Question

A 30-year-old woman with a history of myocarditis and end-stage cardiomyopathy had a HeartMate II placed while awaiting transplantation. Prior to leaving the hospital, you notice that the PI has decreased. What is the appropriate intervention for this patient?

A) Increasing the pump speed
B) Giving the patient a fluid bolus
C) Turning down the pump flow
D) Anticoagulation
E) Surgical intervention to assess device

Answer 1

For a patient with a HeartMate II experiencing decreased Pump Index, the appropriate intervention depends on clinical symptoms and diagnostics. Non-surgical adjustments are first attempted, but surgical intervention may be necessary if these adjustments fail or the patient is symptomatic.

Step-by-step explanation:

Appropriate Intervention for Decreased Pump Index (PI)

In the case of a 30-year-old woman with a history of myocarditis and end-stage cardiomyopathy who had a HeartMate II placed, a decreased PI (Pump Index) post-implantation suggests there may be a problem with the ventricular assist device (VAD) performance. Before considering an intervention, it is essential to assess the clinical symptoms and perform necessary diagnostics to understand the cause of the decreased PI. If the patient is stable, non-surgical interventions such as adjusting the pump settings could be attempted to improve flow and resolve the issue. However, if non-surgical adjustments fail or if the patient is symptomatic, surgical intervention may be necessary to assess and rectify any device-related issues such as thrombosis, device malfunction, or infection.

Given the advancements in VAD technology that reduce device-related complications, and the effectiveness of non-invasive measures like lifestyle changes and medication in managing cardiac conditions, the decision to turn down the pump flow or proceed with surgical intervention will depend on the patient's specific clinical picture and potential risks associated with each choice.