Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 151: A 55-Year-Old with Cardiac Amyloid
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Jun 19, 2025 Discover the fascinating case of a 55-year-old woman battling trans-thyretin amyloid cardiomyopathy. Learn about the evolving history and recent advancements in cardiac transplantation that have significantly increased survival rates. Explore the stringent eligibility requirements for candidates with cardiac amyloidosis, as well as the challenges of organ availability. Gain insights into donor heart allocation urgency and the surgical techniques involved, including potential postoperative complications and overall success rates.
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Amyloid Not Contraindication
- Cardiac amyloid is not a contraindication for transplantation.
- Inpatient status, including on inotropic therapy, can elevate transplant candidacy priority.
Heart Allocation Prioritizes Urgency
- Donor heart allocation is based on urgency, wait time, and distance to recipient.
- Hospitalized critical patients on ECMO or inotropes get higher priority than stable outpatients.
Denervated Heart Resists Atropine
- The transplanted heart is surgically denervated and doesn't respond to autonomic stimuli.
- Atropine is ineffective for post-operative bradycardia after cardiac transplantation.