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cardiac allograft vasculopathy
Etiology:
- complication of cardiac transplantation
Epidemiology:
- occurs in > 50% of patients within 5 years
Pathology:
- represents diffuse intimal hyperplasia rather than focal coronary artery stenosis
Clinical manifestations:
- uncommon to present as chest pain because of lack of cardiac innervation
- syncope
- new heart failure symptoms
- dyspnea on exertion
- heart block
Special laboratory:
- routine ECG to assess
- silent ischemia/infarction
- heart block
- dobutamine echocardiography generally unreliable
Radiology:
- coronary angiography is generally method of choice
- intracoronary vascular ultrasonography may be better than angiography
Complications:
- post-transplant coronary artery disease (CAD) is the primary cause of death >1 year after transplant
- most common cause of heart failure in cardiac transplant patients
Management:
- percutaneous coronary intervention may be considered but does not address the diffuse nature of the vasculopathy
- retransplantation is only treatment for multivessel disease
General
vascular disease (vasculopathy)
heart disease (cardiac disease)
References
- Medical Knowledge Self Assessment Program (MKSAP) 16.
American College of Physicians, Philadelphia 2012
- Schmauss D, Weis M.
Cardiac allograft vasculopathy: recent developments.
Circulation. 2008 Apr 22;117(16):2131-41
PMID: 18427143