Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Hf Boards > Transplant/lvad > Flashcards

Transplant/lvad Flashcards

1
Q

Rejection scales

A

1r interstitial or pervasculqr infiltrate with one focus of myocyte damage
2r two or more infiltrates with myocyte damage
3r diffuse infiltrate with multifocal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 5 drugs that increase prograf levels?

A 
Diltiazem
Erythromycin
Ketoconazole
Cimetidine 
Greatfruit juice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Half life of a transplanted patient
Mean age of donors
Most common indication for transplant

A

10 years
30yo
Myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How often get angiography

A

Annually for 3 to 5 years

Follow up six months after pci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors for early transplant failure

A 
Recipient age/bmi
Donor age
Center volume
Ischemic time 
Billi, creatinine, pvr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Indications for transplant

A

Absolute: cardiogenic shock, inotrope dependent, vo2 < 10, arrhythmia
Relative:NYHA IV with vo2 < 14, severe Angina, fluid/renal despite maximal therapy and good compliance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is anaerobic threshold

A

When rer >1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are predictors of bad outcomes on cpet

A

Vo2< 11
Ve/VCo2 >35
< predicted vo2 < 5x vo2 + 3L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What to do if submax vo2

A

Use ve/vco2 slope>35
In obese can adjust to lean body mass lean vo2< 19 cc/kg/min
Hfss in ambiguous situations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Worst outcomes on rhc

A

No reduction in pvr worse than pvr reduced but bp dropped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pvr cutoff

A

4-6 woods unit

320-480 dynes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Absolute contraindications for txp

A 
Life expectancy less than 2 years
  Malignancy within 5
   Aids with frequent oi
   Lupus sarcoid amyloid if axtiv
    Irreversible other organ dysfunction
   Severe copd
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dig effect on transplanted heart

A

No effect on hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the class I mhc

A

Exogenous ( all nuclearwd cells)
a,b cw
Recognized by cd8 cytotoxic cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Class ii mhcq

A

Exogenous antigen presenting cells b cells.
How dp, dq, dr
Recognized by cd 4 cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are T cells activated after transplant

A

By Recognizong donor apc or recipient apc (indirect) with donor antigens.
This Triggers compliment usually thru classical pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Two types of antibody identification

A 
Cell based.  Allow for quantification. Need donor cells
Solid phase(elisa or antigen based) 
Can use stores sera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does cross matching work? How to assess severity?

A

Mix donor lymphocytes with recipient serum. 20-50 weakly pos
>50% positive
>80 strongly postive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Recs for donor/recipient crossmatch

A

Screen pra. Need further eval if > 10%
Need solid phase
Do compliment fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does CDC stand for

A

compliment dependent cytotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk of rejection in first year

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rf for rejection (5)

A

Young, female, allosensitized, black, female into male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Two noninvasive ways to detect rejection

A

Evoked potentials and allomap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Rematch

A

Class iv, ef <12 or inotropes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Heart mate 2 dt trial
No changes in quality of life or functional capacity in comparison to pulsatile.
26
Hm2 btt trial
Outcomes transplant or alive for 180 days
27
Hm2 dt trial
Compare xve to hm2 Lvef <25 Vo2 less than 14 Class 3b iv inotropes 14 days or iabp x7 days Outcome: survival, free from stroke or reoperation
28
Plasma free Hgb of concern
if greater than 40 | Ldh greater than 1000
29
Significant rvswi? | 4 other factors that predict rv dysfunction post op
``` >300 Vasopressors Ast billi Creat Cvp/wedge ```
30
Other things besides vo2 max in exercise testing?
Young people use predicted 35 | If obese use 19 of lean body mass
31
Who should get vasodilator challenge
Pa systolic > 50 Tpg > 15 Pvr > 3 BP >85
32
Weight cutoff for transplant
BMI <140
33
What are 5 absolute 1a
``` Incubated Mcs Mcs greater than 30d with complications Sgc+ .5 milrinone or 7.5 dobutamine Non of the above but life expectancy less than 7 days ```
34
2 drugs that don't affect the txp heart
Digoxin, atropine
35
Class1 guidelines for histocompatibility
1. Everyone need a PRA. If >10 Work up 2. use solid phase assays 3. Use complement fixation 4. Define specificities 5. Use virtual crossmatch
36
Emb guidelines (4).
Reasonable to do in preop Standard of care to do during first 6-12 months Ok to do after first year in high risk, hemodynamic compromise, and African Americans
37
Allomap score cutoff
34
38
Class I guidelines for asymptomatic rejection (4 things)
3R should be treated with iv corticosteroid 2R if asymptomatic can be treated with oral or iv Maintainance therapy should be adjusted Restart antimicrobials
39
Guidelines for symptomatic rejection (7 things)
Do emb Hospitalize patients If hemodynamic compromise need to put in icu Repeat 1-2 weeks Serial echoes Consider ACR in patients who dont look good No IL2
40
AMR Classes What are guidelines Rx
Either 0 or 1 Do CD68 or C4D When to screen: if AMR is suspected need to do further staining Check for DSA Repeat emb 1-4 weeks Corticosteroids , cytolytics, plasmapheresis, apheresis, maintain cardiac output with inotropes.
41
What are the two major concepts of rejection
Activation and Replication of t cells
42
How do steroids work | Rx
Bind to specific gr, in lymphocytes inhibits ap1 and nfkb Use 1-3 mg /kg pred or 3mg Class I: withdrawal can be achieved within 3 months.
43
How do calcineurins work
CNI diffuse into cytoplasm bind immunophilins Use micro emulsions Promote IL-2 transcript
44
Side effects of calcineurins
1. Renal failure: acute or chronic 2. neuro: headaches, tremor, seizure 3. Endocrine: Htn with cya, dm with prograf 4. GI: nausea/vomiting 5. Gout, low mg, hus 6 hirsute gingival hyperplasia with cya, allopesia and thrombocytopenia with tac
45
Tac vscya
Less rejection Trend toward survival Fewer drug withdrawals No long term differences.
46
Class I guidelines with cni
You can lower levels when use with mmf
47
Aziothioprine side effects
Replace mmf in combo Dose reduce Do not use with allopurinol See pancreatitis, hepatitis, hepatovenoocclusice disease, skin cancer
48
Mmf adverse effects
Nausea, vomiting and diarrhea Anemia thrombocytopenia hyperkalemia Leukopenia with valcyte
49
What is sirolimis
Proliferative signal inhibitor Binds to fkbp mtor Prevents proliferation
50
Side effects of rapa
``` Wound healing Hepatitis Renal insufficiency Gout, triglycerides Pneumonitis, hepatic vein thrombosis. ```
51
Guidelines for psi
Psi may be substituted for CNI> 6 months for renal nephrotoxicity and cav Mmf evl or sirolimis should be used as it reduces onset of cav
52
Two systems for drug metabolism
Cp450 and p glycoproteins
53
Inhibitors cyp450 | Metabolized by?
Diltiazem verapamil inhibit cp450 | Statins and cni metabolized by cp 450
54
What decrease CNI levels
``` Ethanol Phenytoin Phenobarbital Rifampin Cholestyramine ```
55
Rabdo and cya
Avoid fibric acids and statins.
56
Most common problems for death long term
1. Malignancy | 2. Cav
57
Guidelines for angiography
Annual for 3-5 years Baseline 6 months after pci Ivus at Cath
58
2 papers for cav
Prava 40 or simva 20 | Less cav by Ivus, less rejection, decreased cytokines.
59
Guidelines for cav(6)
1. Control risk factors and prevent cmv 2. Annual angiography 3. Six months after pci 4. Consider psi 5. Stress echo 6. Consider retransplantation
60
What to do when statins are not enough in the patient with a heart transplant
Bile acid need to be given 4 hours from csa Zetia increased 12 times by cyclo Watch out for fibric acids
61
Infections after 1st month in the heart transplant patient
1. First bacteria 2. Then opportunistic thru first six months 3. Then community acquired
62
Define cmv
DNA or seroconversion & cmv syndrome or tissue invasion Rx 900 PO for prophylaxis Iv gancyclovir 5mg/kg iv bid 3 weeks, then for 3 months after.
63
Rate of malignancy at 10 years after heart transplant
30%
64
Sx of ptld | Risk factors for ptld
Malaise and fever, abdominal masses | Ebv, okt3, atg, cmv, rejection
65
What bones are affected by transplanted
Axial bone (cancellous, think vertebral) and not appendicular
66
Guidelines for bones post txp
Screen with Dexa, Improve pore transplant if possible Everyone needs calcium and vitamin d All heart transplant candidates should be on bis phosphonates for the first year
67
Class I guidelines for insertion of lvad
``` Class IV despite med therapy 45/60 days. Life expectancy less than 2 years Not a candidate for heart transplant cardiogenic shock Failure to respond to medical therapy in last 60 of 90 days. Ef < 25 Vo2 < 12 BSA > 1.5 Continuous inotropes Recurrent vt. ```
68
Risk factors for death one year after heart transplant?
Congenital, mcs, vad, vent, dialysis, female.
69
Indications for surgery for aortic insufficiency
Severe with symptoms or ef 75
70
Avr for as
Severe with sx or ef %50
71
Who should get mvr
Severe with sx Severe without symptoms but ef >30-60 and or end systolic > 40 HF but ef > 30 or end systolic <55
72
Leitz miller 9
Ast, Hct, inr, albumin, platelets, billi Pulm pressures <25 No Inotropes vasodilators
73
6 absolute contraindications for txp
1. Systemic illness 2. HIV with oi 3. Severe copd 4. Multisystem organ failure 5 high pvr 6. Cancer within five years

Hf Boards (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions