Yes, No, Unknown (If yes, please fill out the Device Malfunction Adverse Event Form) Right Heart Failure Zone Information that you provide in this section will be used to – assess the existence of right heart failure and its degree. Clinical Findings Since the last Follow-Up visit. – CVP or RAP > 16 mmHg? Yes, No, Unknown, or Not Done Dilated Vena Cava with absence of Inspiratory Variation by Echo (If absence of Inspiratory Variation is not documented, Check No)? Yes, No, Unknown, or Not Done Clinical findings of elevated jugular venous distension at least half way up the neck in an upright patient (If 6 cm, Yes)? ≥ Yes, No, Unknown Peripheral Edema (If 2, Check Yes)? ≥ Yes, No, Unknown Ascites? Yes, No, Unknown Has the patient been on Inotropes since the last Follow-Up visit? Yes, No, Unknown If yes, select all that apply: Dopamine Dobutamine Milrinone Isoproterenol Epinephrine Norepinephrine Levosimendan Unknown Nesiritide? Yes, No, Unknown Has the patient had a RVAD implant the last Follow-up visit? Yes, No, Unknown Please click on the link below for further instruction on administering Stroke Scales in Appendix I. Has the patient experienced a Neurological since time of implant? Yes, No, Unknown
Yes, No, Unknown (If yes, please fill out the Device Malfunction Adverse Event Form) Right Heart Failure Zone – Information that you provide in this section will be used to assess the existence of right heart failure and its degree. Clinical Findings – Since the last Follow-Up visit. CVP or RAP > 16 mmHg? Yes, No, Unknown, or Not Done Dilated Vena Cava with absence of Inspiratory Variation by Echo (If absence of Inspiratory Variation is not documented, Check No)? Yes, No, Unknown, or Not Done Clinical findings of elevated jugular venous distension at least half way up the neck in an upright patient (If ≥ 6 cm, Yes)? Yes, No, Unknown Peripheral Edema (If ≥ 2, Check Yes)? Yes, No, Unknown Ascites? Yes, No, Unknown Has the patient been on Inotropes since the last Follow-Up visit? Yes, No, Unknown If yes, select all that apply: Dopamine Dobutamine Milrinone Isoproterenol Epinephrine Norepinephrine Levosimendan Unknown Nesiritide? Yes, No, Unknown Has the patient had a RVAD implant the last Follow-up visit? Yes, No, Unknown Please click on the link below for further instruction on administering Stroke Scales in Appendix I. Has the patient experienced a Neurological since time of implant? Yes, No, Unknown