CHF: Devices

Question 1

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

Answer 1

AVA 30mm Hg

Question 2

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

Answer 2

AI

Question 3

class I indication to fix severe TR

Answer 3

when going in for MV surgery

Question 4

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

Answer 4

3-6 mo’s

Question 5

do LVADs improve survival?

Answer 5

yes

Question 6

who are the ideal candidates for LVAD?

Answer 6

stable or worsening on inotropes

need temp mech support

Question 7

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

Answer 7

low platelets
low albumin
high INR

Question 8

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

Answer 8

> 300

Question 9

what is a desirable PVR?

Answer 9

<4 woods units

Question 10

what is a desirable Transpulmonic gradient

Answer 10

<15 mm Hg

Question 11

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

Answer 11

<14 cc/kg/min

Question 12

PVR equation

Answer 12

PVR = (mean PA - PCWP)/CO

Question 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?

Answer 13

<3 woods units

give nitroprusside

Question 14

define UNOS IA

Answer 14

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

Question 15

define UNOS IB

Answer 15

any inotrope without swan

LVAD

Question 16

define UNOS 2

Answer 16

out of hospital

Question 17

define UNOS 7

Answer 17

inactive

Question 18

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

Answer 18

statins

Question 19

what class of immunosuppresants are cyclosporine and tacrolimus? mechanism?

Answer 19

calcineurin inhibitors

decrease IL-2

Question 20

side effects of calcineurin inhibitors

Answer 20

renal insufficiency

HTN

Question 21

side effects of cyclosporine

Answer 21

gingival hyperplasia

hirsutism

Question 22

side effects of tacrolimus

Answer 22

DM

Question 23

mech and AE’s of mycophenolate

Answer 23

decreases lymphocyte proliferation

GI

Question 24

which is more potent, mycophenolate or azathioprine?

Answer 24

mycophenolate

Question 25

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

Answer 25

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

Question 26

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

Answer 26

premeditate with benadryl and tylenol

Question 27

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

Answer 27

Basiliximab

Question 28

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

Answer 28

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

Question 29

Rx for humoral or Ab-mediated rejection

Answer 29

IVIG and plasmapharesis

Question 30

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

Answer 30

Cardiac Allograft Vasculopathy

Question 31

3 presentations of Cardiac Allograft Vasculopathy

Answer 31

sudden death
silent MI
malignant arrhythmias

Question 32

protocol for infection ppx in post- OHT pt’s

Answer 32

CMV- 6 mo’s

fungal and PCP- 1yr

Question 33

name 6 transplant-related medical problems

Answer 33

HTN
DM
obestiy
osteoporosis
gout
malignancy

Question 34

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

Answer 34

diltiazem
erythromycin
fluconazole