RESUMO
BACKGROUND: Ventricular assist device (VAD) recipients are at high risk of depression and anxiety, and poor psychosocial functioning is associated with worse medical outcomes. PURPOSE: We present a case of a 31-year-old depressed patient who demonstrated passive suicidal behavior through multiple episodes of noncompliance, including temporarily discontinuing warfarin (Coumadin) several months after VAD implantation. The patient's psychosocial and medical histories and outcomes are presented. CONCLUSIONS: This case underscores the importance of pre-VAD as well and ongoing psychosocial evaluation and management for this unique patient population. CLINICAL IMPLICATIONS: Medical teams who are treating patients with cardiovascular disease who are under consideration for VAD or heart transplantation need to be aware of the multitude of ways in which patients can express depressed and suicidal mood and work with a multidisciplinary team to treat such symptoms to optimize patients' success with VAD/heart transplantation.
Assuntos
Transtorno Depressivo/psicologia , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Suicídio/psicologia , Adulto , Humanos , MasculinoRESUMO
Left ventricular assist devices (LVADs) are approved for both a bridge to cardiac transplantation as well as for destination therapy. Most patients with LVADs have implantable cardioverter-defibrillators (ICDs) and several interactions between LVADs and ICDs have been reported. In the present case, we describe an interaction of an approved LVAD with remote telemetry of a previously implanted Sorin ICD (Sorin Group, Milan, Italy) that could not be resolved with standard shielding techniques.
Assuntos
Artefatos , Desfibriladores Implantáveis , Falha de Equipamento , Coração Auxiliar , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Cardiopatias/cirurgia , Transplante de Coração/tendências , Hospitais Universitários , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias/mortalidade , Transplante de Coração/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , South Carolina/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Twelve heart transplant recipients selected for conversion from cyclosporine to tacrolimus because of adverse effects of cyclosporine therapy underwent echocardiography at baseline and 6 months after conversion. Left ventricular mass decreased by 24% and left ventricular geometry returned toward normal at 6 months after conversion, without significant changes in blood pressure.
