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2.1
Heart Transplantation
Cardiac Transplantation

Images

WIKIDATA, CC BY-SA 3.0

Presentation

When it occurs, presentation is usually obvious, and it carries high morbidity unless emergent and timely surgical treatment is instituted. [ncbi.nlm.nih.gov]

Entire Body System

  • Weakness

    In both patients, the post-transplant course was complicated by profound skeletal muscle weakness that resolved with corticosteroid withdrawal. [ncbi.nlm.nih.gov]

    Side effects include weakness, dizziness, headache, upset stomach, mild skin rash or itching, muscle cramping, or dry mouth. [mountsinai.org]

    There was a trend to correlation with age and T2*MRI cardiac values (Fig 1C) similarly there was a significant though weak correlation between T2*MRI cardiac values and conventional risk stratification (Fig 1B). [bloodjournal.org]

    Rejection, if it occurs, may cause weakness and a rapid or other abnormal heart rhythm. [merckmanuals.com]

  • Fever

    An initially event-free period was followed by recurrent fever attacks and staphylococcal bacteremia was diagnosed. [ncbi.nlm.nih.gov]

    At home, patients watch for other signs of rejection, including shortness of breath, flu-like symptoms, and low-grade fever. [montefiore.org]

    Continued Warning signs of infection include: Fever over 100.4°F (38°C) Sweats or chills Skin rash Pain, tenderness, redness, or swelling Wound or cut that won't heal Red, warm, or draining sore Sore throat, scratchy throat, or pain when swallowing Sinus [webmd.com]

  • Amyloidosis

    Cardiac magnetic resonance imaging, laboratory studies, and bone marrow biopsy established the diagnosis of cardiac amyloidosis. [ncbi.nlm.nih.gov]

    Less frequent causes are congenital heart defects and metabolic disorders (muscle dystrophies and amyloidosis). [klinikum.uni-heidelberg.de]

    For example, our team is familiar with heart transplantation for patients with amyloidosis, a condition that impairs the function of multiple organs and demands the input of several medical subspecialties. [massgeneral.org]

    Twelve patients with amyloidosis were transplanted. [circ.ahajournals.org]

    […] heart transplantation is Pulmonary hypertension that does not respond to preoperative treatments Relative contraindications include organ insufficiency (eg, pulmonary, renal, hepatic) and local or systemic infiltrative disorders (eg, cardiac sarcoma, amyloidosis [merckmanuals.com]

  • Chills

    Continued Warning signs of infection include: Fever over 100.4°F (38°C) Sweats or chills Skin rash Pain, tenderness, redness, or swelling Wound or cut that won't heal Red, warm, or draining sore Sore throat, scratchy throat, or pain when swallowing Sinus [webmd.com]

    These include: weakness, fatigue, malaise (feeling lousy), fever, and " flu -like symptoms", such as chills, headaches, dizziness, diarrhea, nausea and/or vomiting. [medicinenet.com]

  • Noncompliance

    Severe health problems that would make you unable to tolerate the surgery Serious health problems other than heart disease that would not get better after transplant Noncompliance with treatment regimen. [urmc.rochester.edu]

Respiratoric

  • Cough

    A 13-year-old girl had been diagnosed with dilated cardiomyopathy 5 years before this case, due to intractable dyspnoea and cough. She received multiple medical treatments after diagnosis, with minimal effects. [ncbi.nlm.nih.gov]

    ACE-I side effects may include dizziness, non-productive cough, or in rare occasions swelling of your face, lips, or throat. [mountsinai.org]

    When you are able to breathe completely on your own and are able to cough, your doctor will remove the breathing tube. After the breathing tube is out, a nurse will help you cough and take deep breaths every 2 hours. [urmc.rochester.edu]

Jaw & Teeth

  • Oral Ulcers

    Complications and side effects include bacterial and viral infections (17-30%), oral ulcerations, pericardial effusions (up to 25%) and pleural effusions (15-40%), hematologic abnormalities including anemia and thrombocytopenia, impaired wound healing [intechopen.com]

    Some of the side effects of mTOR inhibitors include hypertension, headaches, acne, impaired wound healing, oral ulceration, anemia, thrombocytopenia, thrombotic microangiopathy, venous thromboses, lymphedema, pulmonary toxicity, alveolar hemorrhage, hypertriglyceridemia [thecardiologyadvisor.com]

Cardiovascular

  • Heart Disease

    BACKGROUND: Because survival on the heart transplantation waitlist depends on underlying heart disease, a new allocation system will include the type of heart disease. [ncbi.nlm.nih.gov]

    Electrophysiology Hypertension Clinic Interventional and Structural Heart Disease Marfan Syndrome Clinic Nuclear Cardiology The Advanced Heart Failure and Cardiac Transplant Team has one of the most active advanced heart failure programs in the region [cardiology.wustl.edu]

    Read more In addition, our results exceed national standards for heart transplantation for people with irreversible, life-threatening heart disease. [health.ucsd.edu]

    By numbers, the ischaemic heart disease on the basis of a coronary heart disease is the most significant one. Then follow dilative cardiomyopathy and valvular diseases. [klinikum.uni-heidelberg.de]

  • Palpitations

    Some symptoms of arrhythmias include palpitations, weakness, fatigue, low blood pressure, dizziness, fainting, heart failure and cardiac arrest. Many risk factors can affect the electrical system of your heart and cause an arrhythmia. [uwmedicine.org]

    Symptoms may include chest pain or palpitations; shortness of breath; fatigue, weakness or inability to maintain regular activity level; lightheadedness or loss of consciousness; or swollen ankles, feet or abdomen. [heart.memorialhermann.org]

    Palpitations associated with arrhythmias may also occur as a manifestation of advanced CAV. Premonitory symptoms are often missing or atypical, and hence it is important to identify asymptomatic patients early by screening studies. B. [thecardiologyadvisor.com]

Skin

  • Flushing

    After instrumentation was placed and a 5-minute rest period, baseline measurements were recorded; then, phenylephrine was injected intravenously over 5 to 10 sec followed by a 10-mL saline flush. [circ.ahajournals.org]

    He directs 30,000 units of a drug called Heparin to be administered to thin the blood and prevent clotting as it’s flushed out of the body through plastic tubes that look ready to burst from the volume. Finally, he cross-clamps the aorta. [dmagazine.com]

Musculoskeletal

  • Myopathy

    Corticosteroid use may exacerbate skeletal myopathy, and therefore, steroid minimization may be warranted whenever possible. [ncbi.nlm.nih.gov]

    Some heart conditions that may require a heart transplant include: Advanced heart disease Cardiomyopathy Congenital heart disease or defect Coronary artery disease Dilated cardiomyopathy Heart failure and advanced heart failure Restrictive myopathy Valvular [loyolamedicine.org]

    Common pitfalls and side-effects of management Heart transplant patients treated with statins must be monitored for myopathies and rhabdomyolysis due to the inhibition of CYP3A4 by concurrently administered calcineurin inhibitors, which results in increased [thecardiologyadvisor.com]

    J Heart Lung Transplant 19 : 529 – 537, 2000 ↵ Ballantyne CM, Corsini A, Davidson MH, Holdaas H, Jacobson TA, Leitersdorf E, Marz W, Reckless JP, Stein EA: Risk for myopathy with statin therapy in high-risk patients. [cjasn.asnjournals.org]

Neurologic

  • Seizure

    She was sent home on a short course of seizure prophylaxis, which was discontinued after the resolution of radiological findings. She had no further episodes of seizures for 6 months following discontinuation of her anti-epileptic regimen. [ncbi.nlm.nih.gov]

    Other acute and chronic illness: Active peptic ulcer disease, gastrointestinal bleeding, and recent stroke or seizure are all examples of relative acute contraindications to transplant. [thecardiologyadvisor.com]

Workup

[…] fraction of less than 20% Intractable angina or malignant cardiac arrhythmias for which conventional therapy has been exhausted Pulmonary vascular resistance of less than 2 Wood units Age younger than 65 years Ability to comply with medical follow-up care Workup [emedicine.medscape.com]

Treatment

Many work groups observed an increased portion of patients with heart arrhythmias who partly required permanent pacemaker treatment. [klinikum.uni-heidelberg.de]

Surgical repair is usually the only definitive treatment for these patients because medical management is associated with a 30-day mortality approaching 100%. [ncbi.nlm.nih.gov]

Prognosis

The prognosis of amyloid heart disease is poor with 1-year survival rates of 35 to 40%. [ncbi.nlm.nih.gov]

News & Views Prognosis after heart... [bmj.com]

Etiology

The etiology and management of this complication are reviewed. [ncbi.nlm.nih.gov]

Possible etiologies including sympathetic denervation, ischemic injury to the sinus node, and graft ischemia. [openanesthesia.org]

Training in clinical management of heart failure includes supervised experience in both inpatient and outpatient settings and involves a spectrum of underlying etiologies for the heart failure. [heart.ucla.edu]

We aim to review the epidemiology of coronary artery disease in this population and the etiology as it relates to ESRD and its associated co-factors. [academic.oup.com]

Implicated as well is that female heart failure patients may be up to 3 times more likely to refuse heart transplantation than men. 14 Finally, some series have suggested that when compared with men, women with advanced heart failure of nonischemic etiologies [doi.org]

Epidemiology

We sought to determine the impact of valganciclovir (VGC) duration on the epidemiology of CMV infections after heart transplantation. [ncbi.nlm.nih.gov]

In this chapter, we will review the epidemiology, natural history, clinical manifestations, screening and diagnostic strategies for CAV while emphasizing current treatment strategies designed to prevent or slow the progression of this disease. 2. [intechopen.com]

Diagnosis N/A Pathophysiology N/A Epidemiology N/A Special considerations for nursing and allied health professionals. N/A What's the evidence? Rose, EA. "Long-term use of a left ventricular assist device for end-stage heart failure". [clinicaladvisor.com]

PCS are such lethal diseases with a median overall survival of only 6 months in patients with diagnoses of PCS registered in the Surveillance, Epidemiology and End Results database [ 1 ]. [cardiothoracicsurgery.biomedcentral.com]

We aim to review the epidemiology of coronary artery disease in this population and the etiology as it relates to ESRD and its associated co-factors. [academic.oup.com]

Pathophysiology

Software-assisted EMB analysis may enable greater pathophysiologic understanding of LGD and identification of targets for future study and intervention. Copyright © 2017 International Society for the Heart and Lung Transplantation. [ncbi.nlm.nih.gov]

The primary goal of this fellowship is to provide a thorough knowledge of the diagnosis and treatment of congestive heart failure with an emphasis on pathophysiology, therapeutics, and prevention as well as on the humanistic, moral, and ethical aspects [heart.ucla.edu]

Evidence suggests that aerobic exercise training may be effective in reversing the pathophysiological consequences associated with cardiac denervation and prevent immunosuppression-induced adverse effects in heart transplant recipients. [cochrane.org]

Prevention

Ultra-fast anesthesia might provide the most effective measure to prevent this type of complication. Immediate extubation after heart transplantation (IEAHT) has recently been reported in adult patients. [ncbi.nlm.nih.gov]

The third stage of heart transplant is the postoperative period, which is directed toward providing adequate antirejection treatment with close monitoring to prevent rejection of the heart. [britannica.com]

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