Heart Transplant

The Heart

Different types of heart disease.

Heart disease encompasses a wide range of cardiovascular problems. Several diseases and conditions fall under the category of heart disease. The term cardiovascular disease may be used to refer to heart conditions that specifically affect the blood vessels.

Types of heart disease include:

Arrhythmias are abnormal heart rhythms. The symptoms you experience may depend on the type of arrhythmia you have — heartbeats that are too fast or too slow. Symptoms of an arrhythmia include:

  • lightheadedness

  • fluttering heart or racing heart beat

  • slow pulse

  • fainting spells

  • dizziness

  • chest pain

Atherosclerosis reduces blood supply to your extremities. In addition to chest pain and shortness of breath, symptoms of atherosclerosis include:

  • coldness, especially in the limbs

  • numbness, especially in the limbs

  • unusual or unexplained pain

  • weakness in your legs and arms

Congenital heart defects are heart problems that develop when a fetus is growing. Some heart defects are never diagnosed. Others may be found when they cause symptoms, such as:

  • blue-tinged skin

  • swelling of the extremities

  • shortness of breath or difficulty breathing

  • fatigue and  energy

  • irregular heart rhythm

CAD is plaque buildup in the arteries that move oxygen-rich blood through the heart and lungs. Symptoms  include:

  • chest pain or discomfort

  • a feeling of pressure or squeezing in the chest

  • shortness of breath

  • nausea

  • feelings of indigestion or gas

Cardiomyopathy is a disease that causes the muscles of the heart to grow larger and turn rigid, thick, or weak. Symptoms of this condition include:

  • fatigue

  • bloating

  • swollen legs, especially ankles and feet

  • shortness of breath

  • pounding or rapid pulse

  • Several types of cardiomyopathy exist. Each type is the result of a separate condition.

  • Dilated cardiomyopathy. It’s unclear what causes this most common type of cardiomyopathy, which leads to a weakened heart. It may be the result of previous damage to the heart, such as the kind caused by drugs, infections, and heart attack. It may also be an inherited condition or the result of uncontrolled blood pressure.

  • Hypertrophic cardiomyopathy. This type of heart disease leads to a thicker heart muscle. It’s usually inherited.

  • Restrictive cardiomyopathy. It’s often unclear what leads to this type of cardiomyopathy, which results in rigid heart walls. Possible causes may include scar tissue buildup and a type of abnormal protein buildup known as amyloidosis.

The term heart infection may be used to describe conditions such as endocarditis  or myocarditis  Symptoms of a heart infection include:

  • chest pain

  • chest congestion or coughing

  • fever

  • chills

  • skin rash

  • Bacteria, parasites, and viruses are the most common causes of heart infections. Uncontrolled infections in the body can also harm the heart if they’re not properly treated.

Are you at risk?

  • being overweight

  • being inactive

  • smoking tobacco

  • eating a high-fat, high-sodium, and high-carbohydrate diet

  • having diabetes mellitus

  • having high blood pressure

  • having high cholesterol

  • having a family history of heart disease

  • Family History

Male relative under 55 years old, such as a father or brother

Female relative under 65 years old, such as a mother or sister

  • Ethnicity

Heart disease is the leading cause of death for men of most racial/ethnic groups in South Africa

heart disease is second only to cancer.

  • Sex

Men are at greater risk for heart disease than women. In fact, the estimates are between 70 and 89 percent of all cardiac events in the South Africa occur in men.

  • Age

Your age can increase your risk for heart disease. From ages 20 to 59, men and women are at a similar risk.

After age 60, however, the percentage of men affected rises to between 20 and 30 percent. Only 10 to 20 percent of women that age are affected.

A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that’s usually reserved for people who have tried medications or other surgeries, but their conditions haven’t sufficiently improved,

While a heart transplant is a major operation, your chance of survival is good, with appropriate follow-up care.

When faced with a decision about having a heart transplant, know what to expect of the heart transplant process, the surgery itself, potential risks and follow-up care.

Heart transplants are performed when other treatments for heart problems haven’t worked, leading to heart failure. In adults, heart failure can be caused by several conditions, including:

A weakening of the heart muscle (cardiomyopathy) Coronary artery disease Heart valve disease A heart problem you’re born with (congenital heart defect)Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other treatments Amyloidosis Failure of a previous heart transplant

In children, heart failure is most often caused by either a congenital heart defect or a cardiomyopathy.

Another organ transplant may be performed at the same time as a heart transplant (multiorgan transplant) in people with certain conditions at select medical centers. Multiorgan transplants include:

Heart-kidney transplant. This procedure may be an option for some people with kidney failure in addition to heart failure.

Heart-liver transplant. This procedure may be an option for people with certain liver and heart conditions.

Heart-lung transplant. Rarely, doctors may suggest this procedure for some people with severe lung and heart diseases, if the conditions aren’t able to be treated by only a heart transplant or lung transplant.

A heart transplant isn’t the right treatment for everyone. Certain factors may mean you’re not a good candidate for a heart transplant. While each case is considered individually by a transplant center, a heart transplant may not be appropriate if you:

Are an advanced age that would interfere with the ability to recover from transplant surgery. Have another medical condition that could shorten your life, regardless of receiving a donor heart, such as a serious kidney, liver or lung disease. Have an active infection Have a recent personal medical history of cancer. Are unwilling or unable to make lifestyle changes necessary to keep your donor heart healthy, such as not drinking alcohol or not smoking

For some people who can’t have a heart transplant, another option may be a ventricular assist device (VAD). A ventricular assist device is a mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body.

VADs are commonly used as a temporary treatment for people waiting for a heart transplant. These devices are increasingly being used as a long-term treatment for people who have heart failure but aren’t eligible for a heart transplant. If a VAD doesn’t help your heart, doctors may sometimes consider a total artificial heart — a device that replaces the ventricles of your heart — as an alternative short-term treatment while you’re waiting for a heart transplant.

Heart transplant surgery requires open heart surgery, which carries the risk of many complications, including:

Bleeding, Infection, Blood clots ,Heart attack,Stroke and Death

Risks of having a heart transplant

Although receiving a donor heart can save your life, having a heart transplant has many risks. Risks include:

Rejection of the donor heart. One of the most significant risks after a heart transplant is your body rejecting the donor heart.

Your immune system will see your donor heart as a foreign object that’s not supposed to be in your body. Your immune system will try to attack your donor heart. Although all people who receive a heart transplant receive immunosuppressants — medications that reduce the activity of the immune system — about 10 percent of heart transplant recipients still have some signs of rejection that need treatment during the first year after transplantation. This is often effectively treated with medication.

Usually the rejection is without any symptoms and requires only an adjustment of medications. If you miss doses of medications, however, the rejection can be severe and very serious. It’s important that you follow the instructions as explained by your doctors.

To determine whether your body is rejecting the new heart, you’ll have frequent heart biopsies to test your heart tissue during the first year after your transplant. After the first year, the number of biopsies is significantly reduced.

Problems with your coronary arteries.After your transplant, it’s possible the walls of the arteries in your heart (coronary arteries) could thicken and harden, leading to cardiac allograft vasculopathy (CAV). This can make blood circulation through your heart difficult and can cause a heart attack, heart failure, abnormal heart rhythms (arrhythmias) or sudden cardiac death.

Your doctor may recommend annual tests after your transplant to monitor your coronary arteries for CAV.

The immunosuppressants you’ll need to take for the rest of your life may cause kidney damage and other problems. Other complications of these medications can include high blood pressure, high cholesterol, diabetes and a condition in which your bones become thin and weak (osteoporosis).Cancer. Immunosuppressants can also increase your cancer risk. Taking these medications can put you at a greater risk of skin cancer, non-Hodgkin’s lymphoma and other solid tumors. Regular checkups are necessary to detect the development of cancer.Infection. Immunosuppressants decrease your ability to fight infection. Some heart transplant recipients may develop an infection that requires them to be admitted to the hospital during the first year after their transplant. The risk of infection decreases over time as the amount of immunosuppressant medication is decreased.

Preparations for a heart transplant often begin long before the surgery to place a transplanted heart. You may begin preparing for a heart transplant weeks, months or years before you receive a donor heart, depending upon the waiting time for transplant.

If your doctor recommends that you consider a heart transplant, you’ll likely be referred to a heart transplant hospital for an evaluation. Check with your medical aid provider to see which transplant hospitals are covered under your medical plan.

Also consider additional services that may be provided by a transplant center. Many centers may coordinate support groups, assist with your recovery period or direct you to organizations that can help with these concerns.

You’ll need to have an evaluation to see if you’re eligible for a transplant. During an evaluation, your doctors and transplant team will conduct a physical examination, order several tests, and evaluate your mental and emotional health. The evaluation will check to see if you:

Have a heart condition that would benefit from transplantation,

Might benefit from other less aggressive treatment options.

Are healthy enough to undergo surgery and post-transplant treatments.

Will agree to quit smoking, if you smoke Are willing and able to follow the medical program outlined by the transplant team.

Can emotionally handle the wait for a donor heart.

Have a supportive network of family and friends to help you during this stressful time

Your transplant team will also discuss with you the benefits and risks of a transplant and what to expect before, during and after a transplant.

If the transplant team determines that you’re a candidate for a heart transplant, the transplant center will register you on a waiting list. At any given time, there are hundreds of people in South Africa. waiting for heart transplants. Unfortunately, there aren’t enough hearts for every person in need, and some people die while waiting for a transplant.

While you’re on the waiting list, your medical team will closely monitor your condition and alter your treatment as needed. Your transplant team may temporarily remove your name from the waiting list if you develop a significant medical condition, such as a severe infection or stroke, which makes you temporarily unable to have a transplant while you recover.

Your doctors may recommend that you participate in a cardiac rehabilitation program while you wait for a donor heart. Cardiac rehabilitation is a program of exercise and education designed to help improve your health before and after your heart transplant.

If medical therapy fails to support your vital organs as you wait for a donor heart, your doctors may recommend you have a device implanted to support your heart while you wait for a donor organ, such as a ventricular assist device (VAD). These devices are also referred to as a bridge to transplant because they stabilize your condition until a donor heart is available.

Medical urgency of potential recipients Blood type (A, B, AB or O) Antibodies the recipients may have developed.

Size of the donor ,

Time spent on the waiting list

Immediately before your transplant surgery

A heart transplant usually needs to occur within four hours of organ removal for the donor organ to remain usable. As a result, hearts are offered first to a transplant center close by, then to centers within certain distances of the donor hospital.

Doctors and staff can receive donor organs from other locations and transport them to prepare them for transplantation.

You’ll need to remain in close contact with the transplant team and let them know if you have any changes to your health. Make sure the transplant center has phone numbers to be able to contact you anytime. The transplant center needs to be able to reach you 24 hours a day.

When you’re notified that a potential organ is available, you and your transplant team have a limited amount of time to consider whether to accept the donation. You’ll be expected to travel to the transplant hospital immediately after being notified of the potential donation. You’ll usually need to be prepared to get to the hospital within three hours.

As much as possible, you should generally make travel plans ahead of time. Some heart transplant centers provide private air transportation or other travel arrangements. Have a suitcase packed with everything you’ll need for your hospital stay, as well as an extra 24-hour supply of your medications.

Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor heart is suitable for you and if you’re ready to have surgery. If your doctors and transplant team decide that the donor heart isn’t appropriate for you or surgery isn’t appropriate for you, you may not be able to have the transplant.

Cardiac surgeons work with a team to perform heart transplant surgery.

Heart transplant surgery is an open heart surgery that takes several hours. If you’ve had previous heart surgeries, the surgery is more complicated and will take longer. You’ll receive medication that causes you to sleep (general anesthesia) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.

In this procedure, your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart.

Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly.

You’ll be given medication to help with pain after the surgery. You’ll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you’ll also receive fluids and medications through intravenous (IV) tubes.

After you’ve had surgery to place your donor heart, you’ll stay in the intensive care unit (ICU). You’ll generally be moved to a regular hospital room after a few days in the ICU, and you’ll usually remain in the hospital for a week or two. The amount of time you’ll spend in the ICU and in the hospital can vary.

After you leave the hospital, you’ll be closely monitored at your outpatient transplant center by your transplant team. Due to the frequency and intensity of the monitoring, many people stay close by the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and it’s easier to travel back and forth for follow-up visits.

You’ll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It’s important to let your transplant team know if you notice any signs or symptoms of rejection or infection.

After your heart transplant, you’ll have several follow-up appointments at the transplant center. You’ll have regular tests, including blood work, echocardiograms, electrocardiograms and heart biopsies.

To determine whether your body is rejecting the new heart, you’ll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time.

During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. A doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.

Taking immunosuppressants. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. Because your immune system will most likely never completely accept the new organ, you’ll take some of these medications for the rest of your life.

Immunosuppressant medications may cause noticeable side effects. For example, when taking post-transplant drugs such as corticosteroids, your face may become round and full, and you may gain weight, develop acne or facial hair, or experience stomach problems. Some side effects of immunosuppressant drugs may be more noticeable when you first start the drugs, but they may decrease in severity over time.

Because immunosuppressants make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.

Some immunosuppressants could also worsen conditions — or raise your risk of developing conditions — such as high blood pressure, high cholesterol, cancer, osteoporosis or diabetes.

Over time as the risk of rejection is reduced, the doses and number of anti-rejection drugs can be reduced, but you’ll need some immunosuppressant medications indefinitely.

Managing medications, therapies and a lifelong care plan. After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan is important.

Your doctor may give you specific instructions regarding lifestyle guidelines, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection in daily life.

Follow all of your doctor’s instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have any signs or symptoms of complications.

It’s a good idea to set up a daily routine for taking your medications so that you won’t forget. Keep a list of all your medications with you at all times in case you need emergency medical attention, and tell all your doctors what you take each time you’re prescribed a new medicine.

Cardiac rehabilitation programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Staff members trained in cardiac rehabilitation may help you adjust to healthy lifestyle changes — such as regular exercise and a heart-healthy diet — after your transplant.

Your transplant team may also suggest that you begin a cardiac rehabilitation program prior to your transplant to improve your health.

Emotional support. Your new medical therapies and the stress of having a heart transplant may make you feel overwhelmed. Many people who have had a heart transplant feel this way.

Talk to your doctor if you’re feeling stressed or overwhelmed. Transplant centers often have support groups and other resources to help you manage your condition.

Most people who receive a heart transplant enjoy a high quality of life. Depending on your condition, you may be able to return to many of your daily life activities, such as returning to work, participating in hobbies and sports, and exercise. Discuss with your doctor what activities are appropriate for you.

Some women who have had a heart transplant can become pregnant. However, discuss with your doctor if you’re considering having children after your transplant. You’ll likely need medication adjustments before becoming pregnant, as some medications can cause pregnancy complications.

Heart transplant recipient survival rates vary based on a number of factors. A report by the Organ Procurement and Transplantation Network stated that the overall survival rate in South Africa. is about 88 percent after one year and about 75 percent after five years.

Heart transplants aren’t successful for everyone. Your new heart may fail because of organ rejection or because of the development of heart valve disease or coronary artery disease. Should this happen, your doctor may recommend adjusting your medications or in more serious cases, another heart transplant.

In some cases, additional treatment options are limited, and you may choose to stop treatment. Discussions with your heart transplant team, doctor and family should generally address your expectations and preferences for treatment, emergency care and end-of-life care.

Explore testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

It’s normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Seeking the support of friends and family members can help you cope during this stressful time.

Your transplant team can assist you with other useful resources and coping strategies throughout the transplant process, such as:

Joining a support group for transplant recipients. Talking with others who have shared your experience can ease fears and anxiety.

Sharing your experiences on social media. to helping transplant recipients and donors connect to each other online.

Setting realistic goals and expectations. Recognize that life after transplant may not be exactly the same as life before transplant. Having realistic expectations about results and recovery time can help reduce stress.

Educating yourself. Read as much as you can about your procedure and ask questions about things you don’t understand. Knowledge is empowering.

Researchers study medications and treatments for people with heart transplants, including new medications (immunosuppressant medications) to keep your body from rejecting your heart transplant.

In the past, people with heart transplants usually took corticosteroids (prednisone, others) and other immunosuppressant medications for life to prevent rejection. However, corticosteroids may cause many side effects and complications such as weight gain, diabetes, high blood pressure and osteoporosis.

You may be able to reduce or stop taking corticosteroids at some time after your heart transplant, which may lessen your side effects and complications. You’ll still need to take other immunosuppressant medications.

Researchers also study lowering the dose of immunosuppressant medications, such as calcineurin inhibitors, to reduce complications such as kidney function problems.

Doctors may prescribe an immunosuppressant called sirolimus (Rapamune) for some people who have had heart transplants. Doctors may recommend some people use sirolimus instead of calcineurin inhibitors. If used with calcineurin inhibitors, the dose of the calcineurin inhibitors is usually reduced, or may be discontinued.

Sirolimus may help slow the progress of kidney problems or improve kidney function. This medication may also help slow or prevent the progress of a disease that can occur after a heart transplant called cardiac allograft vasculopathy. In this disease, the walls of the arteries in your heart (coronary arteries) thicken and harden, which can cause limited blood flow through your heart.

Other immunosuppressant medication options that have increased in use for people with heart transplants include basiliximab (Simulect), anti-thymocyte globulin, rabbit (Thymoglobulin), mycophenolate mofetil (CellCept) and mycophenolic acid (Myfortic).

After your heart transplant, you may need to adjust your diet to keep your heart healthy and functioning well. Maintaining a healthy weight through diet and exercise can help you avoid complications such as high blood pressure, heart disease and diabetes.

Your transplant team includes a nutrition specialist (dietitian) who can discuss your nutrition and diet needs and answer any questions you have after your transplant.

Your dietitian will provide you with several healthy food options and ideas to use in your eating plan. Your dietitian’s recommendations may include:

Eating plenty of fruits and vegetables each day Eating whole-grain breads, cereals and other grains Drinking low-fat or fat-free milk or eating other low-fat or fat-free dairy products, to help maintain enough calcium in your body Eating lean meats, such as fish or poultry Maintaining a low-salt diet Avoiding unhealthy fats, such as saturated fats or trans fats Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppressant medications (calcineurin inhibitors)Avoiding excessive alcohol Staying hydrated by drinking adequate water and other fluids each day Following food safety guidelines to reduce the risk of infection

Exercise

After your heart transplant, your doctor and treatment team may recommend that you make exercise and physical activity a regular part of your life to continue to improve your overall physical and mental health.

Exercising regularly can help you control your blood pressure, reduce stress, maintain a healthy weight, strengthen your bones and increase your physical function.

Your local health and fitness consultant can create an exercise program designed to meet your individual needs and goals. You’ll participate in cardiac rehabilitation to help improve your endurance, strength and energy. Cardiac rehabilitation incorporates education and exercise to help you improve your health and recover after your heart transplant.

Your exercise program may include warm-up exercises such as stretching or slow walking. Your treatment team may suggest physical activities such as walking, bicycling and strength training as part of your exercise program. Specialists in the treatment team will likely recommend you cool down after you exercise, perhaps by walking slowly. Discuss with your treatment team what activities may be appropriate for you.

Take a break from exercising if you feel tired. If you feel symptoms such as shortness of breath, nausea, irregular heart rate or dizziness, stop exercising. If your symptoms don’t go away, contact your doctor right away.

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