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Cardio 2 > Thoracic Organ Transplantation > Flashcards

Thoracic Organ Transplantation Flashcards

1
Q

Primary indication for transplant

A

terminal cardiopulmonary disease with limited life expectancy

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2
Q

Heart transplantations performed as a result of

A
  • coronary artery disease
  • myocardial damage
  • cardiomyopathy
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3
Q

what is cardiomyopathy

A

a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body

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4
Q

1 Lung transplantations performed as a result of

A
  • Emphysema & COPD
  • Idiopathic pulmonary fibrosis
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5
Q

Double lung transplant increases survival rate to what

A

to 65 years old

therefore it is reserved for younger pt

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6
Q

Congenital heart disease

A

are present at birth and can affect the structure of a baby’s heart and the way it works

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7
Q

NYHA class III–IV despite maximal therapy such as the following

A
  • Medication
  • Pacing (CRT)
  • Revascularization or valve repair
  • Ventricular remodeling procedure
  • Recurrent hospitalization for heart failure
  • Refractory ischemia and EF <20%
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8
Q

Idiopathic pulmonary fibrosis

A

a condition in which the lungs become scarred and breathing becomes increasingly difficult

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9
Q

Indications for Lung Transplantation

A

COPD
Idiopathic pulmonary fibrosis
Cystic fibrosis
Idiopathic pulmonary arterial hypertension
Sarcoidosis

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10
Q

Sarcoidosis

A

a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body

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11
Q

Idiopathic pulmonary arterial hypertension

A

a rare disease characterized by elevated pulmonary artery pressure with no apparent cause

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12
Q

Cystic fibrosis

A

Cystic fibrosis affects the cells that produce mucus, sweat, and digestive juices. It causes these fluids to become thick and sticky. They then plug up tubes, ducts, and passageways.

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13
Q

primary physician who must consider what when thinking of transplant

A

health status of the patient vs the average time spent on the waiting list

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14
Q

transplant center refferals

A

If put on waiting list – must re-evaluate every 6 months for status changes

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15
Q

Tests and Procedures before being put on the weight list

A

Required examination and assessment for transplant candidacy or waitlist placement

lung assessment
cardiac assessment
lab test
bone density scan

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16
Q

Cardiac transplantation Absolute Contraindications

A

Systemic illness with a life expectancy <2 years despite HT

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17
Q

Physical therapist role in the transplant team

A

Exercise tolerance test and exercise prescription Musculoskeletal assessment
Cough/mucociliary clearance

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18
Q

PT and lung transplant candidates need to test what

A

eed to assess efficacy of airway clearance techniques

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19
Q

Primary pulmonary hypertension and exercises

A

Exercise may be contraindicated in patients with primary pulmonary hypertension as it may aggravate the condition

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20
Q

Factors affecting ranking on the transplant list

A

tissue match, blood type, length of time on list, immune status, distance between potential recipient and donor

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21
Q

Status 1A HT days

A

50 days

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22
Q

Status 1B HT days

A

78 days

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23
Q

Status 2 HT days

A

309 days

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24
Q

lung transplant 12 and younger are ranked by what

A

Recipients 12 years or younger are ranked first by ABO blood status

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25
Q

lung transplant older then 12 ranked by what

A

Other candidates are provided a Lung Allocation Score (LAS)
* score from 0 to 100 and are reassessed every 6 months

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26
Q

training effects in transplantation candidates

A

Research supports significant training effects in transplantation candidates

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27
Q

Components of rehab for transplant pt include

A

patient and family education, cardiovascular endurance training, musculoskeletal strength and flexibility training, breathing retraining

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28
Q

Goal of Preoperative Rehabilitation

A

Goal to improve or prevent deteriorations of candidate’s physical condition, improve exercise tolerance

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29
Q

what guidelines​ do you use for Preoperative Rehabilitation

A

hemodynamic guidelines

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30
Q

what is the purpsoe of Left ventricular assist device (LVAD)

A

is used to “bridge” the
patient to heart transplant leads to improved performance

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31
Q

Preoperative Rehabilitation how much

A

Most patients are able to participate in exercise 30 to 40 minutes three to five times per week

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32
Q

why use ECMO as a Bridge to Transplant

A

Some pre–lung transplant patients who must avoid or are failing ventilatory support

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33
Q

what kind of ECMO is used to bridge to transplant

A
  • Venovenous (VV) ECMO is used for respiratory failure
  • Venoarterial (VA) ECMO is used for circulatory collapse due to pulmonary hypertension
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34
Q

Venovenous (VV) ECMO

A

is used for respiratory failure

35
Q

Venoarterial (VA) ECMO

A

is used for circulatory collapse due to pulmonary hypertension

36
Q

Mobility and ECMO PT role

A

PT supports patient with gait belt and steadies rolling walker

37
Q

Alternatives to Lung Transplantation

A

Lung volume reduction surgery (LVRS)
Noninvasive ventilation or BiPAP

38
Q

Lung volume reduction surgery (LVRS)

A
  • 20% to 30% of volume of each lung is removed
  • Decreased lung hyperinflation & improve elastic recoil
39
Q

Noninvasive ventilation or BiPAP

A
  • Tightly fitting nasal mask
  • Delivers positive airway pressure during inspiration and exhalation
40
Q

Noninvasive ventilation or BiPAP used for what kind of pt

A

Indicated for patients with signs of respiratory failure despite maximal drug and O2 therapy

41
Q

Noninvasive ventilation or BiPAP - when is it normally used

A

Typically used at night to decrease work of breathing, daytime fatigue and improved sleep

42
Q

Alternatives to Heart Transplantation

A
  • Mechanical Circulatory Support Devices (MCSD)
    Cardiomyoplasty
    Intravenous pharmacological management
43
Q

Mechanical Circulatory Support Devices (MCSD) types

A

Ventricular Assistive Device (VAD)
Total Artificial Heart (TAH)

44
Q

Ventricular Assistive Device (VAD)

A
  • Biventricular (BiVAD)
  • Right Ventricular (RVAD)
  • Left Ventricular (LVAD)
  • “Destination VAD”
45
Q

what do Mechanical Circulatory Support Devices allow for the pt

A

Able to resume ADLs and participate in a cardiac rehabilitation program in preparation for a heart transplantation

46
Q

Cardiomyoplasty

A

Fatigue-resistant skeletal muscle is wrapped around the patient’s heart/stimulated electrically

47
Q

Intravenous pharmacological management

A

Becoming more common to manage chronic heart failure in those waiting for transplant

48
Q

Four methods of cardiac transplantation

A
  1. Heterotopic(HHT)
  2. Totaltransplantation
  3. Biatrial
  4. Bicaval
49
Q

Heterotopic Heart Transplantation (HHT othere name

50
Q

Native heart HHT

A

native heart is not removed

51
Q

in HHT how is the heart connected

A

Donor heart is connected to the native heart via right/left atria

52
Q

HHT complications

A

More associated complications

53
Q

Total Heart Transplantation use

A

not used much

54
Q

Total Heart Transplantation artia of recipient

A

Complete excision of the recipient atria

55
Q

Total Heart Transplantationrpocedure

A

omplete atrioventricular transplantation, bicaval and pulmonary venous anastomoses

56
Q

Orthotopic heart transplant

A

involving excision of the recipient’s heart and implantation of a donor’s heart in the chest of the recipien

57
Q

Orthotopic Heart Transplantation two techniques

A

Biatrial technique
Bicaval technique

58
Q

Biatrial technique overall

A

Donor and recipient atrial cuffs sewn together

59
Q

Biatrial technique

A

leaves recipient SA node intact, which remains functional; donor heart SA is denervated

  • Two separate P waves will be seen on ECG
60
Q

Bicaval technique

A

Sewing separate caval anastomoses

61
Q

Bicaval technique popularity

A

Most popular with less complications

62
Q

Harvest of donor lungs

A
  • Pulmonary veins are detached from heart with cuff of left atrium
  • Pulmonary arteries are transected
  • Lungs removed en bloc, divided into separate right and left lungs
63
Q

Procedure for lung transplant - methods

A

bilateral anterior thoracotomies
or
transsternal bilateral thoracotomy (clamshell)

64
Q

which lung is removed first in LT

A

Least functional lung is removed and transplanted first

65
Q

ingle lung transplant— method

A

posterolateral thoracotomy

66
Q

Acute Complications with transplant

A
  • Acute Rejection
  • Nonspecific graft failure
  • Infection
  • Reperfusion injury
67
Q

Pharmacological Management of transplant

A
  • immunosuppressiveagentsanddrugs
    targeting side effects of these agents
  • necessary to prevent rejectionof donor organ
68
Q

Acute rejection due to

A

Occurswhentheimmunesystemis not adequately suppressed;

69
Q

how to treat acute rejection

A
  • treated with strong doses of immunosuppressive meds
70
Q

Myalgia

A

muscle aches and pain, which can involve ligaments, tendons and fascia, the soft tissues that connect muscles, bones and organs. Injuries, trauma, overuse, tension, certain drugs and illnesses can all bring about myalgia.

71
Q

signs and Symptoms of Acute Rejection -HT

A

Low-grade fever
Increase in resting blood pressure
Hypotension with activity
Myalgia
Fatigue
Decreased exercise tolerance
Ventricular dysrhythmias
Dyspnea
Decreased exercise tolerance
Weight gain due to water retention

72
Q

signs and Symptoms of Acute Rejection - LT

A

Fever over 100°F (38°C)
“Flulike” symptoms: chills, aches, headache, dizziness, nausea, and/or vomiting
Chest congestion
Cough
Shortness of breath
Decreased exercise tolerance
New pain or tenderness around the lung
Fatigue or generally feeling “lousy”
Decreased exercise tolerance
Decrease in FEV1 and FVC

73
Q

Cardiac Changes Post-Heart Transplant - BP

A
  • High risks associated with hypertensive episodes
  • HTN is of significant concern and must be avoided
  • Need to consider patient positioning and exercise prescription to reduce HTN episodes from occurring
74
Q

Cardiac denervation occurs​ when

A

initially occurs following heart transplant; infrequent with isolated lung transplant

75
Q

Cardiac denervation - HHT

A

donor heart responds in same manner as denervated heart; native heart still innervated, but attention should be on donor heart response

76
Q

for heart transplates when is a good way to measure activity intensity

A

not HR and use of RPE is better

77
Q

Changes in Pulmonary Status after Heart & Lung Transplant

A

Maximum O2 uptake and exercise capacity improve significantly, but remain below predicted values

78
Q

what kind of preccaustiosn for median sternotomy and clamshell incisions

A

sternal precuations

79
Q

The Acute Postoperative Inpatient Phase - PT role

A
  • PT goals are to improve function and QOL, specifically functional abilities in self-care and mobility
80
Q

Postoperative Outpatient Phase - Frequent complications

A

chronic​ rejection, infection, hypertension, steroid myopathy, osteoporosis…

81
Q

out patient discharge goals

A
  • functional capacity improvement
  • Achieved planned goals
  • competent with self-monitoring and independent with home exercise
82
Q

CU PT examination is focused on what

A

on impaired gas exchange, airway clearance, effects of prolonged static positioning during surgery, pain, mobility restrictions

83
Q

Post-Operative exercise

A

low to mod intensity, may begin in supine, progress to sit to stand, and ambulation

84
Q

After ICU - PT focus

A

Focus continues on ventilation and airway clearance for optimal oxygen transport; thoracic mobility, breathing exercise, multiple sessions of mobility training

Cardio 2 (12 decks)

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