CCTN Heart Transplant Exam Questions with
Correct Solutions
What happens during chronic rejection in heart tx? - ANSWER -coronary artery vasculopathy
-impairs circulation to the heart
-can be asymptomatic
When would you see humoral rejection in heart tx? What happens during humoral rejection? -
ANSWER -first 4 weeks after tx
-antibodies attack CORONARY arteries
What sx would you see with heart rejection? - ANSWER -dyspnea
-tachy
-hypotension
-wt gain
-decreased UOP
-poor appetite
What is an orthotopic transplant? - ANSWER -most common type of heart transplant
-entire diseased heart is replaced by donor's heart
What is a heterotopic transplant? - ANSWER -risky, rare
-native heart left in place
-donor's heart tx is put in the R chest cavity "piggybacking"
-end-to-side anastamosis
-connects aortae, SVC, and pulmonary arteries
-higher risk of thromboembolism
,-this method=last resort if normal heart is too small and can't keep good R ventricular function
What are the criteria for heart donation? - ANSWER 1. donor < 50 y.o.
2. arterial O2 sat > 80% with ventilator
-no infections
-no cancer outside cranium
-no ventricular arrhythmias
-no HIV/AIDS/ HepB/C
-no hx heart disease/MI/coronary heart disease
-no heart structural abnormalities
-no IV drug use hx
Is it ok to transplant a heart of older donor ( >50 y.o.) to an older recipient? - ANSWER yes
heart donor contraindications? - ANSWER -active peptic ulcer disease
-old age >60 or 65
-AIDS
-decreased life expectancy of co existing disease
-cancer hx
-stroke/TIA
-chronic bronchitis
-diverticulitis
-severe muscle wasting (cachexia)
-oseoporosis
-obesity
, -severe peripheral vascular disease
-irreversible liver disease, pulmonary HTN, kidney disease
what do you make sure with pre heart transpalnt patients if they're getting a blood transfusion?
- ANSWER -Leukocyte depleted blood
-ask blood bank to use leukocyte removing filter
-if pt is CMV negative, need to use CMV negative blood
How often do you get heart biopsy after transplant? - ANSWER -First month = weekly
-month 2-3 = q2weeks
-months 5-6= q4weeks
-months 7-12 = q6weeks
-year 1-2 = q3months
-years 2-3=q6 months
-After that, prn
Heart Allograft Grading for Rejection
0, 1A, 1B, 2, 3A, 3B, 4 - ANSWER 0= no rejection
1A= infiltrate, no necrosis
1B= sparse infiltrates, no necrosis
2= 1 focus; myocyte damage
Correct Solutions
What happens during chronic rejection in heart tx? - ANSWER -coronary artery vasculopathy
-impairs circulation to the heart
-can be asymptomatic
When would you see humoral rejection in heart tx? What happens during humoral rejection? -
ANSWER -first 4 weeks after tx
-antibodies attack CORONARY arteries
What sx would you see with heart rejection? - ANSWER -dyspnea
-tachy
-hypotension
-wt gain
-decreased UOP
-poor appetite
What is an orthotopic transplant? - ANSWER -most common type of heart transplant
-entire diseased heart is replaced by donor's heart
What is a heterotopic transplant? - ANSWER -risky, rare
-native heart left in place
-donor's heart tx is put in the R chest cavity "piggybacking"
-end-to-side anastamosis
-connects aortae, SVC, and pulmonary arteries
-higher risk of thromboembolism
,-this method=last resort if normal heart is too small and can't keep good R ventricular function
What are the criteria for heart donation? - ANSWER 1. donor < 50 y.o.
2. arterial O2 sat > 80% with ventilator
-no infections
-no cancer outside cranium
-no ventricular arrhythmias
-no HIV/AIDS/ HepB/C
-no hx heart disease/MI/coronary heart disease
-no heart structural abnormalities
-no IV drug use hx
Is it ok to transplant a heart of older donor ( >50 y.o.) to an older recipient? - ANSWER yes
heart donor contraindications? - ANSWER -active peptic ulcer disease
-old age >60 or 65
-AIDS
-decreased life expectancy of co existing disease
-cancer hx
-stroke/TIA
-chronic bronchitis
-diverticulitis
-severe muscle wasting (cachexia)
-oseoporosis
-obesity
, -severe peripheral vascular disease
-irreversible liver disease, pulmonary HTN, kidney disease
what do you make sure with pre heart transpalnt patients if they're getting a blood transfusion?
- ANSWER -Leukocyte depleted blood
-ask blood bank to use leukocyte removing filter
-if pt is CMV negative, need to use CMV negative blood
How often do you get heart biopsy after transplant? - ANSWER -First month = weekly
-month 2-3 = q2weeks
-months 5-6= q4weeks
-months 7-12 = q6weeks
-year 1-2 = q3months
-years 2-3=q6 months
-After that, prn
Heart Allograft Grading for Rejection
0, 1A, 1B, 2, 3A, 3B, 4 - ANSWER 0= no rejection
1A= infiltrate, no necrosis
1B= sparse infiltrates, no necrosis
2= 1 focus; myocyte damage
