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An 8 year-old girl develops bradycardia with poor perfusion on POD #2 after an orthotopic heart transplant. The immediate best treatment is with:


a) Transcutaneous pacing

b) Phenylephrine

c) Endotracheal intubation and positive pressure ventilation with 100% oxygen

d) Epinephrine

e) Atropine

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Answer

Answer d.

The acutely transplanted heart is denervated and will not respond to atropine. Epinephrine is the appropriate pharmacologic agent. If unsuccessful, transcutaneous pacing should be considered.


Notes


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