CHF: Devices Flashcards Preview

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Flashcards in CHF: Devices Deck (34):
1

what proves true AS on a dobutamine echo (low flow low gradient)

AVA 30mm Hg

2

which valvular abnormality needs to be addressed when placing an LVAD?

AI

3

class I indication to fix severe TR

when going in for MV surgery

4

for NICM, how long do you wait until ICD for primary prevention?

3-6 mo's

5

do LVADs improve survival?

yes

6

who are the ideal candidates for LVAD?

stable or worsening on inotropes
need temp mech support

7

what are blood test factors that put pt's at high in-hospital mortality after LVAD?

low platelets
low albumin
high INR

8

what is a desirable value for RV Stroke Work Index (RVSWI)?

> 300

9

what is a desirable PVR?

<4 woods units

10

what is a desirable Transpulmonic gradient

<15 mm Hg

11

what value of VO2 on CPET should be referred for OHT?

<14 cc/kg/min

12

PVR equation

PVR = (mean PA - PCWP)/CO

13

if patient is a transplant candidate, what is a goal PVR? if it is high, what can you do for pt until he gets a heart?

<3 woods units
give nitroprusside

14

define UNOS IA

milrinone .5 or dobutamine 7.5 or combo + swan
IABP
LVAD complication

15

define UNOS IB

any inotrope without swan
LVAD

16

define UNOS 2

out of hospital

17

define UNOS 7

inactive

18

which class of meds has been shown to improve mortality in OHT?

statins

19

what class of immunosuppresants are cyclosporine and tacrolimus? mechanism?

calcineurin inhibitors
decrease IL-2

20

side effects of calcineurin inhibitors

renal insufficiency
HTN

21

side effects of cyclosporine

gingival hyperplasia
hirsutism

22

side effects of tacrolimus

DM

23

mech and AE's of mycophenolate

decreases lymphocyte proliferation
GI

24

which is more potent, mycophenolate or azathioprine?

mycophenolate

25

what is thymoglobulin's mech? what do you use to follow efficacy? who do you use it for?

kills lymphocytes (cytolytic)
CD3
highly sensitized pt's w/ CRI

26

what should you always do to avoid side effects of thymoglobulin?

premeditate with benadryl and tylenol

27

what med can you use as an IL-2 receptor blocker to hold off on giving calcineurin inhibitors?

Basiliximab

28

what is Rx for mild, mod and severe OHT rejection?

mild- mild inc in immunosup.
mod- pulse steroids
severe- thymoglobulin, hemodynamic support

29

Rx for humoral or Ab-mediated rejection

IVIG and plasmapharesis

30

what is the leading cause of death 5 yrs after OHT?

Cardiac Allograft Vasculopathy

31

3 presentations of Cardiac Allograft Vasculopathy

sudden death
silent MI
malignant arrhythmias

32

protocol for infection ppx in post- OHT pt's

CMV- 6 mo's
fungal and PCP- 1yr

33

name 6 transplant-related medical problems

HTN
DM
obestiy
osteoporosis
gout
malignancy

34

3 common drugs that interact with calcineurin inhibitors (cyclosporine, tacrolimus)

diltiazem
erythromycin
fluconazole