Heart Transplant Tutoring By Alaina Darby

JD has been diagnosed with CAD JD has been diagnosed with CAD. Which of the following would qualify him for a heart transplant? Angina requiring multiple stents Angina requiring pharmacotherapy Myocardial infarction CHF with preserved ejection fraction a

Risk factors… affect vessels and heart through pressure, work, and toxicity Vessel function Hypertension Clogging Valves Increased work of the heart Tachycardias Arrhythmias Drugs/Alcohol Cocaine EtOH Tobacco Chemotherapy Steroids Comorbidities Diabetes Metabolic syndromes Pregnancy Cancers Immunological Hormones Inflammation Age Heredity Congenital defects

BJ has CHF with reduced EF BJ has CHF with reduced EF. He presents to you with shortness of breath and edema. What stage of heart failure would this be? A B C D c

BJ has CHF with reduced EF BJ has CHF with reduced EF. He presents to you with shortness of breath and edema. Which of the following additional symptoms would qualify him for a transplant? EF 35% Peak VO2 13 ml/kg/min STEMI requiring PCI Dobutamine dependence d

BJ has CHF with reduced EF BJ has CHF with reduced EF. He presents to you with shortness of breath and edema. Which of the following would be used to assess pulmonary hypertension? Left heart catheterization Right heart catheterization ECG ECHO b

BJ has CHF with reduced EF BJ has CHF with reduced EF. He presents to you with shortness of breath and edema. What is the significance of assessing for pulmonary hypertension? Potential for left sided HF in the old heart Potential for right sided HF in the old heart Potential for left sided HF in the new heart Potential for right sided HF in the new heart d

Assessment of severity Test Method for the madness… CPX Exercise ECHO Imaging ECG Rhythm Right heart cath Pulmonary Prognostic scoring Survival

TR is supposed to be getting a heart transplant due to cardiogenic shock From CHF. Which of the following immunizations would she not be required to receive? Flu Hep B Varicella Pneumococcal c

TR is supposed to be getting a heart transplant due to cardiogenic shock from CHF. She has a VAD placed, since it doesn’t look like she will be able to get a heart in time. Which of the following parameters might this affect if a heart were to become available? HLA composition Immune sensitization PRA screening Anti-HLA antibodies b

TR is supposed to be getting a heart transplant due to cardiogenic shock from CHF. She has a VAD placed, since it doesn’t look like she will be able to get a heart in time. What other factors might increase her risk of immune sensitization? Previous pregnancies Past blood transfusion Having to wait 4 months for the transplant Previous kidney transplant History of HIV/AIDS 2 of the above 3 of the above 4 of the above All of the above h Greatest risk of immune sensitization 2 weeks to 6 months… don’t ask me why

TR is supposed to be getting a heart transplant due to cardiogenic shock from CHF. Which of the following would disqualify her from the transplant? VAD-related infection COPD BMI 34 Current tobacco use b

TR is supposed to be getting a heart transplant due to cardiogenic shock from CHF. Which of the following MCS’s would be installed if she were to need support until a heart that is expected to arrive within the next 2 days can be transplanted? IABP LVAD RVAD BiVAD a

TR is supposed to be getting a heart transplant due to cardiogenic shock from CHF. Which of the following MCS’s would be preferred if she were to need long-term support until a heart can be found? Pulsatile VAD Continuous flow VAD ECMO IABP b

TR is supposed to be getting a heart transplant due to cardiogenic shock from CHF. Which of the following would be preferred if she had breast cancer that has been in remission for 4 years? Pulsatile VAD as destination therapy Continuous flow VAD as destination therapy VAD as a bridge to transplant Immediately transplant c

JS is a 22 yo WM who has CHF with episodes of atrial fibrillation JS is a 22 yo WM who has CHF with episodes of atrial fibrillation. He has reduced ventricular output and labs show lactic acidosis. He has had multiple CABG procedures due to clotting of his coronary arteries. PMH includes ischemic stroke due to his AF. He was also diagnosed with CKD 2 years ago and has pulmonary hypertension per his cath assessment. Which of the following would most likely qualify him for a heart transplant? Reduced ventricular output A fib Lactic acidosis Multiple CABG procedures c… anaerobic metabolism d potentially… ischemia not amenable to further intervention

JS is a 22 yo WM who has CHF with episodes of atrial fibrillation JS is a 22 yo WM who has CHF with episodes of atrial fibrillation. He has reduced ventricular output and labs show lactic acidosis. He has had multiple CABG procedures due to clotting of his coronary arteries. PMH includes ischemic stroke due to his AF. He was also diagnosed with CKD 2 years ago and has pulmonary hypertension per his cath assessment. Which of the following would be a contraindication for transplant? Renal failure Ischemic stroke A fib Age a

JS is a 22 yo WM who has CHF with episodes of atrial fibrillation JS is a 22 yo WM who has CHF with episodes of atrial fibrillation. He has reduced ventricular output and labs show lactic acidosis. He has had multiple CABG procedures due to clotting of his coronary arteries. PMH includes ischemic stroke due to his AF. He was also diagnosed with CKD 2 years ago and has pulmonary hypertension per his cath assessment. Which of the following would be the best reason for VAD? Destination therapy Bridge to transplant Bridge to decision Improve secondary organ function d

JS is a 22 yo WM who has CHF with episodes of atrial fibrillation JS is a 22 yo WM who has CHF with episodes of atrial fibrillation. He has reduced ventricular output and labs show lactic acidosis. He has had multiple CABG procedures due to clotting of his coronary arteries. PMH includes ischemic stroke due to his AF. He was also diagnosed with CKD 2 years ago and has pulmonary hypertension per his cath assessment. Which of the following would not be a reason to not choose vad? H/o ischemic stroke Mitral regurgitation Pulmonary hypertension A fib b

Which of the following patients would be staged as 1B? VAD for 60 days with thromboembolism and high dose dobutamine VAD for 25 days with thromboembolism and high dose dobutamine VAD for 25 days with high dose dobutamine No current VAD with high dose dobutamine d

JL received a heart transplant two weeks ago JL received a heart transplant two weeks ago. What is the least important medication for her at this time based on risk? Methylprednisolone Mycophenolate Vancomycin Tacrolimus c

Which of the following would be optional within the first few weeks? Calcinurin inhibitor Anti-T cell antibodies Corticosteroids Mycophenolate b

When would you be more likely to use basiliximab? Renal failure 3 HLA mismatches First transplant CMV mismatch a

What would you be likely to use with Antithymocyte globulins? Valagancyclovir for CMV prophylaxis APAP for infusion reactions Mycophenolate for renal sparing Azathioprine for additional immunosuppression b

Your patient has hypertension and hyperlipidemia Your patient has hypertension and hyperlipidemia. Which of the following would you want to exclude from post-op therapy? Tacrolimus Mycophenolate Cyclosporine Corticosteroids c

JF was taking amiodarone for his arrhythmia prior to transplant JF was taking amiodarone for his arrhythmia prior to transplant. What would he be more at risk for afterward? Bradycardia Pulmonary hypertension Decreased oxygen saturation Bleed a

JF was taking amiodarone for his arrhythmia prior to transplant JF was taking amiodarone for his arrhythmia prior to transplant. Should he develop bradycardia, how should you treat this arrhythmia? Atropine Dobutamine Isoproterenol Epinephrine c

RH develops pulmonary hypertension. His blood pressure is 89/64 RH develops pulmonary hypertension. His blood pressure is 89/64. What would you prefer to give him? Sildenafil Sodium nitroprusside Nitroglycerine Milrinone a

Which of the following would receive acyclovir as CMV prophylaxis? D-/D- d

What lab values would you need to evaluate in acyclovir? WBC SCr RBC LFTs b

Which of the following is preferred for toxoplasma gondii prophylaxis? Dapsone Atovaquone Bactrim Pentamidine c

Which of the following would be more difficult to treat? ACR 1R ACR 3R AMR 1 AMR 3 d

How would you treat ACR 1R rejection initially? IV steroid pulse with taper PO steroid pulse with taper IV high dose steroids IV high dose steroids with rATG b

How would you treat ACR 3R rejection initially? IV steroid pulse with taper PO steroid pulse with taper IV high dose steroids IV high dose steroids with rATG c

How would you treat ACR 3R rejection if there is no response to initial therapy? IV steroid pulse with taper PO steroid pulse with taper IV high dose steroids IV high dose steroids with rATG d

How would you treat AMR 1 rejection through targeting of plasma cells? Rituximab IVIg Bortezomib Eculizumab c

Your patient has had cancer Your patient has had cancer. What should you prescribe to prevent complications? Aspirin Clopidogrel Pravastatin Methotrexate c

Your patient has had cancer Your patient has had cancer. What should you consider as a antirejection therapy to prevent complications? Sirolimus immediately Sirolimus after 8 months Tacrolimus immediately Tacrolimus after 8 months b