8^th Global Cardiologists and Echocardiography Annual Meeting

Biography

Biography: Noemi Csaszar-Nagy

Abstract

There are increasing number of patients needing medical care for medication resistant, chronic cardiac failure. Heart transplantation is a multidisciplinary area, where cooperation of well-organized professional team is required in every stage of the procedure. Patient suitability is a crucial point in transplantation; adequate patient selection is therefore a key stage regarding long-term success. Evaluation of suitability for heart transplantation must be carried out in the following domains: 1. Severity of heart disease and prognosis for conservative treatment 2. Overall health of other organs and organ systems. Is general condition of the patient sufficient enough to tolerate surgical stress and the side effects of prolonged immunosuppressive treatment? Is there any comorbidity influencing chance of survival or endangering the new heart? 3. Psychosocial suitability The aim of this presentation is to summarize the most important psychological and psychiatric diagnostic aspects of patient evaluation. Certain diseases of the central nervous system, mental disorders, psychiatric conditions, substance abuse and noncompliance are all to be considered in the screening process. Complex psychodiagnostics provides a tool for clinicians to identify potential risk factors so that adequate therapy can be started or optimized accordingly. Absolute contraindications include: - Acute psychosis where – regardless of treatment - sufficient compliance cannot be achieved. - Suicidal ideation, urges, motivation, or attempted suicide in patients’ history – which implies insufficient coping. - Acute bereavement, severe depression with or without psychotic symptoms and untreated recurrent depression. Acute bereavement and depression are important risk factors of morbidity and mortality, hostility and PTSD symptoms in the postoperative period, serving as a predictor of poor compliance. - Mental and behavioral disorders caused by psychoactive substance abuse, such as nicotine, alcohol or drugs. Relative contraindications that may lead to insufficient compliance include dissocial and unstable affective personality disorders, organic and symptomatic mental disorders (mental retardation and dementia), schizophrenia, schizotypal and paranoid disorders and bipolar affective disorders. Some other conditions must be considered as risk factors that can contribute to developing postoperative complications and prolonged hospitalization. These include adjustment disorders triggered by severe stress, neurotic, stress related and somatoform disorders, mild- and moderate levels of depression and dysthymia. Scientific background and clinical practice of risk assessment guided by national guidelines will be reviewed in the presentation.