We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Clinical Crossroads: An 88-Year-Old Woman Facing the End of Life

Valery A. Portnoi, MD
JAMA. 1997;278(12):977. doi:10.1001/jama.1997.03550120037019.
Text Size: A A A
Published online


To the Editor.  —As a practicing geriatrician, I enjoyed reading Dr Lynn's discussion of Mrs J, an 88-year-old woman at the end of life.1 I have under my care a 92-year-old woman with strikingly similar conditions, ie, severe aortic stenosis, coronary artery disease, and congestive heart failure (CHF). But, in contrast to Mrs J, 2 years ago my patient reversed her initial decision to have hospice care and underwent 2 balloon valvuloplasties.It appears that Mrs J 1 year before discussion was ready for more aggressive treatment. Otherwise why would she consent to cardiac catheterization? Open heart surgery was not a good treatment option, as Lynn commented. But what about valvuloplasty? A wide range of invasive treatment options can be successful, even in very elderly patients.2Regardless of decisions regarding invasive procedures or surgery, medical management of CHF should be optimized for the patient discussed by Lynn. Angiotensin-converting enzyme inhibitors are a


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.