Heart & Lung Transplants Flashcards Preview

Cardio Pulm > Heart & Lung Transplants > Flashcards

Flashcards in Heart & Lung Transplants Deck (27):
1

Transplant Considerations

-geographic distance to center
-Heart: severity of disease (ISHLT); in heart failure
-LUNG: severity of disease (ISHLT);
--COPD: (BODE score 7-10);
--IPF: (decr FVC 10%+ 6 months); pulse ox <30% predicted
--lung allocation score

2

Pre heart transplant management

-prevent loss of physical function

(ROM, soft tissue, extensibility, strength)

3

Primary Diagnosis to get on heart donor list

-Adults: severe CAD, end stage cardiomyopathy, heart failure
-Children 1-10: cardiomyopathy
-Children <1: congenital heart disorders

4

Primary Diagnosis to get on lung donor list

-COPD
-Idiopathic Pulmonary Fibrosis
-CF
-Pulmonary Arterial HTN

5

General Selection Process

-Age <1 year w/o transplant
-Adequate social support
-other systems disease free

6

Pre Lung Transplant Management

-same as heart
-with emphysis on chest wall ROM & use of diaphragmatic breathing

7

Normal FEV1=

75%

8

Consequences of Denervated Heart

-RHR: 90-110 bpm
-incr SBP & DBP
-decr HR to response to ex's
-NO SENSATION OF ANGINA!

9

2 Types of Heart Transplants

-heterotopic
-orthotopic

10

Orthotopic Heart Transplant

-donor heart replaces host heart
-recipient vena cava and SA node left behind
-donor SA node attached
-(EKG has 2 P waves)

11

Exercise Response in Denervated Heart

-Cardiac output increaed by stroke volume for submax exercise
-after 5 min, HR incr due to circulating catacholamines (NE/E)
-HR incr slowly and slowly decr to resting

12

Factors Determining Reinnervation of Heart

-longer after surgery
-younger donor
-younger recipient
-lack of surgical complications

=increased chance of reinnervation

13

Heterotopic Heart Transplant

-donor heart anastomosed to host heart w/o removing host heart
-LA attached to LA; RA to RA
-shared venous return
-funky EKG (both have action potentials)

14

PT Considerations (heart transplant)

-longer warm up (10-15 min) and cool down
-use RPE scale b/c of blunted HR response
-SBP more appropriate to assess ex's response & recovery

15

Sternal Precautions

-Lifting: -limitations of end range flexion and horizontal abd

16

Outpatient Exercise (lung transplant)

avoid UE strengthening for 6 weeks

17

Ex's Guidelines (Acute care rehab)
-HR:
-SBP:
-DB:

-HR: not >120 bpm or >20 bpm above resting
-SBP: <120mmHg
-No angina

18

2 Long Term Complications
(lung transplant)

-Osteoporosis
-Bronchiolitis Obliterans

19

Outpatient Rehab Ex's (heart)
F:
I:
T:

F: 4-6 days/week
I: 11-15 RPE
T: prog 15-60 min/session

20

PT General Goals
(Lung)

-prevent infection
-optimize vent-perf matching
-incr time out of bed
-incr ROM surgical site

21

Acute Phase Ex's
(Lung)

-Similar to heart transplant
-secretion management
-Incentive spirometry

22

Acute rejection (heart)

-w/n 1st 6 months
-1st sign: ex's intolerance

23

Strengthening Ex's (Heart)
F:
T:

-2-3 days/week
-Avoid isometric (hemodynamic stress)

24

Terminate/Modify Exercise
(Heart)

-RHR >120
-HR incr >40
-SBP Resting: >190
-SBP incr >40
-SBP decr >10
-DBP resting >110
-DBP incr >15
-Dyspnea Index >15
-RPE >13 at rest
-Excessive fatigue/mental confusion
-vertigo/claudication
-EKG Abnormalities

25

Acute Rejection S/Sx
(Lung)

-ex's intolerance (First sign)
-SOB, desaturation @ rest or w/ ex's of 4-5% with same exertion level

26

Long Term complications
(Heart transplant)

-Osteoporosis
-cardiac allograft vasculopathy (accelerated form of atherosclerosis)

27

S/Sx Acute Rejection
(Heart)

-low grade fever
-incr resting BP
-hypotension w/ activity
-myalgias
-fatigue
-decr ex's tolerance
-ventricular dysrhythmias