8
Diagnosis
Figure 6. HeartMate II Troubleshooting Chart
Hypotension defined as MAP <60 mmHg for continuous flow device
Reprinted from Feldman et al. with permission from the International Society for Heart and Lung
Transplantation. Copyright © 2013, International Society for Heart and Lung Transplantation.
Low VAD flows:
consider hypovolemia, cardiac
obstructive
High VAD flows:
consider vasodilation as cause
Vasodilating
medications:
hold vasodilators
and initiate
pressors
Sepsis: look for
source, start
broad spectrum
antibiotics,
initiate pressors
No fever Fever, leukocytosis
Low JVP: decreased
pulsatility or suction
events
Low
hematocrit
Adequate
hematocrit
Hypovolemia Bleeding
Bolus fluids,
transfuse, hold
or reverse
anticoagulation
identify and treat
bleeding source
Bolus
fluids
High JVP
Perform echocardiogram
and consider PA catheter
placement
• Tamponade
• Pulmonary
embolus
• Pheumothorax
RV dysfunction
Inadequate
unloading by
LVAD
Adjust pump
speed
Assess cannula
position
RV dysfunction
on echo with
high CVP and
low PCWP
No RV
dysfunction on
echo with high
PCWP
