LVAD & Bridge to Transplant
What is heart failure?
Heart failure is a condition in which the heart is unable to pump blood effectively to meet the body’s needs for oxygen and nutrients.
Do you lose intrinsic or extrinsic control with a heart transplant?
Extrinsic
What is the primary purpose of immunosuppressive medications post-transplant?
To prevent organ rejection by suppressing the immune system.
What type of exercise testing is commonly used to assess cardiovascular function after a heart transplant?
a GXT or stress test is commonly used to evaluate cardiovascular function and exercise capacity.
What is the main goal of exercise prescription for heart transplant patients?
To improve overall cardiovascular health, muscular strength, and functional capacity, while avoiding excessive strain on the heart.
What is an LVAD?
A mechanical pump that helps a weakened heart pump blood, often used as a "bridge to transplant" or a long-term solution for patients in severe heart failure.
What is denervation?
Denervation is the loss of nerve control to the heart after transplant, leading to a lack of autonomic regulation of heart rate.
What are common complications after a heart transplant?
Common complications include infection, graft rejection, and bleeding.
Why might traditional heart rate monitoring be unreliable during exercise testing in heart transplant patients?
Traditional heart rate monitoring is unreliable because heart transplant patients experience denervation, meaning the heart rate does not respond normally to autonomic signals.
What does "bridge to transplant" mean?
A “bridge to transplant” is a treatment used to keep patients alive while they wait for a heart transplant.
How does the loss of intrinsic heart rate control affect transplant patients?
Loss of intrinsic heart rate control means the heart rate is no longer regulated by the autonomic nervous system. Patients rely on catecholamines and external stimuli to regulate heart rate.
What medications are commonly prescribed post-heart transplant?
Common medications include immunosuppressants to prevent rejection, antiarrhythmics, and anticoagulants.
Why is RPE (Rate of Perceived Exertion) important for these patients?
RPE is important because the heart transplant patient cannot rely on heart rate for exercise intensity due to denervation.
What are the risks of using an LVAD as a long-term option?
Risks include infection, blood clots, and device malfunction.
What is reinnervation, and how does it affect heart transplant patients?
Reinnervation is the regrowth of nerve fibers to the heart after a transplant, and it can take months or even years. It can help with heart rate control and response to stress.
How does immunosuppressive therapy affect the transplant patient?
Immunosuppressive therapy suppresses the immune system to prevent organ rejection but increases the risk of infection.
How can exercise testing protocols be adapted to accommodate the unique cardiovascular responses of heart transplant patients?
Exercise testing protocols may be adapted by using Rate of Perceived Exertion (RPE) instead of heart rate monitoring and allowing for longer warm-up and cool-down periods to accommodate slower heart rate changes.
What special considerations are needed for patients with an LVAD?
Considerations include infection prevention, anticoagulation therapy, and device management.
Why is the increase in resting heart rate significant post-transplant?
The increase in resting heart rate post-transplant occurs because the heart is no longer under normal autonomic control, requiring external stimuli to maintain function.
How do medications affect exercise tolerance and recovery?
Medications can impact exercise tolerance by causing fatigue, fluid retention, and muscle weakness.