One More Beat covers a lot of medical ground. This page exists so you don’t have to stop mid-article to look something up. Terms are listed alphabetically.
A
Allograft — An organ or tissue transplanted from one person to another. Your donor heart is a cardiac allograft.
Amiodarone — An antiarrhythmic medication used to control atrial fibrillation. Can cause serious side effects with long-term use, including amiodarone-induced hyperthyroid toxicity.
Amlodipine — A calcium channel blocker used to manage blood pressure post-transplant.
ANA (Antinuclear Antibody) — A screening test for autoimmune activity. Monitored in transplant patients as part of routine labs.
Angina — Chest pain caused by reduced blood flow to the heart muscle. Transplant recipients typically cannot feel angina because the sensory nerves are severed during surgery — which is why routine imaging is critical post-transplant. The “check-engine light” is gone.
Angiography (Angio) — An invasive imaging procedure using contrast dye injected into the coronary arteries to visualize blockages or narrowing. Better for detecting advanced CAV than early-stage disease.
Apixaban (Eliquis) — An anticoagulant (blood thinner) used post-transplant to manage clotting issues. In my case, prescribed due to a fully occluded right jugular vein from extensive catheter use during hospitalization.
Arrhythmia — Any abnormal heart rhythm. Includes atrial fibrillation, ventricular tachycardia, bradycardia, and others. A broad term that encompasses many specific conditions. Post-transplant patients are monitored closely for arrhythmias, particularly in the early recovery period.
Aspirin (Low-Dose) — An antiplatelet agent taken daily post-transplant for cardiovascular protection.
Atrial Fibrillation (AFib) — An irregular, often rapid heart rhythm originating in the upper chambers of the heart. Can cause weakness, shortness of breath, and fluid retention.
B
Bactrim (Trimethoprim-Sulfamethoxazole) — A prophylactic antibiotic given to transplant recipients in the early post-transplant period to prevent bacterial and opportunistic infections, particularly Pneumocystis pneumonia (PCP). Standard in most post-transplant protocols.
Bi-V Pacemaker (Biventricular Pacemaker) — A device that coordinates the contractions of both ventricles to improve heart function in patients with heart failure. Removed at transplant.
Biopsy (Endomyocardial) — A procedure in which small tissue samples are taken from the heart muscle, typically via catheter, to check for signs of rejection.
Bradycardia — Abnormally slow heart rate, typically below 60 bpm. Can occur post-transplant as the heart and nervous system adjust. Monitored closely in the early recovery period.
Brain Fog — Cognitive cloudiness common post-transplant, largely attributed to prednisone and the overall trauma of the surgical experience. Typically improves as prednisone is tapered and the body adjusts.
BUN (Blood Urea Nitrogen) — A lab value measuring kidney function. Elevated levels may indicate the kidneys are under stress.
Bundle Branch Block — A delay or obstruction in the electrical pathways of the heart that causes an abnormal pattern on an EKG. Can appear post-transplant and is monitored as a potential indicator of rejection or graft dysfunction.
C
Calcineurin Inhibitors — A class of immunosuppressant medications that prevent rejection by blocking a specific immune pathway. Tacrolimus and cyclosporine are both calcineurin inhibitors. Can affect kidney function and contribute to diabetes with long-term use.
Cardiac Memory — An electrophysiological phenomenon in which the heart’s T-wave pattern on an EKG is altered by a prior abnormal rhythm or pacing pattern. Not to be confused with the more colloquial concept of cellular or psychological memory transfer discussed in transplant circles.
Cardiopulmonary Bypass — The machine that takes over the function of the heart and lungs during open-heart surgery, allowing the surgeon to operate on a stopped heart. The transplant recipient is placed on bypass while the donor heart is implanted.
Cardioversion — A procedure that delivers a controlled electrical shock to the heart to reset it to normal sinus rhythm. Used to treat atrial fibrillation and other arrhythmias when medications fail. I underwent cardioversion multiple times during my pre-transplant hospitalization.
CAV (Cardiac Allograft Vasculopathy) — A form of chronic rejection unique to transplanted hearts. Causes progressive thickening and narrowing of the coronary arteries of the donor heart. Unlike standard coronary artery disease, CAV affects the entire length of the vessels and cannot be fully treated with stents or bypass surgery. The primary long-term threat to transplant longevity.
CBC (Complete Blood Count) — A standard blood test measuring red blood cells, white blood cells, and platelets. Monitors for infection, anemia, and medication side effects.
CGM (Continuous Glucose Monitor) — A wearable sensor that tracks blood sugar levels in real time. The Dexcom is the specific device used in my case.
CHF (Congestive Heart Failure) — A chronic condition in which the heart cannot pump enough blood to meet the body’s needs. Fluid backs up into the lungs and extremities. Managed for 22 years prior to transplant.
CK / Creatine Kinase — An enzyme released when muscle tissue is stressed or damaged. Elevated levels can indicate cardiac or skeletal muscle injury.
CMV (Cytomegalovirus) — A common virus that most people carry without symptoms but which can cause serious illness in immunosuppressed transplant patients. Monitored regularly post-transplant.
CMP (Comprehensive Metabolic Panel) — A blood panel evaluating kidney function, liver function, electrolyte balance, and glucose levels. A standard component of post-transplant monitoring.
Colonoscopy — Endoscopic examination of the large intestine using a flexible camera. Part of the pre-transplant evaluation process to rule out any underlying conditions that could complicate surgery or recovery.
CoQ10 (Coenzyme Q10) — A supplement with antioxidant properties sometimes used to support mitochondrial function and cardiovascular health.
Creatinine — A waste product filtered by the kidneys. A key indicator of kidney function in lab work. Both tacrolimus and sirolimus can affect kidney health over time.
Cresemba (Isavuconazole) — A broad-spectrum antifungal used prophylactically in immunocompromised transplant patients to prevent serious fungal infections including aspergillosis. Typically prescribed during the early post-transplant period when immunosuppression levels are at their highest. Among the more expensive medications in the post-transplant protocol.
CRP (C-Reactive Protein) — A marker of systemic inflammation. Elevated CRP can indicate infection, rejection, or other inflammatory processes.
Cyclosporine (Sandimmune, Neoral) — A calcineurin inhibitor immunosuppressant used in some transplant regimens as an alternative to tacrolimus. Like tacrolimus, it can affect kidney function and contributes to elevated blood pressure. Can interfere with sleep through CNS effects.
CYP3A4 — A liver enzyme involved in metabolizing many medications including tacrolimus and sirolimus. Grapefruit and pomegranate inhibit this enzyme, causing dangerous spikes in drug levels — which is why both are strictly prohibited in transplant patients.
Cystoscopy — Endoscopic examination of the bladder and urethra using a catheter-mounted camera. Part of the pre-transplant evaluation for male candidates. Uncomfortable in a way that defies adequate description.
D
Denervation — The state of the transplanted heart immediately after surgery. All cardiac nerves, including the vagus nerve, are severed during the procedure. The heart runs on its own electrical system and on hormonal signals from the bloodstream rather than direct nerve control from the brain.
Diabetogenic — A term describing medications or conditions that cause or worsen diabetes. Both tacrolimus and sirolimus are diabetogenic — tacrolimus impairs insulin secretion, sirolimus causes insulin resistance.
Differential (WBC Differential) — A blood test that breaks down the white blood cell count by cell type — neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Helps identify the nature of an immune response, infection, or medication effect.
Diuretic — A medication that increases urine output to remove excess fluid from the body. Standard in heart failure management and commonly used in early post-transplant care.
DSA (Donor-Specific Antibodies) — Antibodies the recipient’s immune system develops that specifically target the donor organ. A marker for antibody-mediated rejection risk.
E
Echocardiogram (Echo) — An ultrasound of the heart used to assess its structure, valve function, wall motion, and ejection fraction. Performed regularly post-transplant to monitor graft function and check for signs of rejection or CAV progression.
ECMO (Extracorporeal Membrane Oxygenation) — A form of life support that takes over the function of both the heart and lungs simultaneously, circulating and oxygenating blood outside the body. The highest level of mechanical circulatory support — patients on ECMO are listed at Status 1, above Status 2 on the transplant waiting list.
Edema — Swelling caused by fluid retention, typically in the legs and feet. A hallmark symptom of decompensated heart failure.
EF (Ejection Fraction) — The percentage of blood pumped out of the left ventricle with each heartbeat. Normal is 55–70%. My pre-transplant EF was 5% — the heart was barely functioning.
EKG (Electrocardiogram) — A test that records the electrical activity of the heart. Used to detect arrhythmias, assess heart rhythm, and monitor for changes post-transplant. A routine part of every clinic visit.
Eliquis — See Apixaban.
Empagliflozin (Jardiance) — An SGLT2 inhibitor used for glycemic control and cardiovascular and renal protection in transplant patients. Particularly relevant in CAV management.
Endoscopy — Examination of the upper digestive tract — esophagus, stomach, and upper small intestine — using a flexible camera. Part of the pre-transplant evaluation to rule out conditions that could complicate surgery or recovery.
End-Stage Heart Failure — The final stage of congestive heart failure, in which the heart can no longer maintain adequate circulation despite maximum medical therapy. At this stage, the options are limited to mechanical support, transplant, or palliative care. My ejection fraction of 5% placed me firmly in this category.
Everolimus (Zortress) — An mTOR inhibitor immunosuppressant related to sirolimus. Used in some transplant regimens as an alternative or addition to other immunosuppressants. Like sirolimus, it has shown some ability to slow CAV progression.
Extubation — The removal of the breathing tube placed during surgery. One of the first post-operative milestones — typically occurring within hours of transplant.
F
Fentanyl — A powerful opioid analgesic used for sedation and pain management during cath lab procedures. Used in combination with midazolam (Versed) and diphenhydramine for procedural sedation in my case.
Fungitell — A blood test that detects beta-D-glucan, a component of fungal cell walls. Used to screen for invasive fungal infections in immunocompromised patients. Results typically take longer to return than standard labs.
G
GFR — Glomerular Filtration Rate. Measures how well the kidneys are filtering waste from the blood. Expressed in mL/min/1.73m². Normal is above 60; below 15 indicates kidney failure. Monitored closely post-transplant because both tacrolimus and sirolimus can stress kidney function over time.
GLP-1 Agonist — A class of diabetes medications that slow gastric emptying, reduce appetite, and improve blood sugar control. Semaglutide (Rybelsus, Ozempic) is a GLP-1 agonist.
GMI (Glucose Management Indicator) — An estimated A1C calculated from continuous glucose monitor data. Provides a real-time approximation of average glucose control without a blood draw.
Graft — The transplanted organ. “Graft function” refers to how well the donor heart is performing. “Graft dysfunction” refers to declining performance.
H
Heart Block — A disruption in the electrical conduction system of the heart, causing delayed or absent signals between the upper and lower chambers. Can require a temporary or permanent pacemaker.
Heartiversary — The anniversary of a transplant recipient’s surgery date. Widely observed and celebrated in the transplant community as a second birthday of sorts — the day a new life began.
Hematocrit — A blood test measuring the percentage of red blood cells in the total blood volume. Low hematocrit indicates anemia, which is common post-transplant due to medication effects and the body’s recovery process.
HGB A1C (Hemoglobin A1C) — A lab test reflecting average blood glucose over approximately three months. A standard measure of diabetes management.
High-Risk Donor — A designation applied to donor organs when the donor’s history includes factors that could theoretically affect the organ — prior drug use, positive for hepatitis or CMV. Does not mean the organ is unhealthy; the transplant team evaluates each case individually.
Hyperthyroid Toxicity (Amiodarone-Induced) — A condition in which long-term amiodarone use causes the thyroid to overproduce hormones, leading to toxicity. Treated in my case with total thyroidectomy.
I
Icosapent Ethyl (Vascepa) — A pharmaceutical-grade omega-3 fatty acid used to reduce triglycerides and cardiovascular risk. Supported by the REDUCE-IT trial data.
Immunosuppression — Medications taken to prevent the immune system from rejecting the transplanted organ. Required for life post-transplant. Includes tacrolimus, mycophenolate, sirolimus, prednisone, and others depending on the regimen.
Impella — A catheter-based mechanical heart pump inserted through the femoral artery to support heart function. Used to stabilize my condition prior to transplant listing.
IVUS (Intravascular Ultrasound) — An imaging tool used during catheterization to measure the thickness of artery walls from the inside. The gold standard for detecting early CAV. An MIT ≥ 0.5mm at one year triggers closer monitoring.
J
Jardiance — See Empagliflozin.
K
Ketamine — A dissociative anesthetic used during cath lab procedures and other surgeries. Produces profound altered states of consciousness — including out-of-body experiences and acute awareness of surroundings while under sedation — in some patients. The experiences I had during ketamine sedation are a significant part of this story.
L
LAD (Left Anterior Descending Artery) — The primary coronary artery supplying blood to the front wall of the heart. One of the vessels evaluated for CAV progression.
LHC (Left Heart Catheterization) — An arterial access procedure, typically through the wrist, used to assess coronary artery function and heart performance.
Levothyroxine — Synthetic thyroid hormone (T4) taken to replace the function of the removed thyroid gland. Must be taken on an empty stomach, separated from other medications and supplements.
Liothyronine — Synthetic T3 thyroid hormone, taken alongside levothyroxine for more complete thyroid hormone replacement.
Lipid Profile — A blood panel measuring total cholesterol, LDL, HDL, and triglycerides. Monitored regularly post-transplant as both CAV and medications like sirolimus can adversely affect lipid levels.
Listing (Transplant) — The formal process of being added to the national organ transplant waiting list managed by UNOS/OPTN. Status 2 is the highest urgency level for patients not on mechanical life support.
LVAD (Left Ventricular Assist Device) — A mechanical pump implanted to support or replace the function of the left ventricle. A bridge to transplant or destination therapy for end-stage heart failure patients.
M
Magnesium — An electrolyte that plays a critical role in cardiac function, nerve conduction, and sleep regulation. Commonly depleted post-transplant due to tacrolimus and sirolimus. Requires careful scheduling away from immunosuppressant medications to avoid absorption interference.
Midazolam (Versed) — A benzodiazepine sedative used during cath lab procedures and other invasive procedures. Causes anterograde amnesia — you won’t remember what happened after it’s administered. Used in combination with fentanyl and diphenhydramine for procedural sedation in my case.
MIT (Maximal Intimal Thickness) — A measurement from IVUS showing how thick the inner artery wall has become. Used to stage and monitor CAV.
mTOR Inhibitors — A class of immunosuppressants including sirolimus and everolimus. Used post-transplant to prevent rejection and shown in some studies to slow CAV progression. Can affect lipid levels, blood sugar, and kidney function.
Mycophenolate (CellCept) — A secondary immunosuppressant used alongside tacrolimus to prevent rejection. Can cause GI side effects. In my case, being replaced by sirolimus due to early CAV diagnosis.
P
PET (Positron Emission Tomography) — A non-invasive imaging scan used to assess blood flow and heart perfusion over time. Used in CAV monitoring.
PICC Line (Peripherally Inserted Central Catheter) — A long IV line inserted into a vein in the arm and threaded to a large central vein near the heart. Used for extended medication delivery and blood draws during long hospitalizations, reducing the need for repeated needle sticks. Both a curse and a blessing.
Potassium — An electrolyte critical to cardiac function and nerve conduction. Both too high and too low potassium levels can cause dangerous arrhythmias. Monitored closely post-transplant, particularly given the interaction between valsartan, sirolimus, and potassium levels.
Prednisone — A corticosteroid used heavily in the early post-transplant period to suppress the immune system and reduce rejection risk. Tapered gradually over months. Side effects include altered taste, elevated blood sugar, weight gain, insomnia, emotional volatility, and joint pain. Tapering off prednisone is a significant milestone in recovery.
PR Interval — A measurement on an EKG reflecting the time it takes for an electrical signal to travel from the atria to the ventricles. Prolonged PR interval can indicate conduction issues.
Prospera — A brand-name cell-free DNA blood test used to detect early signs of organ rejection without requiring a biopsy.
PSA (Prostate Specific Antigen) — A blood test screening for prostate issues. Added to the one-year evaluation panel for male transplant recipients as part of broader cancer screening.
PT/INR (Prothrombin Time / International Normalized Ratio) — A lab test measuring blood clotting function. Monitored to assess bleeding risk and certain medication effects.
Q
QRS Complex — The portion of an EKG tracing that represents ventricular depolarization — the electrical event that causes the ventricles to contract and pump blood.
QT Interval — A measurement on an EKG reflecting the time it takes for the ventricles to depolarize and repolarize. Prolonged QT interval can indicate risk of dangerous arrhythmias and is affected by several post-transplant medications.
R
Reinnervation — The slow, partial regrowth of nerve fibers into the transplanted heart over months to years. Never complete — the vagus nerve does not reattach — but sympathetic fibers can reconnect gradually, improving the heart’s ability to respond to exercise and stress.
Rejection (Acute Cellular) — An immune response in which the body’s T-cells attack the donor organ. Graded on a scale; 0R indicates no rejection. Managed with immunosuppression.
Rejection (Antibody-Mediated) — A form of rejection driven by antibodies rather than T-cells. Denoted as pAMR in biopsy results.
RHC (Right Heart Catheterization) — A diagnostic procedure using a catheter inserted through the neck to measure pressures in the heart and lungs, including pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output. Also used to obtain biopsy samples. A standard part of both the pre-transplant evaluation and ongoing post-transplant monitoring.
Rosuvastatin (Crestor) — A statin used for lipid management and CAV prevention post-transplant. See Statin.
RVAD (Right Ventricular Assist Device) — A mechanical pump that takes over the function of the right ventricle. Considered in my case during a particularly severe AFib episode that substantially weakened the right ventricle. Not ultimately implanted, but on the table.
Rybelsus — See Semaglutide.
S
Semaglutide (Rybelsus, Ozempic) — An oral or injectable GLP-1 agonist used for glycemic control and weight management. Slows gastric emptying, which delays glucose spikes after meals. Must be taken on an empty stomach with minimal water, 30 minutes before food.
SGLT2 Inhibitor — A class of diabetes medications that lower blood sugar by causing the kidneys to excrete excess glucose in urine. Also provides cardiovascular and kidney protection. Jardiance (empagliflozin) is an SGLT2 inhibitor.
Sinoatrial Node (SA Node) — The heart’s built-in pacemaker. Generates the electrical impulses that trigger each heartbeat independently of the nervous system. Because it operates on its own, the donor heart continues to beat after denervation.
Sinus Rhythm — The normal, regular heartbeat pattern originating from the sinoatrial node. The goal of cardioversion — to restore AFib or other arrhythmias back to sinus rhythm. “Self-converted to sinus rhythm” means the heart returned to normal rhythm on its own without intervention.
Sinus Tachycardia — An elevated heart rate originating normally from the sinoatrial node, typically above 100 bpm. Common post-transplant due to denervation — without the vagus nerve’s braking effect, the resting heart rate runs higher than normal.
Sirolimus (Rapamune) — An mTOR inhibitor immunosuppressant being substituted for mycophenolate in my regimen to help slow CAV progression. Gentler on the kidneys than tacrolimus but comes with its own side effects including mouth sores, slower wound healing, elevated cholesterol, and insulin resistance.
Sodium — An electrolyte that regulates fluid balance in the body. Low sodium (hyponatremia) is common in heart failure due to fluid retention and diuretic use. Monitored as part of standard CMP labs post-transplant.
Statin — A cholesterol-lowering medication with anti-inflammatory properties. Standard in post-transplant care due to evidence showing effectiveness in managing lipids and slowing CAV progression.
Status (Transplant Listing Status) — The urgency classification assigned by UNOS/OPTN to heart transplant candidates on the waiting list. Higher status numbers indicate less urgent need. The current six-tier adult system:
- Status 1 — Most critically ill. Requires mechanical circulatory support with devices such as ECMO (extracorporeal membrane oxygenation) or certain temporary mechanical assist devices with life-threatening complications.
- Status 2 — Critically ill but on more stable mechanical support — including the Impella and certain LVAD configurations — or experiencing life-threatening arrhythmias. (My status throughout the waiting period.)
- Status 3 — Requires continuous IV inotropes or has an LVAD with complications. Hospitalized or outpatient with significant limitations.
- Status 4 — Stable on oral medications or an uncomplicated LVAD. Typically managed as an outpatient.
- Status 5 — Has a condition that would significantly worsen on dialysis without transplant, or is re-listed after a prior transplant.
- Status 6 — Active on the waiting list but does not meet criteria for Status 1–5. Lowest urgency.
Organ allocation within each status is further determined by blood type, body size, geographic proximity to the donor, and time on the list.
SVT (Supraventricular Tachycardia) — A rapid heart rhythm originating above the ventricles. An umbrella term that includes several specific arrhythmias. Can cause palpitations, lightheadedness, and shortness of breath.
Swan-Ganz Catheter (Pulmonary Artery Catheter) — A catheter inserted through the neck and threaded into the pulmonary artery to measure hemodynamic pressures directly, including pulmonary artery pressure, pulmonary capillary wedge pressure (an indirect measure of left heart filling pressure), central venous pressure, and cardiac output. Used extensively during the pre-transplant hospitalization period to monitor heart and lung function in real time. Often left in place for days at a time. Deeply unpleasant.
T
Tachycardia — Abnormally fast heart rate, typically above 100 bpm. Can be benign (as in post-transplant sinus tachycardia from denervation) or indicate a more serious underlying problem.
Tacrolimus (Prograf, Envarsus) — The primary immunosuppressant used post-transplant. A calcineurin inhibitor that prevents rejection but can stress the kidneys, contribute to diabetes, cause tremors, and interfere with sleep. Levels must be monitored closely and are affected by diet, timing, and other medications.
Tacrolimus Tremors (Tacro Shakes) — Fine motor tremors — most noticeable in the hands — caused by tacrolimus toxicity or elevated tacrolimus levels. A common side effect that typically improves as doses are reduced over time. Severe enough in my case to temporarily prevent typing. Closely associated with prednisone levels as well — as prednisone is tapered, tremors often improve.
Thyroidectomy (Total) — Surgical removal of the entire thyroid gland. Performed in my case due to amiodarone-induced hyperthyroid toxicity that could not be controlled medically and would have precluded transplant.
Trough Level — The lowest concentration of a medication in the bloodstream, measured just before the next dose. For tacrolimus and sirolimus, trough levels are the primary way transplant teams monitor whether dosing is in the therapeutic range.
T-Wave — The portion of an EKG tracing representing ventricular repolarization — the heart resetting after each contraction. T-wave abnormalities can indicate ischemia, electrolyte imbalances, or rejection.
U
UNOS/OPTN — The United Network for Organ Sharing / Organ Procurement and Transplantation Network. The governing body that manages the national transplant waiting list and organ allocation policy in the United States.
V
Vagus Nerve — The primary nerve connecting the brain to the heart, responsible for the parasympathetic “brake” that slows the heart rate. Severed during transplant and not reattached — which is why post-transplant resting heart rates are typically elevated, often 90–110 bpm. Over time, partial reinnervation occurs through other nerve pathways but never fully restores the original connection.
Valganciclovir — An antiviral medication used prophylactically post-transplant to prevent CMV infection. Typically discontinued after the initial prophylaxis period (roughly 1 year).
Valsartan — An ARB (angiotensin receptor blocker) used for blood pressure control and cardiac protection post-transplant.
Ventricular Fibrillation (VFib) — A life-threatening arrhythmia in which the ventricles quiver chaotically rather than contracting effectively, causing cardiac arrest. Treated with defibrillation.
Ventricular Tachycardia (VTach) — A rapid, potentially dangerous rhythm originating in the ventricles. Can degenerate into ventricular fibrillation if untreated.
Versed — See Midazolam.
Vitamin D — Monitored post-transplant as immunosuppressant medications, reduced outdoor activity, and limited sun exposure can lead to deficiency. Supplementation is common.
Vocal Cord Paralysis (VCP) — Paralysis or paresis of one or both vocal cords, causing hoarseness, voice loss, and difficulty speaking or singing. A known complication of Swan-Ganz catheter placement — in my case, the first Swan catheter is believed to have nicked the recurrent laryngeal nerve. When only one vocal cord is affected, recovery is possible over months through therapy and exercise. When both vocal cords are paralyzed, they can fall together and block the airway — a medical emergency requiring a tracheotomy (surgical opening in the neck) to restore breathing. Recovery of speaking voice took approximately six months; full singing range took considerably longer.
This glossary will be updated as new terms appear in the blog. If something isn’t here that should be, use the Contact Page.