CHF / Cardiac Transplant Consultation Wooster Community Hospital - - PowerPoint PPT Presentation

CHF / Cardiac Transplant Consultation

• Wooster Community Hospital

–September, 2008 –Echocardiogram: Est. LVEF of 15%; 1‐2+ MR

• OSUMC Ross Heart Hospital

–October, 2008 –CHF / Cardiac Transplant Consultation –Recommendations: medical therapy & device optimization –Follow up: considered not a candidate for cardiac transplant secondary a history of psychosocial issues including suicidal ideations earlier in life and medication non compliance

CHF / Cardiac Transplant Evaluation Cleveland Clinic Foundation

• Echocardiogram

– March, 2010 – Technically diminished quality study – Dilated LV – Severe global LV systolic dysfunction: LVEF of 10% – Mild global RV systolic dysfunction – Trivial MR

• Pharmacologic Stress ECG –

Nuclear Imaging

– March, 2010 – ECG: non diagnostic due to ventricular paced rhythm – Nuclear:

• Dilated non ischemic cardiomyopathy
• No evidence of infarction or ischemia
• Abnormal global left ventricular dysfunction with no localizing wall motion

abnormalities

• LVEF of 25%

CHF / Cardiac Transplant Evaluation Cleveland Clinic Foundation

• Exercise ECG –

Metabolic Test

– May, 2010 – 54% PMHR – SBP decrease of 16 mmHg – Peak MET capacity of 3.2 METS – Discontinued secondary to chest pain – 5 year mortality rate of 10.3% – 5 year US government mortality rate of 1% – Peak VO2: 11.2 mg/kg/min – Ventilatory anaerobic threshold: 8/7 ml/kg/min

CHF / Cardiac Transplant Evaluation Cleveland Clinic Foundation

• Right Heart Catheterization

– May, 2010 – RA mean: 6 mmHg – RV: 32/6 mmHg – PA: 32/20 mmHg – PA mean: 24 mmHg – PCWP A wave: 24 mmHg – PCWP V wave: 12 mmHg – PCWP mean: 18 mmHg – Thermo CO: 5.7 l/min – Thermo CI: 2.6 l/min/M^2

Clinical Course 2010 ‐ 2012

• Wooster Heart Group

– Out patient follow up visits – Chest pain, dyspnea, fatigue, decreased appetite

• Wooster Community Hospital

– Recurrent admissions for chests pain and dyspnea

• Cleveland Clinic Foundation

– Denied cardiac transplant due to mental status issues, medication non compliance, and nicotine use

• OSUMC Ross Heart Hospital

– Repeat cardiac evaluation and care

OSUWMC Chest X‐Ray

OSUWMC Ross Heart Hospital

• Echocardiogram

– February, 2012 – Severely dilated left ventricle – Severe global LV systolic dysfunction – Estimated LVEF of 15% – Mild LAE – Mild to moderate MR / Mild TR – Estimated RVSP of 35 – 40 mmHg

OSUWMC Ross Heart Hospital

• Cardiac Cath

(02/08)

• Left & Right Heart Cath
• RA A wave: 24; V wave: 37;

Mean: 21 mmHg

• RV: 55/21 mmHg
• PA: 55/33; Mean: 43 mmHg
• PCWP: A wave: 34; V wave: 35;

Mean: 32 mmHg

• PA Sat: 54%
• LV: 88/29 mmHg
• AO: 88/62; Mean: 72 mmHg
• Mild non obstructive luminal

irregularities

• Cardiac Cath

(03/08)

• Right Heart Cath
• Dobutamine

2.5 mcg/kg/min

• RA A wave: 21; V wave: 21;

Mean: 17 mmHg

• RV: 50/17 mmHg
• PA: 49/7; Mean: 28 mmHg
• PCWP: A wave: 30; V wave: 47;

Mean: 32 mmHg

• PA Sat: 37%
• Findings c/w: moderate to

severe biventricular failure

Clinical Course

• Medical therapy

– ASA, Carvedilol, Furosemide, Warfarin – Home IV Dobutamine infusion

• Hospice care

– April, 2012 – Palliative care medications – Discontinuation of IV Dobutamine infusion – Deactivation of the ICD

• Final outcome

– Expired: 7/31/12 of biventricular failure