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) • Cardiac Cath (03/08) • Left & Right Heart Cath • Right Heart Cath • Dobutamine 2.5 mcg/kg/min • RA A wave: 24; V wave: 37; • RA A wave: 21; V wave: 21; Mean: 21 mmHg Mean: 17 mmHg • RV: 55/21 mmHg • RV: 50/17 mmHg • PA: 55/33; Mean: 43 mmHg • PA: 49/7; Mean: 28 mmHg • PCWP: A wave: 34; V wave: 35; • PCWP: A wave: 30; V wave: 47; Mean: 32 mmHg Mean: 32 mmHg • PA Sat: 54% • PA Sat: 37% • LV: 88/29 mmHg • AO: 88/62; Mean: 72 mmHg • Mild non obstructive luminal • Findings c/w: moderate to irregularities 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