Immunosuppression, Right Ventricle, DAN discussed on Cardionerds
One important points in a patient that has a history of accord. Transplant is lack of innovation and the heart, and so the typical symptoms. Of Satan engine our scheme Ya may not present with chest pain. So that's why I wouldn't always be a reliable symptom in a patient such as this but some of the more atypical symptoms like nausea or fatigue would be important to ask with respect to compliance with medications. The patient up into this point had endorsed total compliance with all of his medications Dan I'm going to reflect on the case so far this is a very concerning history giving a young man with a heart transplant is coming in essentially with what sounds I. Don't WanNa Anchorage just yet. But what sounds like left sided heart failure symptoms with this Nia or Nia as well as right Extremity Dima the differential diagnosis for heart failure is essentially the same as any other patient with the addition of a few important features. Right. One is all the causes of heart failure in a heart transplant patient to are related with immunosuppression, right and credits for instance, and then three I. Think it's also useful to go back in the medical history and see what was the indication for heart transplant in the first place better understand our host. For example, there are some entities that result in end stage heart failure indication for transplant by can recur. For example, giants held myocarditis. There is a recurrence after transplant in this patient were a differential diagnosis going have to be essentially the same. As any other patient is going to have to ask all the things that can go wrong with heart transplant, a transplant heart itself, the features with Immunosuppression, as well as the original cause of heart failure that led to the transplant in with less exactly right and I think that's good cerebal perspective because it is important to take the initial indication for the heart transplant into consideration. As you stated, there are many disease processes Malcolm Diana's processes. sarcoidosis processes that can cause residual cardiac dysfunction and that would indeed an important aspect to pursue when you're trying to elicit etiologies forgiven compensation, and that actually brings us quite well into this patient's past medical history and he had actually received a heart. Transplant survivors prior at the age of twenty four, and this was for an easy call rhythmic genetic right ventricular cardiomyopathy, or a R V. C. for those who don't know this is a fibro fatty infiltration of the right ventricle ended about half the patients it can actually involve the left ventricles. Well, it's a progressive carton off the attends to be associated with a high ventricular Arrhythmia burden and does tend to cause quite severe heart failure oftentimes requiring a transplant, and this is the case for our patient following his diagnosis of a RV see as twenty year old or so he had developed several de compensations as well as cardiac arrest. Ultimately, he did eventually require that heart transplant which was. Pursued at outside institution, which unique about our patient is that he was a young man at the time of his heart transplant and that's a lot for a young adult to take on the process of being entwined with the medical system taking suppressive medications showing up for Echocardiogram and diagnostic cats that's not easy for anybody especially challenging for young adults I think that was part of why this patient particular had so many issues with non-appearance fortunately, there were four distinct episodes from the time of his transplantation up until he presented for this hospitalization in which he suffered from various forms of cardiac rejection, and these were invariably in the setting of sub therapeutic immunosuppression levels, not taking immunosuppressive medications..