LVAD EMERGENCIES - Dr. Erin Noste

 LVAD patient in ED = evaluate for (LVAD)2
 
L = Look, listen, and feel the LVAD device
- Look: Connection & controller, green light with no alarm = good sign
- Listen: For the hum of the LVAD, a quiet LVAD is BAD news
- Feel: Hot LVAD controller = BAD, could mean distal obstruction, dislodgment, thrombosis 
 
V = Venous Thromboembolism, Ventricle
- Venous Thromboembolism at greatest risk when INR < 1.5 with increased risk of TIA/Stroke and PE/DVT
- Pump Thrombosis Signs = LVAD is hot, working hard, high RPM, low flow, dilated RV/LV, Low MAP 
- Right Ventricle: Signs of Right Heart Strain, RV failure is VERY concerning for LVAD patients, consider right sided STEMI, PE
 
A = Anti-Coagulation, Arrhythmias 
- Anti-Coagulation: Bleeding risk from anti-coagulation and acquired von Willebrand syndrome (increased shear stress and decrease pulsatility of LVAD) = GI bleeds and head bleeds 
- Arrhythmias: check EKG on LVAD patients, can be in VF and still awake and talking, safe to defibrillate LVAD patient (if not emergent with consultation of LVAD team) 
 
D = Drive Line, Dehydration 
- Drive Line Infections: 40-60% of patients will develop an infection, also consider a deep pocket infection and obtain imaging to identify source of infection
- Dehydration: Very common in patients as they adjust to not having to be fluid restrictive, leading to increased risk of suction events and arrhythmias, LVADs love FLUID

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