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Condition/Disorder Synonyms

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  • Heart 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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Key Features

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Description

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  • Diseased or defective heart is partially (heterotopic transplant)1 or completely (orthotopic transplant) removed due to heart failure and 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 classification2

    • 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 nerves3) following transplantation

    • As a result, pulse rate can no longer be utilized as the primary method of assessing intensity of exercise

    • Circulating catecholamines regulate 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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  • 5,000 heart transplants/year including adults and children

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Clinical Findings

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Signs and Symptoms

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  • Cyanosis

  • Tachycardia

  • Tachypnea

  • Syncope

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Possible Contributing Causes

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  • Four primary reasons2

    • Congenital heart defects such as hypoplastic left heart syndrome or cardiomyopathy

    • Tumors

    • Infections

    • Toxins

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Differential Diagnosis

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  • Cytomegalovirus (CMV)

  • Human Immunodeficiency Virus (HIV)

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Functional Implications

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  • Denervated heart

  • Developmental delay

  • Deconditioned

  • Immunosuppression

  • 92% have no functional loss 10 years following transplant3

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Complete blood count (CBC)

  • Immunosuppressant trough

  • CMV test

  • HIV test

  • Immunoglobulin G levels

  • Isotopic glomerular filtration rate

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Imaging

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  • Fetal ultrasound

  • Echocardiography

  • Renal ultrasound

  • Electroencephalogram (EEG)

  • Electrocardiogram (EKG)

  • CT scan

  • MRI

  • Chest radiograph

  • Kidney radiograph

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Medical Procedures

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  • Cardiac catheterization

  • Endomyocardial biopsy

  • Coronary angiography

  • Sternotomy as part of heart transplant

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Treatment

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Medication4

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  • Immunosuppresants (e.g., cyclosporine)

  • Corticosteroids (e.g., methylprednisolone)

  • Vasodilators (e.g., Nitropress)

  • Inotropic agents (e.g., dopamine)

  • Pulmonary vasodilators (e.g., nitric oxide)

  • Immune globulins (e.g., IVIG)

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Referrals/Admittance

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  • May be admitted for infection due to cardiac catheterization, cardiac biopsy, immunosuppression, rejection, or pulmonary hypertension

  • Cardiology

  • Pulmonology

  • Nephrology

  • Occupational therapy

  • Speech therapy

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Impairments

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  • Decreased strength

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