RT Book, Section
A1 Jobst, Erin E.
A1 Panus, Peter C.
A1 Kruidering-Hall, Marieke
SR Print(0)
ID 1192819188
T1 Immunopharmacology
T2 Pharmacology for the Physical Therapist, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259862229
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192819188
RD 2024/04/23
AB CASE  STUDYJ.M.  is  66-year-old  man  with  a  history  of  three  myocardial  infarctions  within  the  last  decade.  Over  that  time,  his  ejection  fraction  fell  to  less  than  40%  and  he  demonstrated  symptom-limited  exercise  tests  with  a  decline  in  sustainable  workload  of  less  than  5  metabolic  equivalents  (METs).  J.M.  qualified  for  a  heart  transplant  and  was  enrolled  in  an  outpatient  precardiac  transplant  rehabilitation  program  to  help  prevent  further  functional  decline.  Two  months  ago,  J.M.  received  a  heart  transplant.  His  post-transplant  immunosuppressant  maintenance  medication  includes  oral  cyclosporine,  mycophenolate  mofetil,  and  prednisone.  In  addition,  J.M.  is  taking  other  drugs  to  maintain  cardiovascular  hemodynamics  and  improve  his  plasma  lipid  profile.  After  surgery,  J.M.  spent  14  days  in  the  hospital:  4  days  in  the  cardiac  intensive  care  unit  and  10  days  on  the  cardiac  telemetry  floor.  On  post-transplant  day  18,  a  cardiologist  performed  a  symptom-limited  stress  test  to  determine  J.M.’s  readiness  for  a  12-week  Phase  II  outpatient  cardiac  rehabilitation  program.  On  day  21,  J.M.  began  a  physical  therapist-supervised  and  monitored  aerobic  training  by  walking  on  the  treadmill.  Five  minutes  of  low  intensity  warm-up  were  followed  by  20  minutes  at  a  sustained  Borg  rating  of  perceived  exertion  (RPE)  of  11,  and  then  5  minutes  of  cool-down  exercise.  By  day  28,  J.M.  had  progressed  to  sustained  aerobic  exercise  for  35  minutes  at  an  RPE  of  13.  At  42  days  post-transplant,  resistance  training  was  incorporated  into  the  program  with  alternating  upper  and  lower  body  exercises  and  2  minutes  of  walking  between  exercises  to  prevent  hypotension.  One  week  ago  (post-transplant  day  48)  at  his  regularly  scheduled  cardiac  rehabilitation  session,  J.M.  complained  of  chest  pain  and  fatigue.  The  physical  therapist  noted  that  J.M.’s  blood  pressure  was  low  and  also  observed  that  the  patient’s  feet  were  swollen.  The  therapist  called  the  referring  cardiologist’s  office  to  report  J.M.’s  symptoms  and  vital  signs.  Shortly  after,  a  medical  diagnosis  of  rejection-induced  coronary  artery  vasculitis  was  made.  Cyclosporine  and  mycophenolate  mofetil  were  continued  and  prednisone  was  discontinued.  J.M.  was  placed  on  antithymocyte  globulin  and  bolus  intravenous  methylprednisolone.