This case comes to us from Drs. Chris Ding, Jane Kim, Jessica Stetz, and Sigrid Wolfram of SUNY Downstate/Kings County Hospital Centre.
Dr. Ding completed emergency medicine residency at SUNY Downstate/Kings County Hospital in Brooklyn, NY. He is an avid proponent of simulation education and is completing a Simulation Fellowship at the University of Chicago-NorthShore University Health System. His interests include low resource EM simulation, medical device education, 3D printing, and task trainer development.
WHY IT MATTERS
LVADs are an increasingly common treatment modality for severe heart failure, whether as bridge-to-transplant or destination therapy. While many LVAD patients are followed at tertiary care centers with dedicated LVAD teams, ED physicians may play a key role in the detection and treatment of complications from these devices regardless of practice setting. One of the most feared complications is pump thrombosis, which can have a wide range of presenting symptoms and degrees of severity. This case aims to increase awareness of this condition among ED residents and familiarize them with the initial assessment of patients with potential complications from LVADs.
CLINICAL VIGNETTE
70 y/o male with CHF, an ICD, and an LVAD presents with 3 days of shortness of breath on exertion and bilateral leg swelling.
CASE SUMMARY
A 70 y/o male post LVAD implantation presents to the emergency department with a chief complaint of shortness of the breath. The team will need to progress through the initial assessment of an LVAD patient, ultimately leading to a diagnosis of pump thrombosis. They will initiate anticoagulation, consult cardiothoracic surgery, and admit to CTICU.
EM Sim Cases 