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Med Con III > Transplants > Flashcards

Transplants Flashcards

1
Q

what are the goals of transplant?

A
  1. decrease disabling symptoms
  2. improve functional capacity
  3. improve health related quality of life
  4. increase life expectancy?
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2
Q

what is the balance for transplant recovery

A

infection vs rejection

too much immunosuppression can lead to infection and too little immunosuppression can lead to rejection of the new organ

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3
Q

how long are rejection and infection risks for?

A

lifelong

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4
Q

what is failure of immunosuppression medications to prevent activation of immune effector cells

A

rejection

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5
Q

what are common post operative issues with transplants?

A
  1. psychological issues
    -unfullfilled expectations
    understanding of disease process
    complex medical regimen
    unacustomed life stype
  2. medical
    -anemia
    -hypertension
    -electrolyte abnormalities
    -weight gain
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6
Q

what is the median survival after heart transplants

A

10 years

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7
Q

what are some of the general indications for heart transplant?

A

-chronic, irreversible disease
-usually patients will only have a single organ dysfunction

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8
Q

what is the NYHA classification system

A

severity of heart failure
Class 1: no symptoms
Class 2: mild symptoms with normal physical activity
Class 3: moderate symptoms with less than normal physical activity comfortable at rest
Class 4: severe symptoms at rest

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9
Q

what is considered low risk/ medium/ high risk for heart transplant scoring?

A

low risk: score >8.1
medium risk: score >7.2 less than 8.1
low risk: less than 7.2

presense of CAD
HRrest
LV Ejection fracture
MAP
VO2max

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10
Q

Explain the denervated heart

A

electrical activity cannot cross suture line
-recipient atrial activity is present but not conducted—can see occasional 2 pwaves
-Donor atrium denervated but source of electrophysiologic response

no autonomic nervous system from the donor heart but their HR can still increase because of endocrine systme

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11
Q

With transplant there is a loss of _____ and ____ innervation to donor heart

A

SNS and PNS

vagal stimulation has no effect on sinus and AV nodes
no reflex tachycardia in response to hypovolemia, hypotension

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12
Q

how does HR increase in a transplant patient

A

rely on increases in SV via Frank-starling mechanism and circulating catecholamines to increase CO with activity

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13
Q

What are signs/symptoms of rejection?

A

fever
dsyrhythmias
reduced contractility
increased dyspnea
decreased exercise tolerance

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14
Q

when initiated early after cardiac transplant exercise training _____ the capacity for physical work

A

increases

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15
Q

Who are candidates for lung transplant?

A

-advanced lung disease
-50% mortality 24-37 months
-progressive dyspnea
-decreasing function
-high lung allocation score
-good match

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16
Q

what are contraindications for lung transplant?

A

smoking
extreme weight
profound debility
symptomatic osteoporosis leading to disability
other chronic medical conditions poorly controlled or end-organ damage

17
Q

what condition has the highest rate for single lung transplants

A

COPD

18
Q

what two conditions have the highest rate for double lung transplant

A

copd
CF- due to the high risk of infection in patients with CF

19
Q

New lung transplant guidelines are based on lung allocation scores
higher score better or worse?

A

higher score= higher priority

20
Q

What are some post lung transplant considerations

A

-loss of pulmonary lymphatics
-denervated lung- impaired cough reflex
-pulmonary edema
-secretions- increased extravascular fluid

21
Q

what outcomes change with exercise after lung transplant?

A

improved exercise capacity
VO2 increases but remains sub-normal
improves myopathy
improved bone health
Increased BMD
improved quality of life

22
Q

The greatest obstacle to transplantation is _____

A

lack of donor organs

23
Q

heightened vulnerability to stressors in the presence of low physiological reserve

A

frailty

24
Q

frailty increases with age but is NOT synonymous with age T or F

A

true

25
Q

T or F person with heart failure are more likely to be frail than their age-matched counterparts without heart failure

A

true

26
Q

frailty has ben linked to

A

decompensation at lower thresholds
increased number of heart failure hospitalizations
increased rate of mortality
predictive of falls and disability

27
Q

what is the most common measure of frailty

A

fried frailty phenotype

28
Q

what is the cutoff and criteria for the Fried frailty phenotype

A

presence of >3 of 5
1. unintentional weight loss
2. self reported exhaustion
3. weak grip strength
4. slowed walking speed
5. low physical activity

29
Q

what does the SPPB measure

A

balance
gait speed test
5 time chair stand

Med Con III (27 decks)

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