Med Journal March 2021 Final 2 - Page 19

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Figure 2 . Pre- and post- LVAD depression scores . The depression score measured by the PHQ-9 Figure 2 . Pre- and post- LVAD depression scores . The depression score measured by the PHQ-9 reduces from 21 to 8 points post-LVAD . Somatic symptoms were the major contributors to the overall depression scores . The burden of somatic symptoms of depression was higher than cognitive or affective symptoms in pre-LVAD placement . Nevertheless , his somatic symptoms improved after the implantation of LVAD . LVAD placement impacted positively on his overall quality of life . The patient ’ s physical strength improved significantly during his stay at the rehabilitation center . Currently , he can ride a stationary bicycle and walk without assistance . At discharge he was advised to make regular follow-ups with the ventricular assist device ( VAD ) clinic .
hibited peripheral edema with normal peripheral perfusion despite having non-palpable pulses . Also , auscultation of the chest noted clear breath sounds and the whirling sound of an LVAD .
Laboratory workup noted elevated Lactic Acid Dehydrogenase ( LDH ) 310 U / L , B Natriuretic Peptide ( BNP ) 5336pg / ml , and INR2.6 . Sodium was 139 mEq / L , Blood Urea Nitrogen ( BUN ) 50mg / dL , Creatinine2.6 mg / dL , Albumin3.1g / dL , Hemoglobin ( Hgb ) 9.5g / dL , Hematocrit ( HCT ) 28.9 %, Mean Corpuscular Volume ( MCV ) 76.1fL and platelet ( PLT ) 186K / uL .
Patient ’ s surgical history included prior implantation of temporary right ventricular assist device , implantation of extracorporeal membrane oxygenation ( ECMO ) circuit , tracheotomy , gunshot injury of right shoulder , inguinal hernia repair and LVAD replacement .
During his rehabilitation course he was continued on Milrinone drip . Mean arterial pressure was calculated with every blood pressure by checking the mean arterial pressure ( MAP ) and was maintained at 65-85 mmHg .
Pre and Post LVAD Depression Score
Pre-LVAD depression score
Post LVAD Depression score
Discussion
Heart failure ( HF ) is a highly prevalent condition associated with significant morbidity and mortality . According to Gosev et al . ( 2018 ), HF develops when the heart muscle fails to pump blood throughout the body hence leading the cascade to poor health . Congestive heart failure can be fatal if proper treatment is not sought , especially when the disease reaches endstage . According to “ Heart failure ” ( n . d .), this condition can be caused by ischemic heart disease , diabetes , high blood pressure , arrhythmia , congenital heart defects , and excessive use of cocaine or alcohol ( Gosev et al ., 2018 ). The above conditions weaken the heart by releasing certain proteins and other toxic substances into the blood , thus affecting bloodflow , leading to the development of HF . Common manifestations of advanced HF include dyspnea , fatigue , exercise intolerance , unintentional weight loss , refractory volume overload , hypotension , and signs of inadequate perfusion . Advanced heart failure should be suspected when a patient with heart failure experiences persistent and severe symptoms despite optimal guidelines provided through medical therapy . Cardiac resynchronization and heart transplant have emerged in recent years as second-line therapy to heart failure refractory pharmacologic therapy . Left ventricular assist devices ( LVADs ) play a significant role in establishing cardiac resynchronization .
LVADs are an established therapy for end-stage heart failure as either a bridge to heart transplantation or as a destination to permanent therapy . According to Gosev et al . ( 2018 ), the use of LVADs is on the rise because of their positive impacts on patients . These devices are effective and can extend a patient ’ s survival for a long period of time . The latest improvements on LVADs will allow patients to survive for greater than four years with low rates of re-hospitalization ( Gosev et al ., 2018 ).
The history of mechanical circulatory support began in 1953 . Experts argue that this medical revolution was initiated due to the lack of heart donors ( Prinzing , Herold , Berkefeld , Krane , Lange , & Voss , 2016 ). In 1969 , Denton A . Cooley implant-
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Volume 117 • Number 9 March 2021 • 211