On 02/08/17 I was on 4SICU, the cardiothoracic intensive care unit, and my patient was D.B., a 60-year-old male. D.B. was on 4SICU because he had a heart transplant on 1/24/17. However, prior to and after his heart transplant, he had various multi-system physical disruptions. D.B. had ischemic cardiomyopathy with an ejection fraction of 25%. The normal ejection fraction lies somewhere between 55-75%. In 2010, the patient had an implantable cardioverter defibrillator (ICD) placed. In 2014, a ventricular assist device (VAD) was placed as a bridge to transplant. He was considered an urgent/acute case and moved to 1A on the transplant list. Unfortunately, was demoted down to status 7 due to bacteria, which was assumed to be line sepsis in October
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also had a history of chronic kidney disease; stage II, which causes impaired kidney function. This system is directly affected by the patient’s poor cardiac function. As we know, renal failure leads to fluid retention and electrolyte issues. As a patient with cardiac dysfunction, this causes increased stress on the heart. If the heart is already failing, or improperly functioning, further stress on the heart from fluid retention can lead to increased afterload and preload. Chronic kidney disease causes increased mortality in patients without cardiovascular disease, but even more so in these patients. As Ortiz et. al. discussed, there are “common risk factors for chronic kidney failure and mortality include diabetes, hypertension, overweight, atherosclerosis, lipid disorders, smoking, and possibly salt and phosphate intake” (2014). D.B. had many of these risk factors, which furthermore puts his cardiovascular system, as well as renal system, at risk. After the many complications that D.B. experienced after his transplant, it is imperative that the new heart be safeguarded by unnecessary stress. Fluid retention due to poor kidney function was evidenced by the patient’s +1 bilateral upper extremity and +3 bilateral lower extremity edema. His pulses were also difficult to palpate and his albumin level was also low at
also had a history of chronic kidney disease; stage II, which causes impaired kidney function. This system is directly affected by the patient’s poor cardiac function. As we know, renal failure leads to fluid retention and electrolyte issues. As a patient with cardiac dysfunction, this causes increased stress on the heart. If the heart is already failing, or improperly functioning, further stress on the heart from fluid retention can lead to increased afterload and preload. Chronic kidney disease causes increased mortality in patients without cardiovascular disease, but even more so in these patients. As Ortiz et. al. discussed, there are “common risk factors for chronic kidney failure and mortality include diabetes, hypertension, overweight, atherosclerosis, lipid disorders, smoking, and possibly salt and phosphate intake” (2014). D.B. had many of these risk factors, which furthermore puts his cardiovascular system, as well as renal system, at risk. After the many complications that D.B. experienced after his transplant, it is imperative that the new heart be safeguarded by unnecessary stress. Fluid retention due to poor kidney function was evidenced by the patient’s +1 bilateral upper extremity and +3 bilateral lower extremity edema. His pulses were also difficult to palpate and his albumin level was also low at