Cardiac transplantation and ventricular assist devices — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in a tertiary paediatric cardiac centre. A four-month-old infant with a known idiopathic dilated cardiomyopathy and an ejection fraction of 18 percent is on a loop diuretic, an ACE inhibitor and caloric supplementation. Over two weeks the tachypnoea has worsened, feeds take 40 minutes with sweating, the weight has crossed two centiles downward, and the creatinine has begun to rise. The advanced heart-failure team is being consulted. The team asks you to establish that the failure is refractory, to discuss the device pathway, and to begin the family counselling. You have 12 minutes with the team and 5 minutes for examiner discussion. ^[6]