Heart Transplant, Asthma & Pulmonary Hypertension

Heart Transplants

A heart transplantation is the replacement of a diseased or injured heart with a healthy heart from a donor (Rizzo & Spiwak 2004). It is performed at end-stage heart failure or another art condition. All possible treatments to correct the condition are resorted to thoroughly before heart transplantation is decided on. The goal is to extend and improve the patient’s life without which he will die of heart failure. Most patients who undergo heart transplantation are too sick to live a normal life before the procedure. It is only when his heart is replaced that he may be able to return to his normal daily activities (Rizzo & Spiwak).

Age, sex, race or ethnicity is not a consideration when seeking or needing heart transplantation (Rizzo & Spiwak 2004). In 1999, it was performed on patients with coronary artery disease, cardiomyopathy, congenital diseases and re-transplantation because of organ rejection. These patients exhibited cardiomegaly, severe dyspnea and peripheral edema. Even now, adults with end-stage heart failure comprise 90% of all recipients of heart transplants. The remaining 10% are children, 50% of them below 5. In the U.S., 73% of recipients are male, 77% white and 51% aged 50-64. Because of the short supply of healthy donor hearts, strict rules are followed on who should receive them. Those who are diagnosed as too sick to survive the surgery or the side effects on immune suppressive therapy may not be selected. Other disqualifications are active infection; pulmonary hypertension; chronic lung disease with a loss of more than 40% of the lung function; untreatable liver or kidney disease; diabetes, which has damaged vital organs; disease of the blood vessels in the brain, such as stroke; disease of the arteries; mental illness; and continuing alcohol or drug abuse (Rizzo & Spiwak).

A patient with end-stage heart disease, which is unresponsive to medical treatment, generally qualifies for heart transplantation (Rizzo & Spiwak 2004). He undergoes a complete medical examination before being placed in the waiting list. The examination includes blood tests, x-rays, and heart, lung and other organ function examinations. The results of these tests will reveal the seriousness of the heart disease and if the patient is healthy enough to survive the transplant surgery (Rizzo & Spiwak).

Racial Disparity

Studies found that the survival rates of cardiac transplantation were race-dependent

(Flattery & Baker 2004). Caucasians had better chances of survival than African-

Americans. Physiological differences appeared to be a factor. African-Americans developed heart disease and other diseases at an early age and had longer hospitalizations than Caucasians with the same illness. This implied that outpatient resources were under-utilized and that limited patient education. African-Americans tended to seek treatment in big tertiary care centers and without health insurance. Other studies suggested that the disparity could be reduced or eliminated by specialized comprehensive care (Flattery & Baker).

Gallstone Disease

Cardiac transplant recipient stands a high risk of developing gallstone disease, according to a study (Richardson et al. 2003). Compared with the general population, the recipient is likelier to develop de novo cholelithiasis before and after transplantation, according to studies. To offset the risk, pre-transplant cholecystectomy should be performed if the allograft functions properly and acute cholecystitis has not developed

(Richardson et al.).

Asthma

This is a chronic inflammation of the bronchial tubes or airways, which induces swelling and constriction of the airways (Szeftel and Schiffman 2008). Breathing becomes difficult. The bronchial tubes become very sensitive to allergens or irritants. This condition is called “bronchial hyper-reactivity.” Asthma has different effects on those afflicted with it. Each reacts uniquely to environmental triggers and stimuli. This, in turn, determines the type and dose of medication, which is again highly individualized (Szeftel & Schiffman).

Asthma is now considered the most common chronic ailment in children (Szeftel & Schiffman 2008). One in every 15 American children and 5% of American adults are stricken with asthma. Latest statistics say that approximately 1 million Canadians and 15 million Americans have it. New cases and yearly hospitalizations for asthma have gone up by about 30% in the past two decades. With every scientific and technological advance in treatment, deaths from asthma among the young rise at more than double the rate. Records reveal that 5,000 die annually from asthma in the U.S. And 500 in Canada (Szeftel & Schiffman).

Inflammation is the central issue about asthma (Szeftel & Schiffman 2008). In the case of injury or infection, blood moves to the affected part to fight the invader. Inflammation disappears when healing occurs. But in asthma, the inflammation does not resolve completely. Hence, the person experiences recurrence of asthmatic attacks, which can make the thickening of the bronchial walls permanent. The narrowing of the bronchial tubes can become irreversible and unresponsive to medication. The goals of treatment are to control airway inflammation and reduce reactivity and to prevent the thickening of the airways (Szeftel & Schiffman).

Common allergens are seasonal pollens; dust mites, molds, pets and parts of insects; certain foods; additives; and s or agents in the workplace, such as latex (Szeftel & Schiffman 2008). Health reports revealed that approximately 80% of children and 50% of adults with asthma also have allergies. Irritants include respiratory infections; drugs; tobacco smoke; indoor or outdoor items or factors; gastro-esophageal reflux; exercise in cold conditions; work-related items; emotional and hormonal conditions. The most commonly recognized symptoms are shortness of breath, wheezing, coughing and tightness in the chest (Szeftel & Schiffman).

Some studies linked second-hand tobacco smoke and the development of asthma in a child (Vork et al. 2007). To clear doubts, a new study reviewed literature between

1970 and 2005. It found that second-hand smoke could be a bigger culprit in childhood asthma than previously thought. A clearer understanding of the mechanism of second-hand smoke will help authorities come up with more responsive public health interventions (Vork et al.).

Asthma during Pregnancy

Women with uncontrolled asthma are at a high risk for pregnancy complications and fetal abnormalities (Yawn & Knudtson 2007). Findings and guidelines drawn from recent studies recommended medical treatment for pregnant women with asthma. The Asthma and Pregnancy Working Group of the National Asthma Education and Prevention Program said that the treatment should cover co-morbid allergic rhinitis. Allergic rhinitis triggers or aggravates asthma symptoms (Yawn & Knudtson).

Pulmonary Hypertension

This is an acute or chronic and mysterious condition of elevated pressure in the pulmonary ventricles (Albert 1999). Nothing explains it. It eventually leads to pulmonary heart disease, characterized by right ventiicular hyperthrophy, dilation and heart failure. Pulmonary artery pressure goes up and prevents the right ventricle from emptying. As the condition gets worse, the right ventricle fails, cardiac output falls and there is shortness of breath with other symptoms during activity or at rest. The ailment has five categories, namely disease of the left side of the heart, the large left-to-right shunts, thomboembolic hypozia, parenchumal lung disease and idiopathic pulmonary hypertension. Recognizable signs and symptoms are dyspnea upon exertion, angina, syncope, hypoxemia during rest, edema, ventricular gallop, and fatigue (Albert).

The early stage is virtually asymptomatic (Albert 1999). Physiologic changes eventually occur, such as syncope, hemoptysis, and right-sided heart failure at slight exertion or during rest. Changes of recovery and cure depend on the cause and type. If recognized and treated early, pulmonary hypertension may resolve. The chances are poor if the person exhibits heart failure with minimal exercise or at rest or if the right atrial pressure is more than 15m Hg; the mean pulmonary artery pressure is more than 15 mm Hg; the mean pulmonary artery pressure is higher than 60 mm Hg and the cardiac index falls below2 litters per minute. Right-sided heart failure or ischemia, pulmonary embolus, hemorrhage or ventricular tachycardia or fibrillation from hypoxemia and acidosis may be fatal. When the condition no longer responds to medical treatment, lung transplant is recommended as the last resort. Those suffering from severe cardiomyopathy and pulmonary hypertension require a heart and lung transplant (Albert).

Treatments

The American College of Chest Physicians came up with updated guidelines for the treatment of pulmonary arterial hypertension (Badesch et al. 2007). At the same time, add-on and combination therapy continued to be explored for their therapeutic value. The choice of therapy should be made in the light of the patient’s specific situation. But diagnostic evaluation, the search for underlying causes and contributing factors cannot be eliminated. For its part, education proved to be a fundamental element during the initiation of therapy. It improved the recognition and appreciation of pulmonary arterial hypertension. Ultimately, it contributes to the overall results. And in view of complex diagnostic evaluations required and the available treatment options, patients with pulmonary arterial hypertension should be referred to specialized centers. In the meantime, controlled clinical trials should come up with more responsive treatment options (Badesch et al.).

Effects of Pulmonary Angiography

The effects of this procedure were tested on 612 volunteers with moderate PAH at

77% and severe PAH at 23% (Hofman et al. 2004). Results of the tests showed that complications with the use of pulmonary angiography were low. Its use on those with acute PAH should be performed with caution. The complication rate was observed at 2%

in patients with acute PAH. The use of the procedure was deemed relatively safe for chronic pulmonary arterial hypertension. Severely ill patients should be subjected to non-invasive imaging method exhaustively before resorting to pulmonary angiography (Hofman et al.).#

BIBLIOGRAPHY

Albert, Nancy M. Caring for Patients with Pulmonary Hypertension. Nursing:

Springhouse Corporation, May 1999. Retrieved on April 25, 2009 from http://findarticles.com/p/articles/mi_qa3689/is_199905/ai_n8846566/?tag=content;col1

Badesch, David, et al. Medical Therapy for Pulmonary Arterial Hypertension.

131 (6). Chest: American College of Chest Physicians, July 20, 2007. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/560041

Flattery, Maureen P. And Kathy M. Baker. Evidence for Racial Disparity in Cardiac

Transplantation Survival Rates. Journal of Cultural Diversity: Tucker Publications,

March 22, 2004. Retrieved on April 26, 2009 from http://findarticles.com/p/articles/mi_m)MJU/is_1_11/ai_n6183827/?tag=content;col1

Hofman, Lawrence V., et al. Safety and Hemodynamic Effects of Pulmonary

Angiography in Patients with Pulmonary Hypertension: 10-Year Single-Center

Experience. 183 (3). American Journal of Roentgenology: American Roentgen Ray

Society, September 21, 2004. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/488868

Richardson, William S., et al. Gallstone Disease in Heart Transplant Recipients. 237 (2)

Annals of Surgery: Lippincott Williams & Wilkins, February 11, 2003. Retrieved

on April 25, 2009 from http://www.medscape.com/viewarticle/448919

Rizzo, Toni and Allison J. Spiwak. Heart Transplantation. Gale Encyclopedia of Surgery:

Gale Group, 2004. Retrieved on April 25, 2009 from http://findarticles.com/p/articles/mi_gx5198/is_2004/ai_n19119801/?tag=content;col1

Szeftel, Alan and George Schiffman. Asthma. MedicineNet: MedicineNet.co., 2008.

Retrieved on April 25, 2009 from http://www.medicinenet.co.uk/script/main/art.asp?articlekey=284

Vork, Kathleen L., et al. Developing Asthma in Children from Exposure to Secondhand

Tobacco Smoke: Insights from a Meta-Regression. Environmental Health

Perspectives: Medscape, October 25, 2007. Retrieved on April 25, 2009 from http://www.medscape.com/viewarticle/564240

Yawn, Barbara and Mary Knudtson. Treating Asthma and Comorbid Allergic Rhinitis in Pregnancy: a Review of the Current Guidelines. Journal of American Board of Family Medicine: American Bord of Family Medicine, June 26, 2007

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