A 60-Year-Old Man Is Admitted for End-Stage Heart Failure and Is

question 526

Multiple Choice

A 60-year-old man is admitted for end-stage heart failure and is being considered for a left ventricular assistance device (LVAD) as a bridge to cardiac transplantation.  The patient has a history of 3 myocardial infarctions and a low ejection fraction secondary to ischemic cardiomyopathy.  He is informed that when an LVAD is used for this purpose the recipient must meet eligibility criteria for transplantation.  He has no other medical conditions and appears to meet the medical criteria for LVAD and heart transplant.  The patient has a history of major depressive disorder and attempted suicide in his late 20s.  He also has a history of alcohol abuse.  He has no current depressive symptoms and states that he has not used alcohol "to excess" in the past 6 months.  The patient lives alone and has no close family except for a niece who visits occasionally.  He has been homeless in the past but not recently.  Mental status examination shows the patient to be cognitively intact; his stated mood is "scared" and his affect is full range and appropriate.  His thought process is linear and his thought content shows no delusions.  The patient has no hallucinations or suicidal ideation.  Based on these findings, which of the following statements is most accurate regarding the determination of this patient's eligibility for heart transplantation?

• A)Eligibility determination requires further evaluation of alcohol use and psychosocial supports
• B)The patient is an appropriate candidate provided he receives alcohol abuse treatment
• C)The patient is an appropriate candidate provided he takes antidepressant medication
• D)These findings cannot be considered in the decision to offer this patient a transplant
• E)These findings exclude the patient from transplantation

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