رجل عمره ٤٨ سنة بعد زراعة قلب بستة أشهر، يأخذ تاكروليموس وموفيتيل وكورتيزون. جاء للعيادة وعنده عدة ملاحظات. الضغط ١١٢/٧٠، والنبض ١٠٤، والحرارة ٣٧٫٢. أي عرض جديد يبلغ عنه أولاً لأنه قد يدل على رفض العضو؟

A 48-year-old man six months after heart transplant takes tacrolimus, mycophenolate and prednisolone. At clinic he reports several things; BP 112/70, HR 104, T 37.2 °C. Which new symptom should be reported first as it may indicate rejection?

1. A slightly increased appetite since discharge
2. New fatigue, dyspnoea and weight gain with oedema
3. Extra facial hair growth noticed recently
4. A mild hand tremor present for several months

Answer: B) New fatigue, dyspnoea and weight gain with oedema. Rejection may present as heart failure (fatigue, dyspnoea, oedema) or arrhythmias. The transplanted heart is denervated, so angina may not be felt. Tremor and hair growth are known drug side effects.