Ventricular assist devices Flashcards
- A left ventricular assist device (LVAD) primarily functions to:
A. Replace the heart completely
B. Assist the left ventricle in pumping blood to the systemic circulation
C. Serve as a pacemaker
D. Regulate blood pressure
o Answer: B
o Rationale: An LVAD supports the failing left ventricle, improving cardiac output in advanced heart failure.
- HF with severely reduced EF, not a transplant candidate – mechanical circulatory support?
Answer: A. Ventricular assist device (LVAD)
* Rationale: LVADs support circulation in advanced HF, reducing mortality in selected patients.
An LVAD typically assists:
A) The right ventricle in pumping to the lungs
B) The left ventricle, pumping blood into the aorta
C) The entire function of the heart, replacing all chambers
D) Only the atrial function
Answer: B
Rationale: LVAD supports the left ventricle pumping systemic circulation into the aorta.
- Which of the following is essential in the management of an LVAD patient to “harm your patient” if not adhered to?
A. Regular battery and device checks
B. Occasional follow-up
C. Ignoring driveline care
D. Limiting patient education
o Answer: A
o Rationale: Regular device and battery checks, along with proper driveline care, are critical to prevent life-threatening complications
- Which complication “will kill your patient” if an LVAD malfunctions due to battery failure?
A. Gradual improvement in symptoms
B. Loss of pump function leading to circulatory collapse
C. Increased exercise tolerance
D. Minor fatigue
Answer: B
o Rationale: Loss of LVAD function from battery failure can rapidly lead to hemodynamic collapse and death.
- A patient with an LVAD presents with a new device alarm. What is the appropriate next step?
A. Ignore the alarm if the patient is asymptomatic
B. Immediately shut down the device
C. Assess the patient and consult the advanced heart failure team for device interrogation
D. Increase the pacemaker output
o Answer: C
o Rationale: Device alarms may signal malfunction; prompt evaluation and consultation with the specialized team are necessary.
- What is “common” in the outpatient management of LVAD patients?
A. Frequent infections at the driveline exit site
B. Complete absence of complications
C. Regular spontaneous device resets
D. Constant intrinsic heart rhythm without device support
o Answer: A
o Rationale: Driveline infections are a common complication in LVAD patients and require vigilant care.
A 55-year-old patient with end-stage HFrEF (EF 15%) is frequently hospitalized for volume overload. After maximally tolerated guideline-directed medical therapy (GDMT), he remains in NYHA Class IV. Which next step is most appropriate if he is not currently a transplant candidate?
A) Ventricular Assist Device (VAD) as destination therapy
B) High-dose dobutamine infusion at home
C) Immediate heart transplant listing
D) Strict bed rest for 6 months
Answer: A
Rationale: For end-stage HF not eligible for transplant, a durable VAD can be used as destination therapy.
Which of the following best describes a ventricular assist device (VAD)?
A) A temporary pacemaker used for arrhythmias
B) A surgically implanted pump that helps one or both ventricles pump blood
C) A device that replaces the entire heart (total artificial heart)
D) A specialized defibrillator for lethal arrhythmias
Answer: B
Rationale: A VAD is an implantable mechanical pump that supports the failing ventricle(s).
Which primary role do VADs serve in advanced heart failure?
A) Short-term bridging to diuresis
B) Long-term fluid management only
C) Bridge to transplant or destination therapy if transplant-ineligible
D) Arrhythmia suppression
Answer: C
Rationale: VADs are used either as bridge-to-transplant in eligible patients or destination therapy if ineligible.
A 68-year-old with biventricular failure and pulmonary hypertension might require:
A) LVAD alone
B) RVAD alone
C) BiVAD (both ventricles supported)
D) No mechanical support feasible.
Answer: C
Rationale: Severe biventricular failure often necessitates BiVAD to assist both LV and RV
In an acute setting, a short-term mechanical circulatory support device used before a durable LVAD might be:
A) Intra-aortic balloon pump (IABP)
B) Permanent pacemaker
C) ECMO or Impella device
D) Subcutaneous ICD
Answer: C
Rationale: Short-term support can be Impella, ECMO, or IABP as a bridge to recovery or decision.
Which factor most commonly qualifies a patient for a VAD?
A) EF 45%, mild symptoms, stable on oral meds
B) NYHA Class I with no hospitalizations
C) Advanced HF, EF <25%, repeated admissions, not immediately transplant-eligible
D) Uncontrolled hypertension but normal EF
Answer: C
Rationale: Indications: advanced, end-stage HF with repeated admissions, EF often very low, not a transplant candidate or waiting for transplant.
A patient with an LVAD typically has:
A) A standard palpable pulse and normal blood pressure readings
B) Continuous flow leading to diminished or absent peripheral pulses
C) No risk of arrhythmias
D) A guaranteed normal ejection fraction
Answer: B
Rationale: Most modern LVADs are continuous-flow pumps, often causing very weak or absent pulses.
Which complication is most frequently associated with VAD implantation?
A) Ventricular arrhythmia resolution
B) Bleeding (particularly GI bleeding), thrombosis, infection
C) Complete cure of heart failure
D) Hypertension resolution.
Answer: B
Rationale: Common VAD complications: bleeding (GI bleeds), device thrombosis, infection, and stroke risk
Which statement is true regarding long-term destination LVAD therapy?
A) Patients no longer require any HF medications
B) There’s no risk of stroke or device-related infection
C) Patients typically remain on anticoagulation or antiplatelet therapy
D) Systolic function spontaneously recovers
Answer: C
Rationale: LVAD recipients generally need chronic anticoagulation to prevent pump thrombosis.
In the immediate post-op period, an LVAD patient has sudden drop in device flow and suction alarms. The next step?
A) Increase afterload
B) Check volume status (fluid bolus if needed) and rule out device kink
C) Immediately turn off LVAD
D) Increase sedation.
Answer: B
Rationale: “Suction” alarms → suspect hypovolemia or obstruction. Evaluate volume and device for kinks
A newly implanted LVAD patient arrives in the ICU. The most critical immediate management concern is:
A) Ensuring high afterload
B) Monitoring device flow, bleeding, hemodynamics
C) Restricting inotropic support
D) Rapid fluid overload
Answer: B
Rationale: Immediate post-op: watch for bleeding, maintain flow and hemodynamics.
Post-LVAD, the nurse notes low flow alarms. The patient is hypotensive. Possible causes?
A) Excess volume overload
B) Hypovolemia, device obstruction, or suction event
C) Hypertension raising device speed
D) Oversensing on pacemaker
Answer: B
Rationale: Low-flow → often from low preload (hypovolemia) or device obstruction. “Suction event” if ventricle underfilled.
Which anticoagulant regimen is common after VAD implantation?
A) No anticoagulation needed
B) Warfarin + antiplatelet agent(s)
C) Low-dose aspirin only
D) IV heparin indefinitely.
Answer: B
Rationale: Warfarin plus possibly aspirin or other antiplatelets is standard to prevent pump thrombosis
After VAD placement, a common neurologic complication is:
A) No risk of neuro events
B) Stroke (ischemic or hemorrhagic)
C) Guillain-Barré syndrome
D) Myasthenic crisis
Answer: B
Rationale: Stroke risk is elevated with VAD due to thrombus or bleeding.
Driveline infection is a known complication in LVAD patients. Which sign is most concerning?
A) Low-grade fever resolving quickly
B) Erythema, drainage, or pain at the driveline exit site
C) Slightly reduced LVAD flow
D) Well-approximated sterile dressing
Answer: B
Rationale: Local infection at the driveline site → erythema, discharge, tenderness.
A key teaching point for patients with a home-based LVAD:
A) They do not need to check any device parameters
B) They should become comfortable with alarm meanings and emergency battery changes
C) They can remove the device for short showers
D) They have normal carotid pulses for assessment
Answer: B
Rationale: Patients must understand alarms, how to manage power sources/batteries, and basic troubleshooting.
Which is a potential advantage of an axial-flow or centrifugal-flow LVAD device over older pulsatile devices?
A) Large external components
B) Smaller, continuous flow with fewer mechanical parts
C) Easy to measure blood pressure with standard cuffs
D) Elimination of all infection risks.
Answer: B
Rationale: Newer LVADs are smaller, continuous flow pumps with fewer mechanical parts, less noise
In the immediate post-LVAD period, controlling afterload is vital. Excessively high afterload can:
A) Improve device flow
B) Increase the risk of suction events
C) Decrease LVAD output and stress the device
D) Completely solve heart failure
Answer: C
Rationale: High afterload reduces flow through the pump, decreasing output.
Why is blood pressure measurement challenging in continuous-flow LVAD patients?
A) They always have normal pulse pressure
B) Continuous flow may yield weak or no palpable pulse
C) Standard automatic cuffs read normal values
D) They cannot become hypotensive
Answer: B
Rationale: Continuous flow → minimal pulsatility → standard BP measurement is difficult; often use Doppler or special technique.
An LVAD patient on warfarin has an INR of 4.5. Which complication is at increased risk?
A) Pump thrombosis
B) GI or intracranial bleeding
C) Driveline infection
D) Hypertension
Answer: B
Rationale: Over-anticoagulation raises risk of bleeding, a common LVAD complication.
A patient with a destination LVAD complains of dizziness. The device flow is normal, but MAP is 60 by Doppler. No signs of volume overload or bleeding. One possibility?
A) Normal reading for VAD patients
B) Device thrombosis
C) Arrhythmia reducing filling
D) Pump power failure
Answer: C
Rationale: If flow is normal, hypotension + dizziness might be from arrhythmia limiting LV filling (thus low MAP).
A 70-year-old with LVAD has episodes of dark stools and mild anemia. This is likely:
A) Hemolysis from pump
B) GI bleed (common in continuous-flow VADs)
C) Normal variation
D) Device thrombosis
Answer: B
Rationale: GI bleeding is very common in continuous-flow LVAD recipients, often from angiodysplasia.
A patient’s LVAD alarm is sounding “High Power, Low Flow.” She has abdominal pain, hypotension, and signs of shock. Suspect:
A) Driveline kink
B) Pump thrombosis or mechanical obstruction
C) Overfilled LV with high output
D) Hemorrhagic stroke.
Answer: B
Rationale: “High power” + “low flow” → the pump working harder but not moving blood → possible pump thrombosis
Why must diuretic therapy sometimes continue in LVAD patients?
A) LVAD eliminates volume overload
B) LVAD is pulsatile; diuretics are worthless
C) Ventricles can still become overloaded if preload is excessive
D) They never require diuretics post-implantation.
Answer: C
Rationale: Even with an LVAD, excess preload can cause issues; diuretics may remain necessary
A nurse calls with an LVAD patient having a “low battery” alarm but the patient is stable. The first advice?
A) Immediately switch to backup batteries per the device protocol
B) Turn off the device to conserve energy
C) Increase afterload
D) Take no action if the patient feels well
Answer: A
Rationale: Low battery → promptly connect to backup or main power to prevent device shutdown.
A 58-year-old with an RVAD in place. He has poor oxygenation, signs of liver congestion. Why might an RVAD be needed?
A) Because the left ventricle is normal
B) To address right HF or inability of RV to handle preload after LVAD
C) To reduce kidney filtration
D) For shortness of breath from pneumonia
Answer: B
Rationale: If RV fails (especially after LVAD), an RVAD might be placed to support right-sided output.
Which complication is unique to having an externally exiting driveline for the VAD?
A) Stroke risk
B) Driveline infection risk
C) Renal failure
D) Malignant arrhythmias
Answer: B
Rationale: Drivelines exiting the skin → high chance of infection at the exit site.
An LVAD patient in the ED is unconscious with no palpable pulse. The device hum is audible. Next step to check for perfusion?
A) Standard brachial pulse
B) Automatic BP cuff
C) Doppler to measure MAP
D) Carotid ultrasound
Answer: C
Rationale: In continuous-flow devices, use Doppler to get MAP if no pulse is palpable.
A persistent challenge in long-term LVAD management includes:
A) Complete resolution of HF
B) Balancing anticoagulation to avoid thrombosis but limit bleeding
C) Stopping all HF meds
D) No diet restrictions
Answer: B
Rationale: The major challenge is to prevent thrombosis while minimizing bleeding
A 64-year-old LVAD patient has new confusion, headache, and device “high power” alarm. You suspect pump thrombosis. One immediate therapy:
A) High-flow oxygen only
B) IV heparin or fibrinolysis (if no contraindications)
C) Rapid fluid bolus
D) Turn off the LVAD
Answer: B
Rationale: For suspected pump thrombosis, urgent anticoagulation or even fibrinolysis to salvage the device.
An LVAD patient collapses. Bystanders see no pulse. The device is humming. If the patient is truly in arrest:
A) Start standard CPR if no perfusion
B) Never do chest compressions with a VAD
C) Turn off the device first
D) Only use rescue breaths
Answer: A
Rationale: If no perfusion or signs of life, CPR may be needed. Some centers advise caution, but standard ACLS if no flow.
A VAD patient has significant GI bleeding. How might you adjust anticoagulation?
A) D/C warfarin temporarily and manage bleed, then reinitiate carefully
B) Increase warfarin for better pump function
C) Stop device to avoid bleeding
D) Keep INR >4.0
Answer: A
Rationale: With GI bleed, hold or reduce anticoagulation short-term; once stable, restart to prevent thrombosis.
An ICD is often combined with LVAD in advanced HF because:
A) VAD patients never have arrhythmias
B) Ventricular arrhythmias remain a risk, ICD can treat lethal rhythms
C) ICD ensures normal ejection fraction
D) ICD alone can replace the LVAD
Answer: B
Rationale: Even with LVAD, they can have ventricular arrhythmias → ICD can rescue from lethal VT/VF.
A “flow” parameter on continuous-flow LVAD typically correlates with:
A) Body temperature
B) Estimated cardiac output through the pump
C) Pulmonary wedge pressure
D) Central venous pressure
Answer: B
Rationale: The “flow” reading approximates the volume (L/min) the device is pumping → akin to CO.
In an emergency with an LVAD patient, you cannot find a radial pulse or standard BP. If the device is functioning, how to assess perfusion?
A) Check a Doppler MAP or end-organ function (mental status, urine output)
B) Assume adequate perfusion without checks
C) Use an automated cuff
D) Palpate pedal pulses vigorously
Answer: A
Rationale: Continuous-flow LVAD → minimal pulses. Doppler MAP or end-organ signs to gauge perfusion.
A 50-year-old with chronic LVAD complains of fatigue. The device speeds are normal, no alarms. Possible reason?
A) No possibility of heart failure symptoms
B) Underlying ventricle or device + poor volume status or arrhythmia
C) Complete resolution of HF
D) Over-sedation
Answer: B
Rationale: Fatigue can result from suboptimal volume/arrhythmia or partial device malfunction, even if no alarm.
A patient with a “bridge-to-transplant” LVAD is listed for a donor heart. This bridging helps:
A) Eliminate HF meds entirely
B) Maintain or improve end-organ function while awaiting transplant
C) Immediately cure pulmonary HTN
D) Worsen their readiness for surgery
Answer: B
Rationale: LVAD as bridge keeps patient stable, improves end-organ perfusion pre-transplant.
Weaning from an LVAD can happen if:
A) The device never gets turned off
B) Myocardial recovery occurs sufficiently
C) The patient’s EF <10%
D) Always mandatory at 6 months
Answer: B
Rationale: Rarely, if heart recovers (e.g., after myocarditis) → weaning and device explant possible
During an outpatient visit, an LVAD reading shows high power consumption but normal flows. One cause?
A) Gradual pump stop
B) Increased afterload or partial clot formation inside pump
C) Hypovolemia only
D) Driveline disconnection
Answer: B
Rationale: High power can suggest the pump working harder—maybe from increased afterload or partial clot.
A 72-year-old with a destination LVAD develops progressive driveline infection not responding to antibiotics. Next possible step?
A) Full removal of the device without plan
B) Heart transplant listing
C) Surgical debridement or device exchange if feasible
D) High-flow oxygen therapy
Answer: C
Rationale: Device infection might need surgical debridement or pump exchange if medical therapy fails.
Which statement about pulsatility in contemporary continuous-flow LVADs is correct?
A) They produce normal arterial pulses
B) Minimal pulsatility is common, MAP ~ 60–80 mmHg is targeted
C) They generate a strong bounding pulse
D) Patients can rely on standard pulse oximetry
Answer: B
Rationale: Continuous-flow devices have reduced pulsatility; target MAP often ~65–80 mmHg
A VAD patient’s mental status deteriorates, and the device alarm shows “low power.” The controller battery is almost depleted. Immediate management?
A) Intubate the patient first
B) Switch to a charged backup battery or power source
C) Start chest compressions
D) Increase device speed
Answer: B
Rationale: Low battery → urgent switch to fresh battery to maintain pump flow.
In advanced HF with an LVAD, significant aortic valve insufficiency can develop over time because:
A) The device lowers afterload
B) The aortic valve never opens, leading to valve fusion
C) Pressure differences cause the aortic valve to be incompetent
D) No effect on aortic valve
Answer: C
Rationale: Chronic LVAD support → altered flows, aortic valve may remain closed → potential for valve insufficiency (regurg).
A 65-year-old with BiVAD is bridging to transplant. They develop acute RVAD “low flow.” Evaluate:
A) Left side only
B) Volume status or R pump obstruction
C) Normal daily activities
D) PCWP reading alone
Answer: B
Rationale: “Low flow” on RVAD → check volume (hypovolemia?), device obstruction or clot.
Which is a recognized hematologic consequence in many LVAD patients?
A) Macrocytosis
B) Acquired von Willebrand syndrome leading to bleeding
C) Low factor VIII exclusively
D) No coagulopathy
Answer: B
Rationale: Shear stress from LVAD can degrade von Willebrand factor, causing GI bleeds/bleeding diathesis.
A 70-year-old with an LVAD for 2 years complains of new onset watery stool with maroon color. Likely cause?
A) Hemorrhoids only
B) Fecal incontinence from sedation
C) GI bleeding from angiodysplasia or AVMs (common in LVAD)
D) Pump thrombosis
Answer: C
Rationale: GI bleeds from angiodysplasia is a frequent complication with continuous-flow VADs.
A patient complains of alarm on the VAD controller “PI event” (pulsatility index) changes. This may reflect:
A) Myocardial recovery
B) Shift in loading conditions (preload/afterload) or arrhythmia
C) Pump meltdown
D) Normal daily variation
Answer: B
Rationale: VAD “PI events” often mean changes in filling or afterload impacting pulsatility.
Which factor most affects long-term survival in VAD patients?
A) Elimination of all HF meds
B) Absence of device alarms
C) Minimizing major complications (stroke, infection, pump thrombosis)
D) Quick removal of the device
Answer: C
Rationale: Major complications (stroke, infection, thrombosis) significantly impact VAD patient longevity.
Answer: C
Rationale: Major complications (stroke, infection, thrombosis) significantly impact VAD patient longevity.
A patient with VAD is found with MAP ~50 by Doppler and confusion. The device is at normal speed, no alarm. The immediate concern is:
A) Adequate volume status or new arrhythmia causing low perfusion
B) Pump thrombosis with high power usage
C) Overly high afterload
D) Driveline disconnection
Answer: A
Rationale: If no alarm, check volume (hypovolemia) or arrhythmias that reduce VAD filling → low MAP, confusion.
VADs (ventricular assist devices)
support the failing ventricle, used as bridge to transplant or destination therapy.
VAD Complications:
bleeding (GI), thrombosis, stroke, infection, device malfunction.
VDA Patient management:
must ensure adequate preload, watch for alarms (low flow, high power), maintain anticoagulation carefully.
In VAD emergencies.
check Doppler MAP if pulses absent, ensure battery/power source, and manage arrhythmias or volume status
