Benjamin Valdez MIS 304 Professor Fang Fang Cal State University San Marcos.
Eve Tan Yi Fang- In Service Traiing Heart Transplantation
Transcript of Eve Tan Yi Fang- In Service Traiing Heart Transplantation
Heart
Transplantation
(HT)
Introduction
More than 5000 HT occur each year
around the world, although it is estimated
that up to 50,000 people are candidates
for transplantation.
According to the British Heart Foundation,
there were 145 HT at 7 hospitals around
the UK in 2013.
Conventional criteria for HT
(Banner et al, 2011)
Indications for urgent
inpatient referral
(Banner et al, 2011)
Risks factors and
contraindications
Related to heart failure (HF)
Cardio-renal syndrome
Hyponatraemia
Liver dysfunction
Secondary pulmonary hypertension
Anaemia
Comorbidity
Age
Diabetes
Obesity
Sepsis and active infection
Recent pulmonary embolism
Autoimmune Disorders
Psychosocial factors
Substance abuse
- Excessive alcohol consumption
- Smoking
Non-adherence to follow-up
Poor family or social support
Factors determining heart
allocation
(Banner et al, 2011)
Outcomes after first HT
Survival
Approximately 85% - 90% of HT patients
are living 1 year after their surgery, with
an annual death rate of approximately 4
percent thereafter.
The 3 year survival approaches 75%.
Prognosis
Recipient Factors Donor Factors
• Pre-operative need
for artificial breathing
support
• Pre-operative need for
heart function
assistance with a VAD
• Second heart
transplantation
• Heart conditions other
than CAD or
cardiomyopathy
• Being female
• Being underweight or
obese
• Female donor
• Increased age
• Left ventricular
hypertrophy
• Elevated blood levels
of Troponin I and T
Early Mortality
50% – 80% of people experience at least 1
rejection episode.
Average of 1 to 3 episodes of rejection in
the first year after transplantation.
Acute rejection is most likely to occur in
the first 3 – 6 months.
Causes of death
Acute rejection
Infections
Artery disease in the transplanted heart
vessels
Lymphoma and other malignancies
Clinical problems post-HT
Physical deconditioning
Muscular atrophy
Muscle weakness
Lower maximal aerobic capacity
Recommendations for exercise
and physical rehabilitation after
HT
Class I:
The routine use of cardiac rehabilitation with performance of aerobic exercise training is recommended after HT. The short-term benefits of this approach include improvement in exercise capacity and possible modification of cardiovascular risk factors such as obesity, hypertension, and glucose intolerance. There is currently no information on potential long-term benefits.
Level of Evidence: B
Class I:
Resistance exercise is also strongly encouraged in HT recipients to restore BMD and prevent the adverse effects of corticosteroid and CNI therapy on skeletal muscle. Resistance exercise should be additive to other therapies for bone mineral loss and muscle atrophy.
Level of Evidence: B
Note: Do not start arm exercises until 3 months after HT
Benefits of post-HT physical
conditioning
(Guimaraes et al, 2004)
Effects of physical training on
HT pathophysiology
Exercises considerations for
HT patients
During exercise and activity, the transplanted
heart is regulated by the humoral system.
The humoral system relies on circulating
catecholamines to elevate the HR in response
to the higher demands of activity.
This lengthens the time between the onset of
activity and the increase in HR.
There is also a prolonged HR recovery after
exercise.
Therefore, patients should extend their warm-up and
cool-down periods to 5-10 minutes.
Exercises considerations for
HT patients
In a normally innervated heart, the vagus
nerve at rest works by depressing the intrinsic
rate of the heart set by the SA node.
However, in the transplanted heart, the SA
node paces the allograft heart resulting in a
higher resting HR.
It is not possible to use your HR as a guide as it is no
longer regulated by the nervous system. To measure the
exertion levels during exercise, the Borg Scale is used.
Conclusion
There are many factors to consider before
patients undergo HT.
The first year after HT is the most crucial
period when mortality rate is the highest
secondary to acute rejection and infections.
Aerobic training and resistance exercise are
beneficial to patients after HT.
Longer warm-up and cool down sessions
should be incorporated into treatment
regime and use of Borg scale to measure
exertion levels during exercise.
References
Banner, N. R., Bonser, R. S., Clark, A. L., Clark, S., Cowburn, P. J., Gardner, R. S., et al. 2011, “UK guidelines for referral and assessment of adults for heart transplantation”, Heart, Vol. 97, no. 18, pp. 1520-1527.
British Heart Foundation. 2014, Heart transplant, [internet]. Available at: https://www.bhf.org.uk/heart-health/treatment/heart-transplant.aspx[Accessed 16th February 2014].
Costanzo, M. R., Costanzo, M. R., Dipchand, A., Starling, R., Anderson, A., Chan, M., et al. 2010, “The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients”, The Journal of Heart and Lung Transplantation, Vol. 29, no. 8, pp. 914-956.
Eisen, H. J. 2014, Patient information: Heart transplantation (Beyond the basics) [online]. Wolters Kluwer, Philadelphia. Available at: http://www.uptodate.com/contents/heart-transplantation-beyond-the-basics [Accessed 16th February 2014].
Guimaraes, G. V., Moraes d’Avila, V., Chizzola, P. R., Bacal, F., Stolf, N. & Bocchi, E. A. 2004, “Physical rehabilitation in heart transplantation”, Rev Bras Med Esporte, Vol. 10, no. 5, pp. 412-415.