Buy Cardiomyopathy And Pulmonary Hypertension

Buy Cardiomyopathy And Pulmonary Hypertension
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Buy Cardiomyopathy And Pulmonary Hypertension
1. 30-year-old multiparous female with left ventricular noncompaction cardiomyopathy presents to
the intensive care unit (ICU) from the operating room after undergoing an orthotopic cardiac
transplantation. The donor organ was retrieved from a 20-year-old brain dead man.
Preoperatively, the recipient was on chronic intravenous dobutamine therapy. Intravenous
basiliximab was administered immediately prior to her transplant for induction of
immunosuppression. Post termination of cardiac bypass in the operating room, temporary
pacing was initiated in view of persistent bradyarrhythmia. The MOST likely cause of her
posttransplant bradyarrhythmia is:
A. Basiliximab induction
B. Surgical trauma
C. Donor age and gender
D. Preoperative dobutamine therapy
2. A 40-year-old male with known nonischemic cardiomyopathy and pulmonary hypertension
returns to the ICU intubated and sedated after undergoing an orthotopic heart transplant. Graft
ischemia time was 4 hours. On arrival, he is on high-dose intravenous vasopressor support
including 0.5 µg/kg/min norepinephrine, 0.5 µg/kg/min epinephrine, and 0.1 units/h of
vasopressin. He is receiving inhaled nitric oxide 40 ppm. Monitoring reveals the following:
Cardiac index of 1.6 L/min/m2
, invasive arterial pressure of 80/40 mm Hg, central venous
pressure of 18 mm Hg, and heart rate 130 beats/min. The LEAST likely cause of his
cardiogenic shock is:
A. T-lymphocyte–mediated rejection of allograft
B. Mediastinal bleeding with regional cardiac tamponade
C. Ischemia-reperfusion injury–related primary graft failure
D. Acute on chronic pulmonary hypertension
3. 50-year-old male with end-stage lung disease and pulmonary hypertension secondary to
emphysema is admitted to ICU after undergoing bilateral lung transplantation on
cardiopulmonary bypass. His body mass index (BMI) is 22 kg/m2
. The lungs were retrieved
from a 25-year-old brain dead man. The donor was a nonsmoker. On POD 2, the recipient’s
PaO2
/FiO2
ratio is 150 and bilateral lung opacities consistent with pulmonary edema are noted
on chest x-ray suggesting a diagnosis of grade 3 primary graft dysfunction (PGD). The risk
factor MOST likely associated with PGD in this scenario is:
A. Donor’s nonsmoker status
B. Recipient and donor age mismatch
C. BMI less than 25 kg/m2
D. Preexisting pulmonary hypertension
4. 40-year-old male underwent liver transplant 20 years ago due to biliary cirrhosis. He is now
listed for a redo liver transplant in view of recurrent cirrhosis. He is admitted to the ICU with
upper gastrointestinal variceal bleeding requiring massive transfusion. He is intubated and on
mechanical ventilation. Bedside echocardiography reveals an ejection fraction of 70% and
absence of diastolic dysfunction. Electrocardiogram exhibits sinus tachycardia with a normal
QT interval. Chest x-ray appears normal. Patient’s invasive arterial pressure is 100/60 mm Hg
and central venous pressure is 8 mm Hg. A pulmonary artery catheter is inserted and the
following values are obtained: Cardiac output of 10 L/min, mean pulmonary artery pressure of
30 mm Hg, and pulmonary artery occlusion pressure of 10 mm Hg. This is MOST likely due to:
A. Porto pulmonary hypertension
B. Hyper dynamic circulation
C. Transfusion-associated circulatory overload
D. Cirrhotic cardiomyopathy
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