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Therapeutic Research
Abstract
The patient was a 63-year-old woman with severe heart failure due to dilated cardiomyopathy diagnosed at the age of 34. In 2007, she presented to our hospital with sudden ventricular tachycardia and ventricular fibrillation and received appropriate treatment including cardiac resynchronization therapy defibrillator implantation for severe heart failure and arrhythmia. While heart failure gradually exacerbating, she presented to our emergency room with dyspnea in March, 2011. Detailed evaluation resulted in left ventricular systolic dysfunction and left ventricular remodeling. Neither ventricular assist system nor heart transplantation was available because of complications such as cerebellar infarction and kidney cancer. Then, we initiated the treatment with adaptive-servo ventilation(ASV)for dyspnea, tolvaptan for diuretic resistance. A port was also installed beneath the skin of the right forearm. Since the patient was eager to spend her limited life at home, she was discharged from the hospital in March 2012 under close observation with continuous dobutamine infusion, ambulatory care once a week, home nursing twice a week, and domiciliary care in nursing home every week.Throughout the admission and home nursing, our heart failure team provided the patient various support, such as adequate education about chronic heart failure by medical nurses, cardiac rehabilitation by physiotherapists, medical compliance instruction by pharmacists, management of ASV by clinical engineers, mental care by clinical psychologists, and management of home healthcare by social workers. Here, we report our specific medical support for a patient with end-stage heart failure.
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