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CONDITION/DISORDER SYNONYM

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  • Cardiac transplant

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ICD-9-CM CODE

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  • V42.1 Heart replaced by transplant

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ICD-10-CM CODE

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  • Z94.1 Heart transplant status

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PREFERRED PRACTICE PATTERN

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  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction

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PATIENT PRESENTATION

An 11-month-old infant is referred from an early intervention program for natural environment (home) physical therapy following a heart transplant 6 months ago for hypoplastic left heart syndrome. He has a gastrostomy tube (G-tube) for all feedings due to unwillingness to take food by mouth. The child requires 1 L of oxygen via a nasal cannula and uses an oxygen saturation monitor at night. He takes the following medications: cyclosporine, captopril, zantac, prednisone, heparin, bactrim, and valcyte valganciclovir. Developmentally, he can prop sit but is not yet rolling, creeping on hands and knees, or transferring in or out of sitting or quadruped.

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KEY FEATURES

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Description
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  • Diseased or defective heart is partially (heterotopic transplant) or completely (orthotopic transplant) removed due to heart failure

  • A healthy donor heart from a deceased person is implanted

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Essentials of Diagnosis
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  • Severity of heart failure classification1

    • Stage A: At risk for heart failure

    • Stage B: Abnormal structure or function but no heart failure

    • Stage C: Abnormal structure or function and history of or current heart failure

    • Stage D: Abnormal structure or function resulting in ventilator or cardiac support

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General Considerations
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  • The heart is considered denervated (due to severing of thoracic and vagus nerves2) following transplantation

    • Pulse rate can no longer be utilized as the primary method of assessing intensity of exercise

    • Circulating catecholamines regulate the heart’s response to exercise

    • As a result, a warm-up period prior to exercise and a cool down period following exercise are crucial to any active exercise program

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Demographics
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  • 5000 heart transplants per year including adults and children

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FIGURE 240-1

Actuarial survival for adult and pediatric heart transplant patients performed between January 1982 and June 2004. The half-life is the time at which 50% of those transplanted remain alive, and the conditional half-life is the time at which 50% recipients surviving the first year after transplantation. (Reprinted from Taylor DO, Edwards LB, Aurora P, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008. J Heart Lung Transplant. 2008;27(9):943–956. Copyright 2010, with permission from Elsevier.)

Graphic Jump Location
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FIGURE 240-2

ECG in a heart transplant patient. ECG demonstrating donor and recipient P waves (arrowhead, donor P wave; arrow, recipient P wave). (From Tintinalli JE, Stephan Stapczynski J, John Ma O, et al., eds. Tintinalli’s Emergency ...

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