Cardiac Care

List of Contributors xiv Foreword xvii Preface xviii Part I Knowledge for Practice 1 1 Mechanics of the Cardiovascular System 3 Brendan Greaney and Angela M. Kucia Overview 3 Basic Heart Anatomy 3 References 11 2 Regulation of Cardiac and Vascular Function 12 Brendan Greaney and Angela M. Kucia Overview 12 Central Nervous System Regulation of the Cardiovascular System 12 Vasomotor Control 14 Baroreceptors 14 Gravity and Venous Return 14 Chemoreceptors 15 Humoral Control 16 Electrolytes 18 Conclusion 19 References 20 3 Cardiac Electrophysiology 21 Brendan Greaney and Angela M. Kucia Overview 21 Cardiac Cells 21 The Action Potential 22 The Action Potential in Non-Pacemaker Cells 22 The Cardiac Conduction System 24 The Electrocardiogram 26 Conclusion 26 References 28 4 The Coronary Circulation 29 Brendan Greaney and Angela M. Kucia Overview 29 The Coronary Circulation 29 The Left Main Coronary Artery 30 The Left Anterior Descending Artery 31 The Left Circumflex Artery 31 The Right Coronary Artery 31 Collateral Circulation 32 Microvascular Circulation 32 Coronary Venous Circulation 32 References 33 Part II Cardiovascular Disease Assessment 35 5 Risk Factors for Cardiovascular Disease 37 Angela M. Kucia and Angela Hartley Overview 37 Absolute Risk 37 Classification of Risk Factors for CVD 38 Biomedical Risk Factors 39 Behavioural Risk Factors 44 Psychosocial Risk Factors 46 Conclusion 48 References 49 6 Cardiovascular Assessment 52 Jan Keenan and Angela M. Kucia Overview 52 Health History 53 Physical Examination 54 Conclusion 65 References 66 7 Laboratory Tests Used in Acute Cardiac Assessment 67 David Barrett and Angela M. Kucia Overview 67 Generic Laboratory Tests 67 Common Laboratory Tests Used in Cardiovascular Disease 67 Laboratory Specimen Collection 73 Conclusion 74 References 74 8 Diagnostic Procedures 76 Steven A. Unger and Angela M. Kucia Overview 76 Purpose of Diagnostic Tests 76 Preparation for Diagnostic Procedures 77 Medical Imaging Tests 78 Electrocardiography Tests 93 Physiological Testing 93 Stress Testing 95 Conclusion 100 References 100 Part III Detection and Management of Heart Rhythm Disturbances 103 9 Electrocardiogram (ECG) Interpretation 105 Carol Oldroyd and Angela M. Kucia Overview 105 Normal Sequence of Depolarisation and Repolarisation 106 Theoretical Basis of Electrocardiography 107 ECG Leads 107 The Cardiac Axis 110 Determination of Heart Rate and Electrocardiographic Intervals 111 Chamber Enlargement 112 Bundle Branch Block 114 ECG Changes Related to Myocardial Ischaemia and Infarction 117 Myocardial Infarction 118 The ST-Segment 118 Pericarditis 118 Key Point 119 T-Wave Abnormalities 120 Q-Waves 120 Site of Infarction 121 Incremental ECG Leads 121 Obtaining a 12-Lead ECG 122 Equipment Preparation 122 Patient Preparation 123 Conclusion 125 References 126 10 Cardiac Monitoring in the Clinical Setting 128 Angela M. Kucia and Carol Oldroyd Overview 128 ECG Monitoring Systems and Lead Formats 129 Three-Electrode Monitoring Systems 129 Five-Electrode Monitoring Systems 129 Twelve-Lead (10 Electrode) Monitoring Systems 130 Telemetry Monitoring Systems 131 Indications for Arrhythmia Monitoring in the Clinical Setting 132 Alarm Fatigue 134 References 138 11 Arrhythmias 139 Angela M. Kucia Overview 139 Mechanisms of Arrhythmia Generation 139 Ectopy, Aberrancy and Escape Beats 145 Sinus Dysrhythmias 147 Atrial Dysrhythmias 150 Ventricular Rhythms and Tachyarrhythmias 156 Heart Block Related to Atrioventricular Nodal Conduction 162 Conclusion 169 References 170 12 Assessment and Management of Cardiac Rhythm Disturbances (Arrhythmias) 173 Carolyn E. Shepherd, Jenny Tagney, and Angela M. Kucia Overview 173 Assessment 173 Taking a Clinical History 174 Physical Examination 174 Diagnostic Investigations 177 Smartphone Technology 180 Imaging 180 Diagnosis of Cardiac Channelopathies 182 Treatment Strategies for Arrhythmia 183 Pharmacological Therapy 183 Electrical (Direct Current) Synchronised Cardioversion 187 Defibrillation 188 Cardiac Ablation 189 Temporary Pacing 190 Temporary Transvenous Pacing 190 Transcutaneous Pacing 190 Other Forms of Temporary Pacing 191 Implantable Cardiac Devices 191 Implantable Pacemakers 191 Implantable Cardioverter Defibrillators 193 Implantation Procedure for Cardiac Devices 194 Implantable Device Complications 196 Practical Advice for Patients Following Device Implantation 197 Advanced Nursing Roles in Arrhythmia Management 199 References 199 Part IV Detection and Management of Acute Coronary Syndromes 205 13 Pathogenesis of Acute Coronary Syndromes 207 Angela M. Kucia and John D. Horowitz Overview 207 Acute Coronary Syndrome 207 Atherosclerosis 208 Endothelial Dysfunction 208 Inflammation 208 Plaque Rupture and Thrombosis 209 Pathological Characteristics of Myocardial Ischaemia and Infarction 210 Conclusion 213 References 214 14 Chest Pain Assessment 216 Angela M. Kucia, John F. Beltrame, and Jan Keenan Overview 216 Background 216 Coronary Heart Disease 217 Angina Pectoris 217 Acute Coronary Syndrome 218 Myocardial Infarction with Non-Obstructive Coronaries (MINOCA) 220 Presentation with Chest Pain in the Emergency Department 220 Typical Clinical Presentation of Ischaemic Chest Pain 221 Atypical Presentations 222 Chest Pain Assessment 223 Physical Examination in ACS Patients 225 The 12‑lead Electrocardiogram in ACS 225 Troponin 227 Clinical Assessment and Risk Stratification in ACS 227 Conclusion 228 References 228 15 Risk Stratification in Acute Coronary Syndromes 231 Deborah Wright, Cassandra Ryan, and Angela M. Kucia Overview 231 Background 231 The Nature of Risk in Cardiovascular Disease 233 Risk Stratification for Differentiating Between Likely Cardiac-Related Pain and Non-Cardiac Pain 233 Risk Stratification Tools 235 The HEART Score 235 Rule-in/Rule-out Strategies for NSTE-ACS 236 Conclusion 237 References 238 16 Management of Acute Coronary Syndromes 240 Christopher J. Zeitz, Ian D. Jones, and Angela M. Kucia Overview 240 Background 240 Considerations in Nursing Care of the Patient with Acute Coronary Syndrome 241 ST Elevation Acute Coronary Syndrome (STE-ACS) 242 ST-segment Myocardial Infarction (STEMI) 242 Ischaemic ECG Abnormalities not Meeting STEMI Criteria 245 Cardiac Biomarkers in STEMI 245 Principles of Reperfusion Strategies 245 Mechanical Reperfusion 246 Role of the Nurse when Caring for a Patient Receiving Thrombolysis 248 Complications of STEMI 249 Non-ST-segment Elevation Acute Coronary Syndrome (NSTE-ACS) 252 Convalescence and Secondary Prevention 253 Conclusion 254 References 255 17 Discharge Planning and Convalescence 257 David R. Thompson, Patricia M. Davidson, and Rosemary A. Webster Overview 257 Hospitalisation 257 Patient and Partner Reactions and Needs after an Acute Cardiac Event 258 Discharge Planning 258 High-Risk Groups 260 Convalescence 261 Promoting Self-Care and Self-Management in the Convalescent Phase 263 Common Concerns of Partners and Family Members 265 Facilitating Convalescence 265 Home-Based Services 266 Nurse-Led Clinics 266 Community Health Workers 266 Information Technology 267 Nursing Strategies to Promote Convalescence 267 Palliative Care 267 Conclusion 267 References 268 18 Prevention Strategies in Cardiovascular Disease 272 Rosemary A. Webster, Patricia M. Davidson, Praba Rabasse, and Angela M. Kucia Overview 272 Prevention Strategies 272 Primary Prevention in Cardiovascular Disease 273 Secondary Prevention in Cardiovascular Disease 273 Target Population for Secondary Prevention 274 Cardiac Rehabilitation 274 Assessment and Short-Term Monitoring 276 Lifestyle/Behavioural Modification 276 Psychosocial Risk Factors 283 Medication Adherence 283 Recovery and Longer-Term Maintenance 284 Conclusion 285 References 285 Part V Cardiac Arrest 289 19 Sudden Cardiac Death 291 Pete Gregory and Angela M. Kucia Overview 291 Background 292 Burden of Disease 292 Risk Factors for Sudden Cardiac Death 293 Screening in the General Population for Risk of Sudden Cardiac Death 294 Mechanisms of Sudden Cardiac Death 294 Sudden Cardiac Death in Structural Heart Disease 296 Cardiomyopathies and Sudden Cardiac Death 297 Inherited Primary Arrhythmia Syndromes 298 Sudden Cardiac Death Related to Special Populations 300 Impact of Sudden Cardiac Death on Families and Loved Ones 300 Conclusion 303 References 303 20 Pre-hospital Management of Cardiac Emergencies 306 Pete Gregory and Angela M. Kucia Overview 306 Introduction 307 Hazards to the Victim and Rescuer 308 Scene Safety 308 Risks to the Rescuer 308 Resuscitation During the COVID-19 Pandemic 308 Risks to the Victim 309 Circumstances that make OHCA Different from Hospital Resuscitation 310 Pauses in Chest Compressions 312 Automated External Defibrillation 312 Practical Factors Affecting Defibrillation 312 Chest Compressions Following Defibrillation 313 Conclusion 313 References 314 21 In-Hospital Resuscitation 317 Angela M. Kucia and Melanie Rushton Overview 317 Prevention: Systems for Identifying Patients at Risk of Cardiac Arrest 319 Recommended Strategies for the Prevention of Avoidable Cardiac Arrest 320 Rescuer Safety 323 Equipment 325 Basic Life Support 325 Advanced Life Support 326 Post-Resuscitation Care 327 Audit and Data Collection 328 Conclusion 328 References 329 22 Ethical Issues in Resuscitation and end of Life Care 332 Angela M. Kucia and Annabella S. Gloster Overview 332 Guiding Ethical Principles in Resuscitation 332 Medical Futility 333 Resuscitation Orders 334 Advanced Care Planning and Advanced Directives 335 Withdrawal of Treatment 336 Witnessed Resuscitation 337 Organ Donation 337 Training and Research with the Newly Dead 338 Conclusion 338 References 339 Part VI Chronic Cardiac Conditions 341 23 Heart Failure 343 Salimah Hassan, Christopher Nicholson, Robyn Lotto, and Angela M. Kucia Overview 343 Definition of Heart Failure 344 Heart Failure Terminology 344 Epidemiology 346 Significance 347 Prognosis 347 Aetiology 347 Diagnosis 348 Investigations 353 Chronic Heart Failure Management 354 Comorbidities in Heart Failure 361 Systems of Care 364 End of Life 365 Acute Heart Failure 365 Conclusion 367 References 367 24 Congenital Heart Disease 372 Robyn Lotto, Christopher Nicholson, and Angela M. Kucia Overview 372 Background 372 Epidemiology 372 Risk Factors for the Development of Congenital Heart Disease 373 Embryology 374 Congenital Heart Disease Classification 375 CHD with Shunt Between Systemic and Pulmonary Circulation 376 Acyanotic CHD 378 Acyanotic CHD with Outflow Obstruction 381 Cyanotic CHD 383 Dextrocardia 386 Conclusion 393 References 394 25 Structural Heart Disease 399 Christopher Nicholson, Salimah Hassan, Robyn Lotto, and Angela M. Kucia Overview 399 Valvular Heart Disease 399 Cardiomyopathy 404 Other Forms of Cardiomyopathy 407 The Multidisciplinary Team Caring for Patients with Acquired Structural Heart Disease 408 Conclusion 408 References 409 26 Takotsubo Syndrome 412 Angela M. Kucia Overview 412 Background 412 Epidemiology 413 Prognosis 413 Pathophysiology 415 Triggers for TTS 416 Clinical Presentation 417 Wall Motion Abnormalities in TTS 419 Cardiac Biomarkers 420 Diagnostic Criteria 420 Diagnostic Imaging 420 Clinical Course 421 Management 422 Conclusion 423 References 424 27 Non-Obstructive Coronary Artery Disease (MINOCA/INOCA) 428 Angela M. Kucia and John F. Beltrame Overview 428 Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) 428 Management 430 Conclusion 434 References 435 Index 437