UMEM Educational Pearls

Title: What's the Diagnosis?

Posted: 4/29/2013 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Question

57 year old male presents with a cough. The CXR is shown below. What's the diagnosis?

Answer

Answer: Left Ventricular Assist Device (LVAD)

An LVAD is a mechanical pump that pulls blood from the left ventricle and pumps it to the ascending aorta for systemic delivery; LVADs are increasingly being placed in patients with heart failure so you must be aware of them.

The three indications for an LVAD are:

Bridge to cardiac transplant
Temporizing measure when a reversible cardiac disease (e.g., myocarditis) exists
Destination therapy; patients ineligible for cardiac transplant who would otherwise die from heart failure

There are several models, which have been implanted in people (http://www.mylvad.com/lvad-devices). The main distinction between devices are pulsatile or non-pulsatile (or linear) flow; newer generation devices are non-pulsatile.

Patients with LVAD may develop complications such as infections, arrhythmias, or anemia, but bleeding can be a life-threatening one; bleeding occurs secondary to an acquired von Willebrand factor deficiency, AVMs within the GI tract, or secondary to over anti-coagulation (typically with Warfarin).

References

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