How do heart transplants change MI s/s?

[spenac]

This is a spin off of another thread about 12 lead and MI. Someone said many transplant patients do not know they are having an MI. So now I want to know more. Please help the students by giving more info. Thanks.

According to Rapid Interpretation of EKG's by Dale Dubin "transplant patients therefore have two SA nodes, each producing P waves."

What other changes are noticed? What should we expect or look for?

[AZCEP]

The major differences will depend on the type of transplant the patient has received. Some will have only ventricular tissue grafted into the existing heart. Others will have the entire heart replaced.

Single SA node with dual ventricular activation is pretty common. With a full replacement, the heart is no longer innervated so they typically won't respond to the vagal stimulation that comes with inferior wall events. They will still respond to the release of adrenergic hormones, but anti-cholinergic drugs won't have much of an effect.

[Off Label]

The major differences will depend on the type of transplant the patient has received. Some will have only ventricular tissue grafted into the existing heart. Others will have the entire heart replaced.

 

Single SA node with dual ventricular activation is pretty common. With a full replacement, the heart is no longer innervated so they typically won't respond to the vagal stimulation that comes with inferior wall events. They will still respond to the release of adrenergic hormones, but anti-cholinergic drugs won't have much of an effect.

The cardiac transplant patient won't feel the pain of ischemia for the same reason anticholinergics don't work. The nerves are cut. Direct acting sympathomimetics work because of the receptors present on the transplanted heart.

Further, cardiac transplant patients have a higher resting heart rate, so 90 is normal for them. Two P waves, one from the native atrial remnant and one from the graft, can be seen as well.