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Spring Cardiac Theory > LVAD > Flashcards

LVAD Flashcards

1
Q

How have LVADs been used?

A
  1. as a bridge to transplantation
  2. as destination therapy
  3. as a bridge to transplant candidacy
  4. as a bridge to recovery
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2
Q

What are the 2 TYPES of CF LVADS? Where is the impeller located?

A
  1. Heart Mate II: below the diaphragm
  2. HVAD: implanted above the diaphragm within pericardial sac
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3
Q

List the types of temporary forms of cardiac mechanical support in cardiogenic shock

A
  1. Intra-aortic balloon pump
  2. ECMO
  3. Impella
  4. Tandem
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4
Q

What is more COMMON to occur when AV remains CLOSED POSTOPERATIVELY?

A
  1. aortic thrombus
  2. new onset “de novo” AI
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5
Q

How can you view TERMINAL portion of OUTFLOW CANNULA?

A

high left parasternal long axis view

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6
Q

How can you view MID portion of OUTFLOW CANNULA?

A

right parasternal view with patient in right lateral decubitus position

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7
Q

What is the velocity norm for OUTFLOW grafts?

A
  • normal ≤ 2m/s
  • > 2 at any level may represent obstruction
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8
Q

What is the velocity norm for INFLOW HEART MATE II?

A

normal < 1.5 m/s

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9
Q

What is the velocity norm for HVAD?

A

can’t be performed due to color and doppler artifact caused by closeness of the impeller

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10
Q

When is BP taken?

A

Pre exam BP and BP after any pump speed changes.

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11
Q

What is being determined when checking the BP?

A

mean arterial pressure = cuff pressure is gradually reduced until a constant sound is heard

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12
Q

What MAP NORM is recommended?

A

MAP BP < 85 mmHg

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13
Q

What MAP NORM indicates hypertension and what does this mean?

A
  • MAP BP > 85 mmHg
  • too high speed pump
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14
Q

What MAP NORM indicates hypotension and what does this mean?

A
  • MPAP < 60 mmHg
  • too low speed pump
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15
Q

What are reasons to stop a SPEED CHANGE TEST?

A
  1. completion of test
  2. suction event occurs
  3. symptoms of hypertension
  4. symptoms of hypotension
  5. cannula flow reversal
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16
Q

Describe a SUCTION EVENT?

A

when high pump speeds, malplaced cannula or hypovolemia pulls LV segment obstructing flow into the cannula: very critical as dangerous arrhythmia occur and cardiac outflow is impeded

17
Q

What are SIGNS of too LOW of speed?

A
  1. LVIDd increased
  2. Right ward shifted IVS
  3. More prominent MR
  4. Frequent AV opening
  5. RA and RVSP increased
18
Q

What are SIGNS of too HIGH of speed?

A
  1. leftward shifted IVS and/or impedes flow into cannula
  2. Worsening TR and AR
19
Q

What is an OPTIMAL speed?

A
  1. speed just below the maximum speed that keeps the AV closed or only intermittent opening depending on institution
  2. Typically at least 400 and 40 below maximal speedster HMII and HVAD

Spring Cardiac Theory (11 decks)

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