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  • Heart transplant

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  • V42.1 Heart replaced by transplant

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  • Z94.1 Heart transplant status

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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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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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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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Medical Procedures

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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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  • 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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  • Decreased strength
  • Decreased endurance
  • Limited active range of motion
  • Unable to ambulate independently
  • Dependent for transfers

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