Heart & Lung Transplants Flashcards
1
Q
Transplant Considerations
A
- 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
2
Q
Pre heart transplant management
A
-prevent loss of physical function
ROM, soft tissue, extensibility, strength
3
Q
Primary Diagnosis to get on heart donor list
A
- Adults: severe CAD, end stage cardiomyopathy, heart failure
- Children 1-10: cardiomyopathy
- Children <1: congenital heart disorders
4
Q
Primary Diagnosis to get on lung donor list
A
- COPD
- Idiopathic Pulmonary Fibrosis
- CF
- Pulmonary Arterial HTN
5
Q
General Selection Process
A
- Age <1 year w/o transplant
- Adequate social support
- other systems disease free
6
Q
Pre Lung Transplant Management
A
- same as heart
- with emphysis on chest wall ROM & use of diaphragmatic breathing
7
Q
Normal FEV1=
A
75%
8
Q
Consequences of Denervated Heart
A
- RHR: 90-110 bpm
- incr SBP & DBP
- decr HR to response to ex’s
- NO SENSATION OF ANGINA!
9
Q
2 Types of Heart Transplants
A
- heterotopic
- orthotopic
10
Q
Orthotopic Heart Transplant
A
- donor heart replaces host heart
- recipient vena cava and SA node left behind
- donor SA node attached
- (EKG has 2 P waves)
11
Q
Exercise Response in Denervated Heart
A
- 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
12
Q
Factors Determining Reinnervation of Heart
A
- longer after surgery
- younger donor
- younger recipient
- lack of surgical complications
=increased chance of reinnervation
13
Q
Heterotopic Heart Transplant
A
- 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)
14
Q
PT Considerations (heart transplant)
A
- 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
15
Q
Sternal Precautions
A
- Lifting: </= 10 lbs for 6-8 weeks
- limitations of end range flexion and horizontal abd
