CHF: Devices Flashcards
what proves true AS on a dobutamine echo (low flow low gradient)
AVA 30mm Hg
which valvular abnormality needs to be addressed when placing an LVAD?
AI
class I indication to fix severe TR
when going in for MV surgery
for NICM, how long do you wait until ICD for primary prevention?
3-6 mo’s
do LVADs improve survival?
yes
who are the ideal candidates for LVAD?
stable or worsening on inotropes
need temp mech support
what are blood test factors that put pt’s at high in-hospital mortality after LVAD?
low platelets
low albumin
high INR
what is a desirable value for RV Stroke Work Index (RVSWI)?
> 300
what is a desirable PVR?
<4 woods units
what is a desirable Transpulmonic gradient
<15 mm Hg
what value of VO2 on CPET should be referred for OHT?
<14 cc/kg/min
PVR equation
PVR = (mean PA - PCWP)/CO
if patient is a transplant candidate, what is a goal PVR? if it is high, what can you do for pt until he gets a heart?
<3 woods units
give nitroprusside
define UNOS IA
milrinone .5 or dobutamine 7.5 or combo + swan
IABP
LVAD complication
define UNOS IB
any inotrope without swan
LVAD
define UNOS 2
out of hospital
define UNOS 7
inactive
which class of meds has been shown to improve mortality in OHT?
statins
what class of immunosuppresants are cyclosporine and tacrolimus? mechanism?
calcineurin inhibitors
decrease IL-2
side effects of calcineurin inhibitors
renal insufficiency
HTN
side effects of cyclosporine
gingival hyperplasia
hirsutism
side effects of tacrolimus
DM
mech and AE’s of mycophenolate
decreases lymphocyte proliferation
GI
which is more potent, mycophenolate or azathioprine?
mycophenolate
what is thymoglobulin’s mech? what do you use to follow efficacy? who do you use it for?
kills lymphocytes (cytolytic)
CD3
highly sensitized pt’s w/ CRI
what should you always do to avoid side effects of thymoglobulin?
premeditate with benadryl and tylenol
what med can you use as an IL-2 receptor blocker to hold off on giving calcineurin inhibitors?
Basiliximab
what is Rx for mild, mod and severe OHT rejection?
mild- mild inc in immunosup.
mod- pulse steroids
severe- thymoglobulin, hemodynamic support
Rx for humoral or Ab-mediated rejection
IVIG and plasmapharesis
what is the leading cause of death 5 yrs after OHT?
Cardiac Allograft Vasculopathy
3 presentations of Cardiac Allograft Vasculopathy
sudden death
silent MI
malignant arrhythmias
protocol for infection ppx in post- OHT pt’s
CMV- 6 mo’s
fungal and PCP- 1yr
name 6 transplant-related medical problems
HTN DM obestiy osteoporosis gout malignancy
3 common drugs that interact with calcineurin inhibitors (cyclosporine, tacrolimus)
diltiazem
erythromycin
fluconazole
