HEART FAILURE: LVAD AND CARDIOMEMS

Quick Review:
HFpEF HFrEF
Defined: Clinical HF symptoms, Diastolic _______ Clinical HF symptoms, ___Systolic____________
dysfunction, and normal EF (___≥50%_______) dysfuction, and LOW EF (_____<40%_________)
Presentation: Dyspnea, fatigue, orthopnea, JVD, rales, peripheral edema
Treatment: May use same classes as with HFrEF (no Beta blockers, ACE/ARB/ARNI, aldosterone
evidence to decrease mortality) antagonist, loop diuretics
Device?: CardioMEMS CardioMEMS
LVAD

CardioMEMS:
Only FDA-approved wireless heart failure monitor
 Detects changes in pulmonary artery pressure ,
 Reduced HF
which is an early _ sign of worsening heart failure
hospitalizations
 Claims it’s a “PROACTIVE approach to patient care
 Shorter hospital
 Implants a small pressure sensor during a right heart cath
 It is _ PERMANENT or TEMPORARY . stays
 No batteries required  Better QOL
 Patient blood pressure affects resonant frequency changes to
determine pulmonary artery pressure

What does pulmonary artery pressure tell us? Why do we care in

HF patients?

 ______________________________________________________________

1)
https://www.cardiovascular.abbott/us/en/hcp/products/
heart-failure/cardiomems-hf-system.html
2) https://www.daviddarling.info/encyclopedia/P/pulmonary_artery.html
 HEART FAILURE: LVAD AND CARDIOMEMS

Patient initiates a wireless

_ transmission of data to a website for
clinicians
Hand held device and pillow with
antenna
Only takes a few minutes
Allows patients to take an active part in
their
own care, possibly empower them to make
healthy, informed decisions

CHAMPION TRIAL

Who gets CardioMEMS?

 NYHA Class III_ heart failure

 Marked limitation in activity

due to symptoms, even
during less-than-ordinary
activity, e.g. walking short
distances (20—100 m).

 Comfortable only at rest

 HEART FAILURE: LVAD AND CARDIOMEMS

What is a drive line?

 __Cord that connect power to the device, runs from outside of body to the pump on the heart___

How does the power source work??

 Batteries: Has __TWO__ battery packs, unplug one at a time
 ALWAYS __ensure patient has a power source (charged batteries, don’t unplug both etc________

What does “Continuous flow system” mean?

 Goal MAP 70-80 mmHg (How do we get a blood pressure??) _ Doppler ultrasound probe and
sphygmomanometer (generally brachial)____

Medical Management
 Anticoagulation (WARFARIN)
o INR goal specific for device manufacturer
and patient (Typically INR 2-3 for HM2 and
Heartware)
Thrombu
 Heart Failure management
o Beta Blockers, ACE/ARB, aldosterone
s GI Bleed
antagonist, loops

What about CPR?

 _________________________________________________________________
 Defibrillate/AED
 HEART FAILURE: LVAD AND CARDIOMEMS

1. Feldman D, Pamboukian SV, Teuteberg JJ, et al. The 2013 International Society for Heart and Lung Transplantation
Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013 Feb;32(2):157-
87.
2. Borlaun BA, Colucci WS, Yeon SB. Clinical manifestations and diagnosis of heart failure with preserved ejection
fraction. UpToDate. Updated March 5, 2019. Accessed October 9, 2019.
3. Mancini D, Hunt SA, Leung L, et al. Practical management of long-term mechanical circulatory support devices.
UpToDate. Updated March 15, 2018. Accessed October 9, 2019.
4. CardioMEMS HF System. Abbott. https://www.cardiovascular.abbott/us/en/patients/living-with-your-
device/heart-failure/pulmonary-pressure-artery-monitoring/cardiomems-hf-system.html. Accessed October 9,
2019.