Monday, May 11, 2015
Advanced Circulatory Support I
A patient with end stage nonischemic cardiomyopathy undergoes placement of a permanent left ventricular assist device as a bridge to cardiac transplantation. It is a continuous flow device. His surgery is uncomplicated, he is started on coumadin, and then discharged to home. Several weeks later, he calls your office because over the last few days, his device has been reporting changing numbers. The pump speed, revolutions per minute, is the same as it was when he was discharged. The cardiac output is similar to his discharge value at 3.5 L/min. However, the pump power, has been markedly rising. It is now five times what it was at discharge (2W versus 10W). The patient has been doing his usual activities, does not feel thirsty or dehydrated, and feels otherwise well.
Challenge: What is your main concern?
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