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Chapter 73: Mechanically Assisted Circulation

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Which of the following is not among the indications for destination therapy (DT) left ventricular assist device (LVAD) implantation?

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A. Continuous infusion of inotropic medications for at least 7 days

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B. NYHA class IIIb or IV functional limitations on maximally tolerated medical therapy

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C. Left ventricular (LV) ejection fraction < 25%

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D. Peak oxygen consumption of < 14 mL/kg/min

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E. Need for acute mechanical circulatory support (MCS) for at least 7 days

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The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 73) The DT LVAD population continues to grow. Eligible patients have NYHA class IIIb or IV functional limitations on maximally tolerated medical therapy (option B), an LV ejection fraction < 25% (option C), and a peak oxygen consumption of < 14 mL/kg/min (option D). In less stable patients, treatment with continuous infusion of inotropic medications for at least 14 days (option A) or the need for acute circulatory support for at least 7 days are also indications for durable LVAD therapy (option E).

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A 43-year-old man develops cardiogenic shock after an acute myocardial infarction (MI). An intra-aortic balloon pump (IABP) is inserted. Which of the following is not true about the IABP tracing in Figure 73-1?

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FIGURE 73-1. IABP tracing.

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(Adapted with permission from Trost JC, Hillis LD. Intra-aortic balloon counterpulsation, Am J Cardiol. 2006 May 1;97(9):1391-1398.)

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A. A reflects unassisted systole

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B. B is an augmented diastolic beat

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C. C and F are a part of an assisted beat

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D. D is an unassisted end diastolic pressure

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E. E indicates balloon deflation

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The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 73) Option A reflects unassisted systole. Option B is an augmented diastolic beat. Options C and F are assisted systole and diastole respectively. Option D is an unassisted end diastolic pressure. Option E indicates balloon inflation, and it is an important landmark to assess the timing of balloon inflation.

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A 67-year-old woman received an orthotopic heart transplant 6 months ago. She presents with generalized malaise and new onset heart failure. Echocardiography confirms allograft dysfunction, and serum PCR demonstrates HCMV viremia. Which of the following is true about HCMV myocarditis?

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A. Myocardial infection with HCMV is usually observed in immunocompetent hosts

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B. Myocardial pathology is notable for an infiltrate by eosinophils

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C. Viral infection is restricted to myocytes

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D. In immunosuppressed patients, infection often occurs by reactivation of a latent infection

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E. First-line treatment ...

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