Heart & Lung Transplants Flashcards
Transplant Considerations
- geographic distance to center
- Heart: severity of disease (ISHLT); in heart failure
- LUNG: severity of disease (ISHLT);
- -COPD: (BODE score 7-10);
- -IPF: (decr FVC 10%+ 6 months); pulse ox <30% predicted
- -lung allocation score
Pre heart transplant management
-prevent loss of physical function
ROM, soft tissue, extensibility, strength
Primary Diagnosis to get on heart donor list
- Adults: severe CAD, end stage cardiomyopathy, heart failure
- Children 1-10: cardiomyopathy
- Children <1: congenital heart disorders
Primary Diagnosis to get on lung donor list
- COPD
- Idiopathic Pulmonary Fibrosis
- CF
- Pulmonary Arterial HTN
General Selection Process
- Age <1 year w/o transplant
- Adequate social support
- other systems disease free
Pre Lung Transplant Management
- same as heart
- with emphysis on chest wall ROM & use of diaphragmatic breathing
Normal FEV1=
75%
Consequences of Denervated Heart
- RHR: 90-110 bpm
- incr SBP & DBP
- decr HR to response to ex’s
- NO SENSATION OF ANGINA!
2 Types of Heart Transplants
- heterotopic
- orthotopic
Orthotopic Heart Transplant
- donor heart replaces host heart
- recipient vena cava and SA node left behind
- donor SA node attached
- (EKG has 2 P waves)
Exercise Response in Denervated Heart
- Cardiac output increaed by stroke volume for submax exercise
- after 5 min, HR incr due to circulating catacholamines (NE/E)
- HR incr slowly and slowly decr to resting
Factors Determining Reinnervation of Heart
- longer after surgery
- younger donor
- younger recipient
- lack of surgical complications
=increased chance of reinnervation
Heterotopic Heart Transplant
- donor heart anastomosed to host heart w/o removing host heart
- LA attached to LA; RA to RA
- shared venous return
- funky EKG (both have action potentials)
PT Considerations (heart transplant)
- longer warm up (10-15 min) and cool down
- use RPE scale b/c of blunted HR response
- SBP more appropriate to assess ex’s response & recovery
Sternal Precautions
- Lifting: </= 10 lbs for 6-8 weeks
- limitations of end range flexion and horizontal abd
Outpatient Exercise (lung transplant)
avoid UE strengthening for 6 weeks
Ex’s Guidelines (Acute care rehab)
- HR:
- SBP:
- DB:
- HR: not >120 bpm or >20 bpm above resting
- SBP: <120mmHg
- No angina
2 Long Term Complications
lung transplant
- Osteoporosis
- Bronchiolitis Obliterans
Outpatient Rehab Ex’s (heart)
F:
I:
T:
F: 4-6 days/week
I: 11-15 RPE
T: prog 15-60 min/session
PT General Goals
Lung
- prevent infection
- optimize vent-perf matching
- incr time out of bed
- incr ROM surgical site
Acute Phase Ex’s
Lung
- Similar to heart transplant
- secretion management
- Incentive spirometry
Acute rejection (heart)
- w/n 1st 6 months
- 1st sign: ex’s intolerance
Strengthening Ex’s (Heart)
F:
T:
- 2-3 days/week
- Avoid isometric (hemodynamic stress)
Terminate/Modify Exercise
Heart
- RHR >120
- HR incr >40
- SBP Resting: >190
- SBP incr >40
- SBP decr >10
- DBP resting >110
- DBP incr >15
- Dyspnea Index >15
- RPE >13 at rest
- Excessive fatigue/mental confusion
- vertigo/claudication
- EKG Abnormalities
Acute Rejection S/Sx
Lung
- ex’s intolerance (First sign)
- SOB, desaturation @ rest or w/ ex’s of 4-5% with same exertion level
Long Term complications
Heart transplant
- Osteoporosis
- cardiac allograft vasculopathy (accelerated form of atherosclerosis)
S/Sx Acute Rejection
Heart
- low grade fever
- incr resting BP
- hypotension w/ activity
- myalgias
- fatigue
- decr ex’s tolerance
- ventricular dysrhythmias
