Author: Sana Ullah, MB ChB, FRCA - Dallas, TX


A 16-year-old adolescent male with a history of dilated cardiomyopathy is transferred to the cardiac intensive care unit from the emergency room due to persistent “low flow” alarms on a Heartmate 3 left ventricular assist device (LVAD). On examination, he appears fatigued with a heart rate of 130 in sinus tachycardia. A transthoracic echocardiogram demonstrates LVAD inflow and outflow cannulas in the appropriate position and normal position of the interventricular septum. The LVAD controller is showing a low-flow alarm and a decreased pulsatility index. What is the MOST LIKELY etiology of the low-flow alarm on the LVAD?