Total Artificial Hearts and Heart Transplants
What native parts of a patients anatomy are removed before they put in a total artificial heart?
Both ventricles and all four valves are removed, the atria stay intact
Which organ has the highest 1 year survival rate? A) Heart B) Liver C) Kidneys D) Lungs
C) Kidneys
Explain cardiac denervation in regards to heart transplant.
In an orthotopic heart transplant nerves from the CNS will not be connected to the new transplanted heart.
What are the "outcome tracks" for patient who get a TAH (total artificial heart) placement?
- Bridge to transplantation - Destination therapy
What are signs of myocardial ischemia?
- Chest, neck, jaw pain - Increased heart rate - Dyspnea on exertion - Nausea and vomiting - Sweating - Fatigue
What are 5 reasons why someone would get a heart transplant?
- End stage renal disease - NYHA class 3-4 - Poor quality of life that is heart related (arrhythmia, angina, low V02 max) - Congenital heart disease - Cardiac Tumors
what are 2 strategies for avoiding HTN in patients with heart transplant?
- Exercises in seated position rather than supine - Avoid long periods of isometric exercise
What are important considerations for exercise when working with patients who have a heart transplant?
- Need extensive warm-up/cool down - Use RPE not BP - Look out for Myocardial ischemia
For patients with a total artificial heart (TAH) what are appropriate "response to activity limits," you should monitor during therapy?
- Right and Left ventricle fill volumes should me 50-60 mL, with 65 mL being the upper limit for activity - During activity, there should be less than 20 mm Hg decrease in systolic BP, with 80 mm Hg being the lower limit - Heart Rate should be set to 100-130 bpm
What are the important positional considerations when working with patients who've had a TAH placed?
- They rely on venous return to increase CO - Cannot be positioned on left side or stomach - Poor sitting posture can disturb driveline
What is the general average cost of a heart transplant?
1 Million dollars
How long can a heart survive outside of the body?
4-6 hours
How will the following change after a patient has had a heart transplant? A) HR at rest B) Elevation of HR in response to exercise C) Peak HR with exercise D) Stroke Volume E) Ejection Fraction F) Systolic BP G) Diastolic BP
A) HR at rest will be elevated to 90-110 bpm B) Elevation in response to exercise will be delayed C) Peak HR with exercise will be 70-80% of normal D) Stroke volume will be lower than normal E) EF will be lower than normal F) Systolic BP will be the same or higher G) Diastolic BP will be elevated
What is the difference between an orthotopic heart transplant and a heterotopic heart transplant?
An orthotopic heart transplant involves the removal of the native heart and placement of the donor heart. A heterotopic heart transplant involves the donor heart being added and attached to the recipient's native heart and acting as a "piggy back" assistive device.
Which organ has the lowest 5 year survival rate? A) Heart B) Liver C) Kidneys D) Lungs
D) Lungs
What is the most common cause of death of heart donors?
Head trauma
Where should RPE and RPD be during activity for patients with a TAH?
RPE: 11-14 (somewhat hard) RPD: not to exceed 6 (moderate)
