- V42.1 Heart replaced by transplant
- Z94.1 Heart transplant status
- 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.
- 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
- 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
- 5,000 heart transplants/year including adults and children
Possible Contributing Causes
- Four primary reasons2
- Congenital heart defects such as hypoplastic left heart syndrome or cardiomyopathy
- Cytomegalovirus (CMV)
- Human Immunodeficiency Virus (HIV)
- Denervated heart
- Developmental delay
- 92% have no functional loss 10 years following transplant3
- Complete blood count (CBC)
- Immunosuppressant trough
- CMV test
- HIV test
- Immunoglobulin G levels
- Isotopic glomerular filtration rate
- 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)
- May be admitted for infection due to cardiac catheterization, cardiac biopsy, immunosuppression, rejection, or pulmonary hypertension
- Occupational therapy
- Speech therapy
- Decreased strength
- Decreased endurance
- Limited active range of motion
- Unable to ambulate independently
- Dependent for transfers
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