O. Medical University of South Carolina Sawyer Naze, M.D. Northwestern University Feinberg School of Medicine

  • Heart transplantation is the gold standard surgical management for end-stage heart disease. This module reviews indications, contraindications, and surgical techniques employed in heart transplantation in addition to overview of common early perioperative considerations and complications. Jai Madhok, MD, MSE Stanford University School of Medicine

  • This module will review the current indications and methods of implantation for pacemakers and defibrillators and outline device functionality and anesthetic management of implantation. Brandon Lebow, M.D. University of Rochester Medical Center

  • This module will discuss anesthetic concerns in patients undergoing pericardial surgery for conditions such as tamponade or constrictive pericarditis​ Andrej Alfirevic, M.D. FASE Cleveland Clinic

  • This module will be an overview of the diagnosis, predictors risk factors, and etiology of post-operative left ventricular failure. This module will also detail inotropes used to manage post-operative left ventricular failure. Robert Nampi, M.D., FASE New York University Langone Health

  • This module will define post-operative right ventricular failure and its risk factors, as well as its management. This module will also review pulmonary vasodilators used in the perioperative setting for cardiac surgery. Jessica R. Was, M.D. Henry Ford Hospital

  • The pulmonary artery catheter provides data that is important for the diagnosis and management of a variety of conditions including shock and pulmonary arterial hypertension. Proper use and interpretation of pressure tracings and hemodynamic values is described in this module. T. Robert Feng, M.D. Stanford University School of Medicine

  • This module will discuss evaluation and anesthetic management of patients with pulmonary stenosis and regurgitation. Philip L. Kalarickal, M.D. MPH Emory University School of Medicine

  • Right ventricular assist devices can be used in cases of refractory right ventricular failure as a result of numerous etiologies. Currently there are several types of RVADs commercially available that have all been shown to improve patient hemodynamics after placement. Each device has it own set advantages and disadvantages.  Yang Gu, M.D. University of Rochester Sreekanth R. Cheruku, MD, MPH, FASE, FCCM UT Southwestern Medical Center

  • This module discuss the clinical features of tricuspid stenosis and regurgitation, assessment of severity including by echocardiography, and intra-operative management and factors to consider in surgical decision-making. Ying Hui Low, MD, FASA, FASE Massachusetts General Hospital

  • This module will take you through the management of thoracoabdominal aortic aneurysms. The module will describe aortic dilation and risk factors, anesthetic considerations, and surgical intervention.  Ashley Budd, M.D. Northwestern University Feinberg School of Medicine

  • Stanford Type A dissection involves the ascending aorta and is considered a surgical emergency. The anesthetic management includes consideration of temporary interruption of blood flow, protection of vital organs during ischemia, and monitoring of end organs for ischemia. Abimbola Faloye, MD, FASE, FASA Emory University

  • Vasoplegia is an important condition to recognize and treat for the cardiac anesthesiologist, specifically in the post bypass period.  This module will take you through the diagnosis and treatment options for vasoplegia.  Joseph Sanders, M.D. Henry Ford Health

  • The heart is the first functional organ to develop during fetal development; the complex sequence of developmental events leads to the functional, four-chamber human heart and disruption of any of these events may lead to congenital cardiac disease. Andrew Notarianni, M.D. Yale University

  • This module will describe pathophysiology, diagnosis and anesthetic management of patients with infiltrative cardiomyopathies. Danielle A. Pulton, M.D. Temple University Hospital/Lewis Katz School of Medicine

  • This module will discuss the different types of cardiomyopathies and their clinical features.  Cara Iorianni, M.D. Emory University School of Medicine Peer Reviewer: Seth Perelman, M.D.

  • This module will discuss the effects of cardiopulmonary bypass (CPB) on the neurologic, metabolic and endocrine systems in the context of use in the operating room. Natalie Bodmer, MD Stanford University Hospital

  • The pharmacokinetics and pharmacodynamics of anesthetic drugs can be profoundly affected by the circulatory, volume, temperature and inflammatory changes associated with cardiopulmonary bypass; it is essential to understand how both the movement of drugs through the body and the body’s biologic response to drugs may be altered during this crucial aspect of surgery. Monique L Roberts, M.D. Temple University Hospital

  • This is an overview of the basics of the cardiac conduction system, its components, and the major types of arrhythmias. Discussion includes main diagnostic features, symptoms, and treatment options. Levi Mulladzhanov, MD Einstein Medical Center

  • This is an overview of the basics of the cardiac conduction system, its components, and the major types of arrhythmias. Discussion includes main diagnostic features, symptoms, and treatment options. Levi Mulladzhanov, MD Einstein Medical Center

  • This module will discuss decision making for coronary revascularization. The indications for CABG vs PCI will be compared, and surgical strategies and conduit choices will be examined. Lastly, myocardial ischemia and revascularization in patients with ischemic cardiomyopathy will be discussed.  Perin Kothari, DO Stanford University School of Medicine

  • This module will discuss the pathophysiology of aortic regurgitation as well as aortic valve repair and replacement interventions.  Paul Frank, MD University of California Davis Medical Center Vikram Eswar, MD Hospital of the University of Pennsylvania

  • Patients undergoing cardiac surgery should be adequately monitored at all times. This module will review the monitoring, interpretation, accuracy, and complications of arterial blood pressure.  Eric Feduska, DO Thomas Jefferson University Hospital 

  • This module will discuss the differences between Non-Ischemic and Ischemic Cardiomyopathy​. Saumil J Patel, MD Hospital of the University of Pennsylvania

  • This module will review the indications for and uses of central venous pressure (CVP) catheters, review the anatomy of the CVP waveform, and discuss the interpretation of the CVP waveform in various pathologic states. Ashley Peterson, MD, MPH Stanford Hospital

  • A synopsis of the rare cardiac storage diseases along with its echo findings. Mathew V Patteril MD, FRCA AFFICM MBA University Hospitals of Coventry and Warwickshire Ellesse Credaroli, MD Hospital of the University of Pennsylvania Ellese Credaroli, DO University of Pennsylvania