Heart transplant complications - Revision history

Elcatracho: /* See Also */

2021-03-08T19:57:56Z

Elcatracho: /* See Also */

2021-02-20T19:22:35Z

Elcatracho: /* Background */

2021-02-12T17:05:08Z

Background

← Revisión anterior		Revisión del 17:05 12 feb 2021
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	==Background==		==Background==
	*Indications: end-stage [[heart failure]] refractory to standard medical/surgical treatment		*Indications: end-stage [[heart failure]] refractory to standard medical/surgical treatment
	*Transplanted heart is denervated ~~(vagus nerve severed during surgery)~~		*Transplanted heart is denervated
	**Resting rate between 90-100 bpm		**Resting rate between 90-100 bpm
	**Response to exertion/stress is blunted by lack of central mediated tachycardia, though can still respond to circulating catecholamines		**Response to exertion/stress is blunted by lack of central mediated tachycardia, though can still respond to circulating catecholamines
			**Upregulation of catecholamine receptors
			**[[Atropine]] is ineffective (no Vagal nerve tone)

	{{Immunosuppressant medication complications}}		{{Immunosuppressant medication complications}}

Elcatracho: /* Background */

2021-02-12T17:03:45Z

Background

← Revisión anterior		Revisión del 17:03 12 feb 2021
Línea 1:		Línea 1:
	==Background==		==Background==
	*Indications: end-stage [[heart failure]] refractory to standard medical/surgical treatment		*Indications: end-stage [[heart failure]] refractory to standard medical/surgical treatment
	*Transplanted heart is denervated		*Transplanted heart is denervated (vagus nerve severed during surgery)
	**Resting rate between 90-100 bpm		**Resting rate between 90-100 bpm
	**Response to exertion/stress is blunted by lack of central mediated tachycardia, though can still respond to circulating catecholamines		**Response to exertion/stress is blunted by lack of central mediated tachycardia, though can still respond to circulating catecholamines

ClaireLewis at 03:19, 25 September 2019

2019-09-25T03:19:46Z

← Revisión anterior		Revisión del 03:19 25 sep 2019
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	*Patients monitored with surveillance biopsies regularly		*Patients monitored with surveillance biopsies regularly
	*Spectrum of presentations, anywhere asymptomatic to in extremis		*Spectrum of presentations, anywhere asymptomatic to in extremis
	**Features include ~~dysrythmias~~, decreased exercise tolerance, and infection may be clues		**Features include [[dysrhythmias]], decreased exercise tolerance, and [[infection]] may be clues
	===Infection===		===Infection===
	*Increased risk of opportunistic/severe infections		*Increased risk of opportunistic/severe [[infections]]
	*Fever and other classic features may be absent due to immunosuppression		*[[Fever]] and other classic features may be absent due to immunosuppression

	===Signs/Symptoms of Congestive Heart Failure===		===Signs/Symptoms of [[Congestive Heart Failure]]===
	*Due to various etiologies		*Due to various etiologies
	*MI may present only with CHF symptoms		*[[MI]] may present only with CHF symptoms
	===Medication Adverse Effects===		===Medication Adverse Effects===
	*Prednisone		*[[Prednisone]]
	**Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension		**[[Hyperglycemia]], psychiatric symptoms, poor wound healing, edema, [[hypertension]]
	*Tacrolimus, cyclosporine		*[[Tacrolimus]], [[cyclosporine]]
	**Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout		**Neurotoxicity, [[tremor]], [[hyperkalemia]], [[AKI\|nephrotoxicity]], [[hypertension]], [[hyperglycemia]], [[gout]]
	*Mycophenolate		*[[Mycophenolate]]
	**Cytopenias, GI distress		**Cytopenias, [[nausea/vomiting\|GI distress]]
	*Azathioprine		*[[Azathioprine]]
	**Cytopenias, pancreatitis, hepatitis		**Cytopenias, [[pancreatitis]], [[hepatitis]]
	===[[Myocardial ischemia]]/CAD===		===[[Myocardial ischemia]]/CAD===
	*Pediatric recipients in particular at risk for graft CAD		*Pediatric recipients in particular at risk for graft CAD
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	''Workup dependent on presentation, considerations include:''		''Workup dependent on presentation, considerations include:''
	*CBC, BMP, Mg/Phos		*CBC, BMP, Mg/Phos
	*Low ~~threshhold~~ for infectious workup, including viral/fungal studies		*Low threshold for infectious workup, including viral/fungal studies
	*Tacrolimus, cyclosporine levels		*Tacrolimus, cyclosporine levels
	*[[ECG]]		*[[ECG]]
Línea 47:		Línea 47:
	*CT Chest		*CT Chest
	**May be required to diagnose PE, hypoxemia, pneumonia		**May be required to diagnose PE, hypoxemia, pneumonia
	*~~Echo~~		*[[Echocardiography]]
	**Consider if signs/symptoms of heart failure		**Consider if signs/symptoms of heart failure

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	**Do not treat if stable, as steroids will muddy biopsy results		**Do not treat if stable, as steroids will muddy biopsy results
	**[[Methylprednisolone]] 1g IV if in extremis		**[[Methylprednisolone]] 1g IV if in extremis
	*~~Dysrythmias~~		*Dysrhythmias
	**[[Bradycardia]] will ‘’’NOT’’’ respond to atropine due to denervation		**[[Bradycardia]] will ‘’’NOT’’’ respond to atropine due to denervation
	***transplant patients with symptomatic bradycardia may respond to isoproterenol 1 μg/min, titrated slowly to max 4 μg/min		***transplant patients with symptomatic bradycardia may respond to isoproterenol 1 μg/min, titrated slowly to max 4 μg/min

ClaireLewis: /* Infection */

2016-10-29T16:41:27Z

Infection

← Revisión anterior		Revisión del 16:41 29 oct 2016
Línea 13:		Línea 13:
	**Features include dysrythmias, decreased exercise tolerance, and infection may be clues		**Features include dysrythmias, decreased exercise tolerance, and infection may be clues
	===Infection===		===Infection===
	**Increased risk of opportunistic/severe infections		*Increased risk of opportunistic/severe infections
	**Fever and other classic features may be absent due to ~~immunopression~~		*Fever and other classic features may be absent due to immunosuppression

	===Signs/Symptoms of Congestive Heart Failure===		===Signs/Symptoms of Congestive Heart Failure===
	*Due to various etiologies		*Due to various etiologies

ClaireLewis: /* Evaluation */

2016-10-29T16:24:58Z

Evaluation

← Revisión anterior		Revisión del 16:24 29 oct 2016
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	***→ two P waves on ECG		***→ two P waves on ECG
	***donor P wave will be in 1:1 relationship with QRS, native P wave has independent rhythm		***donor P wave will be in 1:1 relationship with QRS, native P wave has independent rhythm
	*[[CXR		*[[CXR]]
	**May]] have relative "cardiomegaly" if donor was much larger than recipient		**May have relative "cardiomegaly" if donor was much larger than recipient
	*CT Chest		*CT Chest
	**May be required to diagnose PE, hypoxemia, pneumonia		**May be required to diagnose PE, hypoxemia, pneumonia
	*Echo		*Echo
	**Consider if signs/symptoms of heart failure		**Consider if signs/symptoms of heart failure

	==Management Considerations==		==Management Considerations==
	*Consult/discuss with transplant team		*Consult/discuss with transplant team

Neil.m.young: Text replacement - "EKG" to "ECG"

2016-09-27T16:52:14Z

Text replacement - "EKG" to "ECG"

← Revisión anterior		Revisión del 16:52 27 sep 2016
Línea 38:		Línea 38:
	*Low threshhold for infectious workup, including viral/fungal studies		*Low threshhold for infectious workup, including viral/fungal studies
	*Tacrolimus, cyclosporine levels		*Tacrolimus, cyclosporine levels
	*[[~~EKG~~]]		*[[ECG]]
	**Patient’s native sinus node often preserved		**Patient’s native sinus node often preserved
	***→ two P waves on ~~EKG~~		***→ two P waves on ECG
	***donor P wave will be in 1:1 relationship with QRS, native P wave has independent rhythm		***donor P wave will be in 1:1 relationship with QRS, native P wave has independent rhythm
	*[[CXR		*[[CXR

ClaireLewis at 18:37, 25 September 2016

2016-09-25T18:37:36Z

@@ Línea 1: / Línea 1: @@
 ==Background==
-{{Transplant emergency types}}
+*Indications: end-stage [[heart failure]] refractory to standard medical/surgical treatment
 {{Immunosuppressant medication complications}}
 ==Clinical Features==
 ==Differential Diagnosis==
 ==Evaluation==
+''Workup dependent on presentation, considerations include:''
-==Management==
+*CBC, BMP, Mg/Phos
 ==Disposition==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T12:04:40Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 12:04 24 jul 2016
Línea 8:		Línea 8:
	==Differential Diagnosis==		==Differential Diagnosis==

	==~~Diagnosis~~==		==Evaluation==

	==Management==		==Management==

← Revisión anterior		Revisión del 19:57 8 mar 2021
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	==See Also==		==See Also==
	*[[Transplant complications]]		*[[Transplant complications]]
			*[[Neutropenic fever]]
			*[[Immunocompromised antibiotics]]
	*[[In-Training Exam Review]]		*[[In-Training Exam Review]]

← Revisión anterior		Revisión del 19:22 20 feb 2021
Línea 69:		Línea 69:
	==See Also==		==See Also==
	*[[Transplant complications]]		*[[Transplant complications]]
			*[[In-Training Exam Review]]

	==External Links==		==External Links==