Case Study by Abhilash Makkar , MD ; 1 Stacy Zimmerman , MD , FACP , FAAP ; 1 Siji Thomas , MD ; 3 Sheeba Marian , MS 4 ; 3 Yogesh Vaje , MD ; 4 Anjum Vazifdar , MD , MBA ; 3 Rathna Yallapragada , MD ; 2 Suporn Sukpraprut-Braaten , PhD ; 1 Stephen Wagner , MD , ACP , FAAP 1
1
Unity Health , 2 AMITA Health Adventist Medical Center , 3 Avalon University School of Medicine , 4 Medical University of Dublin
Impact of Left Ventricular Assist Device on Physical , Physiological , and Psychological Wellbeing of a Patient with NYHA Class IV Heart Failure : A Case Report
Introduction
Left ventricular assist devices ( LVADs )
are used to treat end-stage heart failure patients who are refractory to medical therapy . LVADs can be used as destination therapy or as bridge-totransplant therapy , which mainly applies to patients awaiting heart transplant . These patients are placed on LVADs until a suitable heart is available for transplant . LVADs have proven to improve patients ’ general health outcomes . Besides exercise training programs , post LVAD implementation is expected to improve cardiac pump function and quality of life . These outcomes can result in decreased hospitalizations , length of stays , and decreased overall health care costs . There has been a dearth of clinical literature examining the possibility of functional improvement in patients placed on LVAD . This case report examines the functional and emotional improvement in quality of life in a patient after LVAD placement .
Case Presentation
This case studies a 66-year-old male of African-American decent who was admitted to the Nursing and Rehabilitation Center on June 5 , 2017 . Before his admission , he had suffered from several health complications , including congestive heart failure , hypertension , Stage III B-chronic kidney disease , ventricular tachycardia , and seizures . He had undergone heart wire left ventricular assist device ( HWLVAD ) placement on May 2016 . Unfortunately , his post-procedure course was complicated . He had to undergo an emergent LVAD exchange because of acute hemolysis . His replaced LVAD had complications of a driveline infection due to Methicillin-sensitive Staphylococcus aureus ( MSSA ) for which he completed a course of antibiotics .
Patient reported that he could not carry out many activities of daily living ( ADL ) before his surgical procedure . For example , he could not even stand without support before the surgery . Patient ’ s functioning capacity was classified as New York Heart Association ( NYHA ) class IV as his level of distress increased with every physical activity he undertook , and he exhibited symptoms even at rest . His ejection fraction at that time was calculated to be 10 %. Therefore , at discharge , patient was transitioned to the rehabilitation unit to improve his physical endurance .
Social history consisted of a long history of cocaine use and smoking at least
ADL SCALE
10
8
9 9
7 7
Changes in ADLs Pre and Post LVAD
10
8
Pre-LVAD one packet of cigarettes per day ; however , he had stopped smoking six months preceding his last hospitalization . He was married with two children , and several of his family members suffer from heart-related disease . His mother and sister passed away due to myocardial infarction .
His current medications at discharge were Milrinone 0.25 mcg / kg / min drip , Amiodarone 200mg per mouth ( P . O ) daily , acetylsalicylic acid ( ASA ) 325 mg P . O daily , Vitamin D 1000 IU P . O daily , Hydralazine 50 mg P . O daily , Levetiracetam 500 mg P . O . twice daily , Potassium Chloride 40 mEq E . R . P . O twice daily , Torsemide 40 mg P . O twice daily , Warfarin 3mg P . O daily .
On physical examination , the patient demonstrated significant findings . He ex-
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Fig . 1 shows the changes in the activities for daily living ( ADL ) before and after the Figure . 1 shows the changes in the activities for daily living ( ADL ) before and after the implantation of the LVAD . The ADLs for all activities significantly increase post-LVAD . The largest increase in the ADL scores are housekeeping , walking , and climbing stairs . Patient was provided with a Patient Health Questionnaire ( PHQ-9 ) to help him compare his symptoms of depression pre-LVAD placement to post-LVAD placement . The total score in post-LVAD was 8 compared to the rating of 21 in pre-LVAD implantation . Figure 2 . compares the depression scores recorded pre- and post-LVAD implantation .
9
8
Post-LVAD
8
9 9
210 • The Journal of the Arkansas Medical Society www . ArkMed . org