Other ED-based Investigations

What other ED-based investigations will be important in evaluating an unwell patient who has had a cardiac transplant?

Blood tests: U&Es, FBC, CRP, troponin

Routine blood tests will include markers for infection such as white cell count and CRP. CRP is also elevated with graft rejection and graft vasculopathy. U&Es may demonstrate renal impairment associated with a deteriorating heart. Troponin has not been found to be reliable in evaluating graft rejection. It may be useful in identifying patients with graft vasculopathy. An elevated troponin, ideally relative to a previous baseline, suggests myocardial injury. Coronary artery disease and rejection should be considered as causes. Drug levels for immunosuppressants may be helpful if poor compliance is suspected.

Blood and urine cultures

Transplant patients are immunosuppressed, and one should have a low threshold for a septic screen including blood cultures and MSU.

Chest x-ray (CXR)

There will be sternotomy sutures from a previous thoracotomy. If there is LV dysfunction, the CXR may demonstrate cardiomegaly and pulmonary oedema. It may also show evidence of infection or malignant disease.