Cardiac Nursing

Name: Cardiac Nursing
Brand: Wolters Kluwer Health
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Elizabeth M. Perpetua Patricia Keegan(Autor*in)

Wolters Kluwer Health (Verlag)

1. Auflage

Erschienen am 21. Oktober 2020

984 Seiten

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Inhalt

Cover
Title Page
Copyright
Dedication
Acknowledgments
About the Editors
Preface to the 7th Edition
Standards of Cardiovascular Nursing Practice
Previous Edition Contributors
Contributors
Contents
PART I: FUNDAMENTALS
1 Evidence-Based Practice in Cardiac Nursing
BACKGROUND
PRIMER FOR EVIDENCE-BASED PRACTICE
Definition and Rationale
Terminology and Resources
Research Databases
Reference Types
Types of Research
EVIDENCE-BASED PRACTICE MODELS
Ask the Question (Define the Problem)
Construct the PICO Question
Attain and Appraise the Evidence
Plan and Execute the Search Strategy
Appraise the Evidence
Apply the Evidence and Assess the Process
CONCLUSION
2 Cardiac Anatomy and Physiology
BACKGROUND
GENERAL ANATOMIC DESCRIPTION
Location and Dimensions
Anatomical Orientation
EXTERNAL SURFACE OF THE HEART
Pericardial Membranes
Pericardium
Epicardium
Surfaces of the Heart
Sulci
INTERNAL STRUCTURES OF THE HEART
Septa
Fibrous Skeleton
Chambers
Right Heart
Left Heart
Valves
CORONARY CIRCULATION
Coronary Arteries
Vessel Dominance
Right Coronary Artery
Left Coronary Artery
Coronary Capillaries
Coronary Veins
Lymph Drainage
CARDIAC INNERVATION
CARDIAC TISSUE
Myocardium
Endocardium
Conduction Tissues
MYOCARDIAL CELLS
Myocardial Cell Structure
Myocardial Cell Electrical Characteristics
Basis for Myocardial Excitation: Characteristics of Biologic Membranes
Mechanisms of Ion Distribution Across the Myocardial Membrane
CARDIAC ACTION POTENTIAL
Fast-Type Myocardial Action Potentials
Phase 0: Action Potential Upstroke
Phase 1: Early Repolarization
Phase 2: Action Potential Plateau
Phase 3: Late Rapid Repolarization
Phase 4: Interim Between Action Potentials
Slow-Type Myocardial Action Potentials
Action Potential of the Sinus Node Cells
Action Potential of Purkinje-Type Cells
Action Potential of Atrial Cells
Cells in the AV Node
Cells in the Bundle of His
Refractory Periods
SARCOLEMMAL IONIC CURRENTS
Inward Currents
Fast Inward Current INA
Calcium Currents
Pacemaker Current
Transient Diastolic Inward Current Iti
Outward Currents
Outward Rectifying Current IK
Background Outward Current IK1
Transient Outward Current Ito
Other Potassium Currents
FACTORS MODIFYING ELECTROPHYSIOLOGIC FUNCTION
Adrenergic and Cholinergic Effects
Catecholamines
Acetylcholine
Effects of Acidosis and Alkalosis
Other Effects
PROPAGATION OF THE CARDIAC IMPULSE
Atrial Conduction
Junctional Conduction
Ventricular Conduction
Excitation-Contraction Coupling
MECHANICAL CHARACTERISTICS OF CARDIAC CELLS
Overview of Contraction
Molecular Basis for Contraction
Molecular Basis for Relaxation
Modulation of Sarcoplasmic Calcium Ion Concentration
MECHANICAL PROPERTIES OF THE MYOCARDIUM
Preload and Afterload
Preload Role: Length-Tension Relationship
Afterload Role: Force-Velocity Relationship
Contractility of Cardiac Muscle
Treppe
Cardiac Reserve
Assessment of the Pump Performance
MYOCARDIAL METABOLISM
PHYSIOLOGY OF THE CORONARY CIRCULATION
Determinants of MVO2
Intramyocardial Tension
Heart Rate
Shortening
Contractile State
Pressure versus Volume Work
Indices of MVO2
Myocardial Oxygen Supply
Control of Coronary Blood Flow
Collateral Circulation
Clinical Implications
THE CARDIAC CYCLE
Left Ventricular Cardiac Events
Ventricular Systole
Ventricular Diastole
Right Ventricular Cardiac Cycle
Cardiac Valvular Events and Normal Heart Sounds
Valvular Events
Normal Heart Sounds
Clinical Applications of Cardiac Events
Systolic Events
Diastolic Events
CONCLUSION
3 Systemic and Pulmonary Circulation and Oxygen Delivery
BACKGROUND
STRUCTURAL CHARACTERISTICS OF THE VASCULATURE AND LYMPHATICS
Arteries
Microvascular Bed
Arterioles
Capillaries
Exchange Vessel Endothelium
Venules
Veins
Venous Valves
Venoconstriction
Lymphatics
Vascular Smooth Muscle
LOCAL REGULATION
Autacoids
Endothelium-Derived Vasoactive Substances
Endothelium-Derived Relaxing Factors
Nitric Oxide
Prostacyclin
Endothelium-Derived Hyperpolarizing Factors
Endothelium-Derived Contracting Factors
Endothelin-1
Prostanoids
Reactive Oxygen Species
Local Metabolic Control of Blood Flow
NEUROHUMORAL STIMULATION
Adrenergic Stimulation
a-Adrenergic Stimulation
ß-Adrenergic Stimulation
Vasopressin
Intracellular Signals for Vasodilation and Vasoconstriction
Cyclic Guanosine Monophosphate
Inositol Triphosphate
CALCIUM
Sources of Calcium
Calcium Signaling
VOLUME AND FLOW DISTRIBUTION
Resistance
Volume Distribution
BLOOD FLOW
Definition of Flow
Determinants of Flow
Pressure
Resistance
THE VENOUS SYSTEM
Venous Pressure and Resistance
Venous Compliance
MICROCIRCULATORY EXCHANGE
Flow Through the Microvascular Circulation
Microvascular Transport Mechanisms
Diffusion
Ultrafiltration
The Lymphatic System
PULMONARY CIRCULATION
Gross Anatomy
Cellular and Hormonal Effects
Physiology
Ventilation
Dead Space
Lung Zones
Diffusion
Ventilation-Perfusion Matching
Causes of Arterial Hypoxemia
GAS TRANSPORT
Gas Exchange
Oxygen Cascade
Mitochondrial Respiration
OXYGEN DELIVERY, CONSUMPTION, EXTRACTION
Oxygen Delivery
Cardiac Output
Hemoglobin
Partial Pressure of Oxygen
Arterial Oxygen Saturation
Oxyhemoglobin Dissociation Curve
Blood Oxygen Content
Measurement of Oxygen Delivery
Oxygen Consumption
Oxygen Extraction Ratio
CONCLUSIONS
4 Regulation of Cardiac Output and Blood Pressure
AFFERENT INPUT AND RECEPTOR
Arterial Baroreceptors
Cardiopulmonary Receptors
Bezold-Jarisch Reflex
Chemoreceptors
CENTRAL NERVOUS SYSTEM REGULATION
AUTONOMIC NERVOUS SYSTEM REGULATION
Sympathetic Nervous System
Adrenoreceptors
Cutaneous Vasculature
Neurotransmitters
Parasympathetic Nervous System
Receptors
Cotransmitters
Neuropeptide Y
Vasoactive Intestinal Peptide
SYSTEMIC HORMONES
Epinephrine
Arginine Vasopressin
Natriuretic Peptides
Renin-Angiotensin-Aldosterone System
Kallikrein-Kinin System
Interaction Between the KKS, RAAS, and Natriuretic Hormones
Norepinephrine Spillover
ARTERIAL BLOOD PRESSURE
HEART RATE
Control of Heart Rate
Respiratory Sinus Arrhythmia
Heart Rate and Cardiac Output
INTRINSIC CARDIAC CONTROL
Preload
Afterload
Contractility
EXTRINSIC CONTROL: PERICARDIAL LIMITATION
LONG-TERM CONTROL OF BLOOD PRESSURE
Pressure Diuresis-Natriuresis Model
Alternative Models of Long-Term Blood Pressure Control
Basal Tone
LOCAL REGULATION OF SYSTEMIC MICROVASCULAR BEDS
Autoregulation
Myogenic Hypothesis
Metabolic Hypothesis
Tissue Pressure Hypothesis
VENOUS SYSTEM
Neurohumoral Stimulation
Passive versus Active Effects
RELATION BETWEEN CARDIAC OUTPUT AND CENTRAL VENOUS PRESSURE-RETROGRADE VERSUS ANTEGRADE MODELS
Muscle Pump
Respiratory Pump
VALSALVA MANEUVER
OVERALL CONTROL
Baroreflex Control of Blood Pressure
Arterial Baroreceptor Response to Decreased Arterial Pressure
Arterial Baroreceptor Response to Increased Arterial Pressure
CONCLUSION
5 Hematopoiesis, Coagulation, and Bleeding
BACKGROUND
Current State and Context
Hematopoietic Cells
Red Blood Cells
White Blood Cells
Platelets
Coagulation Factors
HEMOSTASIS
Vascular Spasm
Role of the Endothelium in Hemostasis
Platelet Phase
Coagulation Cascade
Extrinsic Pathway
Intrinsic Pathway
Common Pathway and Fibrin Formation
Fibrinolysis
Natural Anticoagulant Systems
COAGULATION-INFLAMMATION LINK
BLEEDING DISORDERS
DISSEMINATED INTRAVASCULAR COAGULATION
Etiology
Pathophysiology
Clinical Manifestations
Medical Management
Nursing Interventions
CLOTTING DISORDERS
Clot Formation
Deep Vein Thrombosis
Etiology
Pathophysiology
Clinical Manifestations
Medical Management
Anticoagulation
Prophylaxis
Nursing Interventions
Pulmonary Embolism
Pathophysiology
Clinical Manifestations
Medical Management
Nursing Interventions
Heparin-Induced Thrombocytopenia
Pathophysiology
Etiology
Clinical Presentation
Medical Management
Nursing Interventions
6 Fluid and Electrolyte and Acid-Base Balance and Imbalance
PRINCIPLES OF FLUID BALANCE
Body Fluid Compartments
Osmolality
Processes Involved in Fluid Balance
Fluid Intake
Fluid Distribution
Fluid Excretion
Fluid Loss by Abnormal Routes
Summary of Fluid Balance
EXTRACELLULAR FLUID VOLUME BALANCE
Extracellular Fluid Volume Deficit
Extracellular Fluid Volume Excess
OSMOLALITY BALANCE
Hyponatremia
Hypernatremia
Mixed ECV and Osmolality Imbalances
PRINCIPLES OF ELECTROLYTE BALANCE
ELECTROLYTE IMBALANCES
Potassium Balance
Hypokalemia
Hyperkalemia
Calcium Balance
Hypocalcemia
Hypercalcemia
Magnesium Balance
Hypomagnesemia and Total-Body Magnesium Depletion
Hypermagnesemia
Phosphate Balance
Severe Hypophosphatemia
SUMMARY OF FLUID AND ELECTROLYTES
PRINCIPLES OF ACID-BASE BALANCE
Terminology Review
Processes Involved in Acid-Base Balance
Acid Production
Acid Buffering
Acid Excretion
SUMMARY OF ACID-BASE BALANCE
ACID-BASE IMBALANCES
Acidosis
Respiratory Acidosis
Metabolic Acidosis
Alkalosis
Respiratory Alkalosis
Metabolic Alkalosis
Principles of Interpreting Arterial Blood Gas Reports
Mixed Acid-Base Imbalances
7 Sleep
INTRODUCTION
NORMAL SLEEP
Sleep and Sleepiness
Normal Sleep
Age
Circadian Rhythms
Environment
Drug and Alcohol Exposure
Health and Sleep Disorders
The Function of Sleep
SLEEP PHYSIOLOGY
Cardiovascular Function in Sleep
Respiratory Function in Sleep
Thermoregulation in Sleep
Cerebral Blood Flow in Sleep
Renal Function in Sleep
Endocrine Function in Sleep
CLINICAL EVALUATION, DIAGNOSIS, AND APPROACHES
Subjective Measurement
Behavioral Assessment
Objective Measurement
IMPAIRED SLEEP, SLEEP DISORDERS, AND EXCESSIVE DAYTIME SLEEPINESS
Sleep-Related Disordered Breathing
Obstructive Sleep Apnea
Central Sleep Apnea
Restless Legs Syndrome and Periodic Limb Movement
SLEEP IN PATIENTS WITH CARDIOVASCULAR DISEASE
Sleep in Coronary Heart Disease
Sleep in the Cardiovascular Intensive Care Unit and After Cardiac Surgery
Sleep After Cardiac Surgery
Sleep and Heart Failure
Interventions in HF
Sleep and Hypertension
Sleep and Stroke
Sleep and Diabetes Mellitus
Sleep and Chronic Obstructive Pulmonary Disease
Sleep and Depression
CARDIAC EVENTS IN SLEEP
Angina
Sleep and Arrhythmias
NURSING CARE GOALS
SLEEP PROMOTING INTERVENTIONS
Nonpharmacologic Outpatient Interventions for the Management of Sleep Disturbances in Patients With Cardiovascular Disease
Sleep Education and Hygiene
Relaxation Therapy
Stimulus Control Therapy
Sleep Restriction Therapy
Cognitive Therapy
Complementary and Alternative Medicine
Meditation
Aromatherapy
Manipulative and Body-Based Practices
Acupressure
Yoga
Tai chi
Pharmacologic Interventions to Promote Sleep
Nonbenzodiazepines and Ramelteon
Benzodiazepines
Other Drugs Used to Treat Insomnia
Antidepressants
Over-the-Counter Medications
Melatonin
SLEEP OF HEALTHCARE PROVIDERS
8 Physiologic Adaptations With Aging
BACKGROUND
General Physiologic Changes
Cardiovascular Changes
Cardiac Structural Changes
Vascular System
Cardiovascular Autonomic Nervous System Modulation
Respiratory Changes
Structural Changes
Functional Changes
Renal Changes
Structural Changes
Functional Changes
Hepatic Changes
Structural Changes
Functional Changes
EFFECTS OF AGING ON PHARMACOKINETICS
Drug Absorption
Drug Distribution
Drug Metabolism and Excretion
Future Considerations and Implications
PART II: EVALUATION
9 History and Physical Exam
BACKGROUND
HISTORY
Cardiovascular History
Health History
Identifying Information
Chief Complaint or Presenting Problem
History of Present Illness
Past History
Psychosocial History
Family History
Personal and Social History
Review of Systems
Functional Patterns
Functional and Therapeutic Classification
PHYSICAL ASSESSMENT
General Appearance
Height, Weight, and Waist Circumference
Head
Facial Characteristics
Color
Temperature
Eyes
Arterial Pulse
Pulse Rate and Rhythm
Pulse Amplitude and Contour
Bruits
Jugular Venous Pulse
Jugular Venous Pressure
Patterns of the Venous Pulse
Blood Pressure
Sphygmomanometer
Technique
Measurement of Pulse Pressure
Measurement of Postural Blood Pressure
Measurement of Paradoxical Blood Pressure
Blood Pressure Measurement Under Special Conditions
Peripheral Vascular System
Inspection and Palpation
Clubbing
Arterial Circulation
Venous Circulation
Heart
Topographic Anatomy
Inspection
Palpation
Auscultation
Lungs
Inspection
Posterior Chest
Anterior Chest
Abdomen
Inspection
Auscultation
Percussion
Palpation
CONCLUSIONS
10 Laboratory Tests Using Blood
BLOOD SPECIMEN COLLECTION
Patient Preparation
Universal Precautions
Blood Sample Collection
Types of Specimens
Interpretation of Results
Sensitivity and Specificity of Laboratory Tests
Point-of-Care Testing
BIOCHEMICAL MARKERS OF MYOCARDIAL INJURY
Myocardial Proteins
Troponins
Cardiac Enzymes
Creatine Kinase
Myoglobin
Biochemical Marker Activity After PCI
Biochemical Marker Activity After Cardiac Surgery
BLOOD LIPIDS
Blood Lipid Laboratory Measurement
ADDITIONAL LABORATORY TESTS ASSOCIATED WITH CARDIAC DISEASE
C-Reactive Protein
Homocysteine
Lipoprotein-Associated Phospholipase A2
Cardiac Natriuretic Peptide Markers
MR-ProADM and Copeptin
HEMATOLOGIC STUDIES
Complete Blood Cell Count
Red Blood Cell Count
White Blood Cells
Erythrocyte Sedimentation Rate
Laboratory Measurement of Complete Blood Cell Values
Complete Blood Count After Cardiac Surgery
COAGULATION STUDIES
Platelet Count
Prothrombin Time
Partial Thromboplastin Time and Activated Partial Thromboplastin Time
Activated Clotting Time
Fibrinogen Level
Protein C and Protein S
D-Dimer (Fibrin Degradation Fragment)
ARTERIAL BLOOD GASES
BLOOD CHEMISTRIES
Serum Electrolytes
Sodium
Potassium
Chloride
Calcium
Magnesium
Carbon Dioxide
Anion Gap
Serum Osmolality
Serum Electrolytes After Cardiac Surgery
SELECTED CHEMISTRIES
Alkaline Phosphatase
Alanine Aminotransferase
Aspartate Aminotransferase
Bilirubin
Catecholamines
Creatinine
Glucose
Glycated Hemoglobin or HbA1C
Lactate Dehydrogenase
Protein
Urea Nitrogen
Uric Acid
BLOOD CULTURES
SERUM CONCENTRATION OF SELECTED DRUGS
11 Radiologic Examination of the Chest
BACKGROUND
HOW X-RAYS WORK
INTERPRETATION OF CHEST RADIOGRAPHS
Airway
Bones
Circulation
Diaphragm
Everything Else
CHEST FILM FINDINGS IN ACUTE CARE DETERMINING LINE, TUBE, AND CATHETER PLACEMENT
CHEST FILM FINDINGS IN CARDIOVASCULAR DISEASE
12 Electrocardiography and Cardiac Rhythm
BACKGROUND
ELECTRICAL CONDUCTION THROUGH THE HEART
Cardiac Conduction System
Sinus Node
AV Node
Bundle of His
Bundle Branches
Purkinje Fibers
WAVES, COMPLEXES, AND INTERVALS OF THE CARDIAC CYCLE
P Wave
PR Interval
QRS Complex
T Wave
ST Segment
J Point
QT Interval
U Wave
R-R and P-P Intervals
BASIC ELECTROCARDIOGRAPHY
Determining Heart Rate on the ECG
Six-Second Method
Large Box Method
Small Box Method
Determining the Cardiac Rhythm on the ECG
12-LEAD ECG
Standard Limb Leads
Augmented Limb Leads
Precordial Leads
Right-Side and Posterior ECG
The Hexaxial Reference System
The 12 Views of the Heart
AXIS DETERMINATION
INTRAVENTRICULAR CONDUCTION ABNORMALITIES
Bundle Branch Block
Right Bundle Branch Block
Left Bundle Branch Block
Differentiating Right and Left Bundle Branch Block
Fascicular Block
Left Anterior Fascicular Block
Left Posterior Fascicular Block
Bifascicular Block
ACUTE CORONARY SYNDROME
ECG DIAGNOSIS OF STEMI
Anterior MI
Inferior MI
Lateral MI
Posterior MI
Right Ventricular MI
ECG DIAGNOSIS OF UA/NSTE-ACS
ATRIAL AND VENTRICULAR HYPERTROPHY/ENLARGEMENT
Atrial Enlargement
Right Atrial Enlargement
Left Atrial Enlargement
Biatrial Enlargement
Ventricular Enlargement
Right Ventricular Enlargement/Hypertrophy
Left Ventricular Enlargement/Hypertrophy
ELECTROLYTE IMBALANCES
Hypokalemia
Hyperkalemia
Hypocalcemia
Hypercalcemia
Hypomagnesemia and Hypermagnesemia
DRUG EFFECTS AND LONG QT SYNDROMES
Digitalis
Drugs That Prolong QT Interval
Long QT Syndromes
MECHANISM OF ARRHYTHMIAS
Abnormal Impulse Initiation
Increased/Decreased Sinus Node Activity
Enhanced Normal Automaticity
Abnormal Automaticity
Triggered Activity Due to Afterdepolarizations
Early Afterdepolarizations
Delayed Afterdepolarizations
Abnormal Impulse Conduction
Conduction Block
Decremental Conduction
Phase 3 Block
Phase 4 Block
Reentry
Arrhythmias and Conduction Disturbances
Rhythms Originating in the SA Node
Normal Sinus Rhythm
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Sinus Arrest
Sinus Exit Block
Sick Sinus Syndrome
Rhythms Originating in the Atria
Premature Atrial Complex
Multiform Atrial Rhythm
Multifocal Atrial Tachycardia
Atrial Tachycardia
Atrial Fibrillation
Atrial Flutter
Supraventricular Tachycardia
Rhythms Originating in the AV Junction
Premature Junctional Complexes
Junctional Rhythm and Junctional Tachycardia
Rhythms Originating in the Ventricles
Premature Ventricular Contractions
Accelerated Idioventricular Rhythm
Ventricular Tachycardia
Ventricular Flutter
Ventricular Fibrillation
Ventricular Asystole
Conduction Abnormalities
First-Degree AV Block
Second-Degree AV Block
Type I (Wenckebach)
Type II
Conduction
High-Grade AV Block
Third-Degree AV Block
Complex Arrhythmias and Conduction Disturbances
Ventricular Pre-Excitation Syndromes
Wolff-Parkinson-White Syndrome
Supraventricular Tachycardia
Atrioventricular Nodal Reentry Tachycardia
Circus Movement Tachycardia
Ventricular Tachycardia
Monomorphic VT
Polymorphic VT
Torsade de Pointes
GENETICS OF CHANNELOPATHIES
Catecholaminergic Polymorphic Ventricular Tachycardia
Short QT Syndrome
Long QT Syndrome
Brugada Syndrome
DIFFERENTIAL DIAGNOSIS OF WIDE QRS BEATS AND TACHYCARDIAS
Mechanism of Aberration
Electrocardiographic Criteria
13 Echocardiography
BACKGROUND
PRINCIPLES AND TECHNIQUES OF ECHO
Sound Waves
M-Mode
2D
Doppler
3D
Transesophageal Echo
ECHO EXAMINATION
Patient Preparation
Transthoracic Echo
Transesophageal Echo
Axis of the Heart
Imaging Windows
Parasternal Window
Apical Window
Subcostal Window
Suprasternal Window
ECHO APPLICATIONS
Contrast Echo
Stress Echo
Periprocedural Transesophageal Echocardiography
NURSING ROLE IN ECHOCARDIOGRAPHY
Foundational Literacy
Patient Preparation and Surveillance
Specialization and Advanced Practice
CONCLUSION
14 Cardiac Stress Testing-Physiologic Evaluation With Exercise and Pharmacologic Agents
BACKGROUND
Historical State and Context
CURRENT STATE AND CONTEXT
INDICATIONS AND GUIDELINES
Indications for Cardiac Stress Testing
Contraindications to Cardiac Stress Testing
Guidelines of Cardiac Stress Testing
Coronary Artery Disease
Arrhythmias
Syncope
SELECTION AND TYPES OF STRESS TESTS
Pretest Considerations
Cardiac Stress Test Selection
Exercise Stress Testing
Pharmacologic Stress Testing
Protocols of Cardiac Stress Testing
Bruce Treadmill Protocol
Balke Treadmill Protocol
Naughton Treadmill Protocol
Bicycle Ergometer Protocols
Ramp Testing Protocol
Submaximal Testing Protocol
Ancillary Methods for the Detection of CAD
Radionuclide Angiography
Pharmacologic Stress Techniques
Ventricular Function Studies
Exercise Echocardiographic Imaging
Gas Exchange Techniques
TEST INTERPRETATION
Heart Rate
Blood Pressure
Troponin
Exercise Capacity
Electrocardiographic Responses
Arrhythmias During Exercise Testing
Subjective Responses
Termination of Exercise Testing
Recovery Period
Assessing Test Accuracy
Sensitivity and Specificity
Predictive Value
Prognosis
Exercise Testing-Special Populations
Women
The Elderly
Patients After Cardiac Transplantation
Patients With Congenital Cardiac Disorders
CONCLUSIONS
ACKNOWLEDGMENT
15 Nuclear, Magnetic Resonance, and Computed Tomography Imaging
BACKGROUND
NUCLEAR CARDIOLOGY
Radioisotope Pharmaceuticals
Diagnostic Indications for Nuclear Imaging
Myocardial Viability
Patient Preparation for Myocardial Perfusion Studies
Radionuclide Ventriculogram
First-Pass
Patient Preparation for RNVG
Hybrid Imaging
Risks of Radionuclides
MAGNETIC RESONANCE IMAGING
Indications
Nonischemic Cardiomyopathy
Ischemic Cardiomyopathy
Congenital Heart Disease
Atrial Ablation Planning
Evaluation of Cardiac Valves
Arrhythmogenic Right Ventricular Cardiomyopathy
Large Vessel Pathology
Intracardiac Mass
Pericardial Effusions
Patient Preparation
COMPUTED TOMOGRAPHY
CT System
CT Scanners
Modern CT Scanner
Cardiac Gating
Contrast
Protocols
Indications
Coronary Anatomy
Cardiac Valve Interventions
Cardiac Arrhythmia Interventions
Left Ventricular Assist Devices
Patient Considerations
Patient Preparation
Contrast Reactions
Post Processing
CONCLUSION
16 Cardiac Catheterization
BACKGROUND
Historical State and Context
Epidemiology (Prevalence, Incidence) and Demographics
Current State and Context
LEFT HEART CATHETERIZATION
Indications for Coronary Angiography
Guideline Recommendations
Contraindications and Special Considerations for Left Heart Catheterization
Contraindications
Special Considerations
Left Heart Catheterization Approaches
Percutaneous Catheterization
Left Heart Catheterization Procedures
Coronary Arteriography
Quantitative Angiography
Intravascular Ultrasound Imaging
Coronary Flow Reserve
Fractional Flow Reserve
Ventriculography
Gradient Assessment
RIGHT HEART CATHETERIZATION AND HEMODYNAMICS
Indications for Right Heart Catheterization
2013 Heart Failure Guidelines for Invasive Evaluation
Right Heart Catheterization Studies
Endomyocardial Biopsy
Hemodynamic Waveform Interpretation
Cardiac Output Studies
Oximetry Runs
NURSING CARE OF THE CARDIAC CATHETERIZATION PATIENT
Nursing Assessment and Patient Preparation Preprocedure
Nursing Care Intraprocedure
Nursing Assessment for Complications
Nursing Care Postprocedure
Psychological Assessment and Patient Teaching
CONCLUSIONS
Future Considerations/Implications
17 Hemodynamic Monitoring
BACKGROUND
PHYSIOLOGIC PRINCIPLES OF HEMODYNAMIC MONITORING
Cardiac Cycle and Electrocardiogram
TECHNICAL ASPECTS OF INVASIVE PRESSURE MONITORING
Referencing
Zeroing
Transducer Setup
Patient Position for Pressure Measurement
Square Wave Test
Relation of Intracardiac Pressure Measurement to ECG
Blood Sampling and Infection Control
INVASIVE BLOOD PRESSURE MONITORING
Indications
Arterial Site Selection for Catheter Placement
Allen Test
Complications Related to Arterial Catheterization
Arterial Pressure Wave
Direct Arterial Versus Cuff Pressure
Interpretation of Arterial Pressure Data
Noninvasive Blood Pressure Measurement
VENTRICULAR FUNCTION CURVES
CVP MONITORING
Indications
Effect of Catheter Type and Location on CVP
Limitations
Complications
Interpretation of CVP Waveform
PULMONARY ARTERY CATHETER
History of Pulmonary Artery Catheter
Indications
Description
Insertion of PAC
Measurement Method
Right Ventricular Pressure
PAP and PAWP
Measuring PAP
Measuring PAOP/PAWP
Left Ventricular End-Diastolic Pressure
Respiratory Variations
Spontaneous Ventilation Versus Mechanical Ventilation
Cardiac Output
Cardiac Index
Preload
Afterload
Contractility
Thermodilution Cardiac Output
Continuous Cardiac Output
Fick Method
Cardiac Output Measurement in Targeted Temperature Management
OXYGEN SUPPLY AND DEMAND
Venous Oxygen Content
SvO2
ScvO2
Serum Lactate
FUNCTIONAL HEMODYNAMICS
Systolic Pressure Variation
Pulse Pressure Variation
Stroke Volume Variation
End-Expiratory Occlusion Test
Clinical Indications and/or Implications of Functional Hemodynamics
Limitations of Functional Hemodynamics
Passive Leg Raising
End-Tidal Carbon Dioxide
Valsalva Maneuver
Other Tests Using Heart-Lung Interactions
LESS INVASIVE METHODS FOR HEMODYNAMIC EVALUATION
Esophageal Doppler
Echocardiography
Collapsibility Index
Bioreactance Technology
Noninvasive Finger Cuff
TISSUE PERFUSION MONITORING
Sublingual Capnometry
Near-Infrared Spectroscopy
Sidestream Dark Field Imagery
IMPLANTABLE PA PRESSURE MONITORING
CONCLUSION
18 Cardiac Electrophysiology Studies
BACKGROUND
DIAGNOSTIC EP STUDIES
Patient Preparation
Nursing Care of the Patient Undergoing EP Procedures
Techniques
Complications
Indications
Cardiac Arrest Survivors
Wide-Complex Tachycardias
Syncope
INTERVENTIONAL EP AND CATHETER ABLATION
Catheter Ablation
Techniques
Complications
Indications
AV Nodal Reentrant Tachycardia
AV Reentrant Tachycardia
Atrial Flutter
Atrial Fibrillation
Atrial Arrhythmias
Ventricular Tachycardia
CONCLUSIONS
PART III: RISK ASSESSMENT AND PREVENTION
19 Psychosocial Risk Factors for Cardiac Disease
BACKGROUND: PREVALENCE AND EPIDEMIOLOGY
PSYCHOSOCIAL RISK FACTORS FOR CARDIOVASCULAR DISEASES
Emotional Factors
Depression
Anxiety
Hostility and Anger
Behavioral Factors
Chronic Psychosocial Stressors
Low Socioeconomic Status
Low Social Support and Social Isolation
Work Stress
PATHOPHYSIOLOGIC RELATIONSHIP BETWEEN PSYCHOSOCIAL RISK FACTORS AND CARDIOVASCULAR DISEASE
Autonomic Dysfunction
Adrenal Dysfunction
Endothelial Dysfunction
Inflammation and Hypercoagulability
ASSESSMENT OF PSYCHOSOCIAL RISK FACTORS IN PATIENTS WITH CARDIOVASCULAR DISEASE
Depression and Anxiety
Low-Perceived Social Support
NURSING AND PHARMACOLOGIC INTERVENTIONS
Nursing Interventions
Emotional Factors
Behavioral Factors
Chronic Stressors
Pharmacologic Interventions
20 Obesity: An Overview of Assessment and Treatment
BACKGROUND
IDENTIFICATION AND ASSESSMENT OF THE OVERWEIGHT OR OBESE PATIENT
Weight Status
Waist (Abdominal) Circumference
Assessment of Cardiovascular Disease Risk Factors
Very High Absolute Risk
High Absolute Risk
Additional Factors That Increase Absolute Risk
Cardiovascular-Related Conditions Influenced by Obesity
Undertreated Groups
CLINICAL EVALUATION
Clinical History
Eating and Physical Activity Patterns
Patient Motivation
Environmental Barriers to Weight Loss
WEIGHT LOSS TREATMENT
Treatment Approach
Goal of Treatment
Components of Treatment
Lifestyle Modification
Dietary Therapy
Exercise and Physical Activity
Behavioral Therapy
Pharmacotherapy
Bariatric Surgery
Maintenance of Weight Loss
ACKNOWLEDGMENT
21 Exercise and Activity
INTRODUCTION
DEFINITIONS
DESIGNING AN EXERCISE PRESCRIPTION
CARDIOVASCULAR HEALTH CONDITIONS
Hypertension
Diabetes
Heart Failure
Myocardial Ischemia/Myocardial Infarction
Peripheral Arterial Disease
Rhythm Disturbances
THE CONTINUUM OF CARE: HOSPITAL BASED ACTIVITY TO HOME
22 Smoking Cessation and Effective Treatment
BACKGROUND
Populations at Risk for Smoking Afflictions
UNDERSTANDING THE NEUROBIOLOGY AND PATHOPHYSIOLOGY OF NICOTINE ADDICTION
Recognizing and Understanding Nicotine Cravings and Withdrawal
Risk for Nicotine Addiction in Adolescence
CARDIOVASCULAR RISK AND SMOKING
Tobacco Smoke and Atherosclerotic Changes
Benefits of Quitting Smoking and Cardiac Events
ASSESSING TOBACCO DEPENDENCY
Approaching the Tobacco Use Conversation With Patients
Assessing Readiness to Quit
Motivational Interviewing for Behavior Change
PHARMACOKINETICS OF NICOTINE IN CIGARETTE SMOKING
PHARMACOTHERAPY AND TREATMENT OF TOBACCO DEPENDENCE
Nicotine Replacement Therapy
Nicotine Transdermal Patch as a Long-Acting Delivery System
Short-Acting Nicotine Replacement Therapy for Breakthrough Cravings
Nicotine Gum and Lozenge
Nicotine Inhaler
Nicotine Nasal Spray
Bupropion
Varenicline
SAFETY OF PHARMACOTHERAPY IN PSYCHIATRIC DISEASE
SAFETY OF PHARMACOTHERAPY IN CARDIOVASCULAR DISEASE
AUGMENTED APPROACHES FOR SUCCESSFUL CESSATION
Reduce-to-Quit Strategies Are Effective in Helping Patients Quit Smoking
Recognizing and Treating Nicotine Dependence as a Chronic Disease
Extended Duration of Nicotine Dependence Treatment
Behavioral Therapy for Tobacco Dependence
RELAPSE PREVENTION, SETTING THE STAGE FOR SUCCESSFUL AND SUSTAINED CESSATION
FUTURE CONSIDERATIONS
23 Hypertension
BACKGROUND
PATHOPHYSIOLOGY
Definitions and BP Classification and Goal
Adults
Children
Hemodynamics of HTN
Epidemiology
Risk Factors for Hypertension
Age, Gender, and Weight
Family History and Genetic Factors
Ethnic and Geographic Differences
Social Determinants
Causes of HTN
Primary HTN
Secondary HTN
Clinical Manifestations of HTN
Signs and Symptoms
Vascular Changes Associated With HTN
ASSESSMENT, DIAGNOSIS, AND CLINICAL EVALUATION
Assessment and Diagnosis
BP Measurement
Out-of-Office and Self-Monitoring of BP
White-Coat Hypertension
Masked HTN or Isolated Ambulatory HTN
Resistant HTN
Clinical Evaluation
Prognosis
PREVENTION AND MANAGEMENT
Prevention
Recommendations for Management
Risk-Based Approach to Management
Nonpharmacologic Interventions
Pharmacologic Management
Management in Special Populations
HTN in Older Adults
HTN in Racial and Ethnic Minorities
HTN in Pregnancy
HTN in Patients With Diabetes
HTN With Chronic Kidney Disease
Hypertensive Crisis
ACHIEVING BP CONTROL
Role of Patients
Role of Health Care Providers
Collaborative Care
Clinician Inertia
Role of Health Care Organizations
Role of the Community
24 Lipid Management
BACKGROUND
Present
Blood Lipids: Structure and Functions
Lipid Metabolism and Transport
Reverse Cholesterol Transport
LDL VARIANTS
LDL Particle Size
Oxidized LDL
The Role of Lp(a)
Lipoprotein-Associated Phospholipase A2
Cholesterol and Endothelial Function
DYSLIPIDEMIC DISORDERS
Hypercholesterolemia
Familial (Severe) Hypercholesterolemia
Hypertriglyceridemia
Hypoalphalipoproteinemia
Combined Dyslipidemias
THE MANAGEMENT OF HIGH BLOOD CHOLESTEROL
Recommendations for the Detection of High Cholesterol
Evaluation of the Patient With Elevated Cholesterol and Current Guidelines
HEART DISEASE IN WOMEN
INITIAL EVALUATION OF THE PATIENT WITH ELEVATED CHOLESTEROL
Lipoprotein Measurement
Dietary Management of Hyperlipidemia
Diet Patterns and Lipid Effects
Dietary Recommendations
Weight Control and Lipid Management
Alcohol and Lipoproteins
Physical Activity and Lipoproteins
Hormones and Lipoproteins
PHARMACOLOGIC MANAGEMENT OF HYPERLIPIDEMIA
Classes of Hypolipidemic Drugs
Bile Acid-Binding Resins
Nicotinic Acid (Niacin)
CETP Inhibitor
HMG-CoA Reductase Inhibitors (Statins)
Intestinal Absorption Inhibitors
Fibric Acid Derivatives
Proprotein Convertase Subtilisin Kexin Type 9 Inhibitors
General Adherence Strategies
Putting It All Together
25 Diabetes and Cardiovascular Disease
CLASSIFICATION OF DIABETES AND OTHER FORMS OF GLUCOSE INTOLERANCE
DIAGNOSIS OF DIABETES AND CATEGORIES OF INCREASED RISK FOR DIABETES
PATHOPHYSIOLOGY OF DIABETES MELLITUS
Normal Physiology and Fuel Metabolism
Hormones of the Endocrine Pancreas
Normal Fuel Metabolism
Postabsorptive State
Absorptive State
Starvation
Fuel Metabolism in Diabetes Mellitus
TYPE 1 DIABETES MELLITUS
TYPE 2 DIABETES MELLITUS
METABOLIC SYNDROME
CARDIOVASCULAR DISEASE AND DIABETES
Prevention of Type 1 Diabetes
Prevention of Type 2 Diabetes
Lifestyle Interventions
Da Qing Study
Finnish Diabetes Prevention Study
Diabetes Prevention Program
Pharmacologic Interventions
TREATMENT OF DIABETES AND PREVENTION OF CARDIOVASCULAR DISEASE
Pharmacologic Treatments
Medical Nutrition Therapy
Physical Activity
Blood Pressure Control
Lipid Management
Prothrombotic Factors
NURSING MANAGEMENT OF DIABETES
26 Cardiovascular Disease in Women
INTRODUCTION
TRADITIONAL RISK FACTORS
Hypertension
Diabetes
Hyperlipidemia
Familial Hyperlipidemia
Tobacco Use
Physical Inactivity
Family History
FEMALE-SPECIFIC OR FEMALE PREDOMINATE CARDIOVASCULAR DISEASE RISK FACTORS
Genetic Risk Factors
Lipoprotein(a)
Autoimmune and Inflammatory Conditions
Hormone
Obesity
Psychosocial Factors
Psychological Stress
Depression
MANAGING ASCVD RISK IN WOMEN
Guidelines for Cardiovascular Disease Risk Assessment in Women
Pooled Cohort Risk Assessment for ASCVD
Advanced Imaging Modalities Used to Identify and Manage CVD Risk
Aspirin Use in Women
ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN WOMEN
Nonobstructive CAD in Women
NONATHEROSCLEROTIC CARDIOVASCULAR CONDITIONS IN WOMEN
Spontaneous Coronary Artery Dissection
Stress/Takotsubo Cardiomyopathy
Peripartum Cardiomyopathy
CONCLUSION
FUTURE IMPLICATIONS
27 Palliative Care in Cardiology
BACKGROUND
Historical State and Context
SCOPE AND STANDARDS OF PALLIATIVE CARE IN CARDIOLOGY
Overview of Palliative Care
Scope and Standards of Palliative Care in Cardiology Overview of Palliative Care
Barriers to Palliative Care Provision
Cardiac-Specific Guidelines
Layers of Palliative Care Provision
PROVISION OF PRIMARY PALLIATIVE CARE
Symptom Assessment in Cardiology
Advance Directives and End-of-Life Planning in Cardiology
End-of-Life Considerations
Implantable Cardiac Device Considerations
CONCLUSIONS
PART IV: PATHOGENESIS, DIAGNOSIS, MEDICAL MANAGEMENT, AND THERAPEUTIC INTERVENTION
28 Medical, Surgical, and Catheter-Based Therapy for Cardiovascular Disease
INTRODUCTION
BACKGROUND
Historical Evolution of Cardiovascular Technology
Minimally Invasive Circulatory Support
Percutaneous Mechanical Circulatory Support
Intra-Aortic Balloon Pump
Percutaneous Ventricular Assist Devices
Extracorporeal Membrane Oxygenation
CORONARY ARTERY DISEASE
Medical Management for Coronary Artery Disease
Catheter-Based Management of Coronary Disease
Stents
Bare Metal Stents
Drug-Eluting Stents
Bioresorbable Stent Technology
Robotic PCI
Surgical Management of Coronary Artery Disease
VALVULAR HEART DISEASE
Mitral Valve Disease
Medical Management of Mitral Disease
Guideline-Directed Medical Therapy
Device Therapy
Mitral Transcatheter Therapies
Repair: Edge-to-Edge
Repair: Annuloplasty
Replacement
Surgical Therapies for Mitral Valve Disease
Tricuspid Valve
Medical Management
Surgical Approach
Percutaneous Approach
Replacement
Aortic Valve Procedures
Aortic Insufficiency
Bicuspid Aortic Valve
Valve-in-Valve
Other Structural Interventions
Left Atrial Appendage Occlusion
Atrial Septal Defect and Patent Foramen Ovale
SUBPART I: ATHEROSCLEROTIC VASCULAR DISEASE
29 Ischemic Heart Disease
BACKGROUND
PATHOGENESIS
Atherosclerosis
AHA Lesion Classification System
Vascular Surface Defects and Hematomas
Atherothrombosis
Atherosclerotic Aneurysms
Severity of Stenosis
Cells and Extracellular Matrix of Lesions
Lipid and Lipoprotein in the Extracellular Matrix
Fibrinogen
Calcium
Inflammation and Biomarkers
ACUTE CORONARY SYNDROME
Definitions
Epidemiology
Etiology and Pathogenesis
Demand versus Supply Ischemia
Principles of Diagnosis and Treatment
Diagnosis
Physical Assessment
Physical Examination
Diagnostic Testing
MEDICAL MANAGEMENT
Early Hospital Care
Initial Antiplatelet/Anticoagulation Strategy
Comprehensive Plan of Care
Fibrinolysis With Invasive Intervention
INVASIVE INTERVENTION
Percutaneous Revascularization
Percutaneous Coronary Intervention
Percutaneous Intervention for ACS
Surgical Revascularization
NURSING CONSIDERATIONS
Percutaneous Coronary Intervention
Preprocedural Management
Intraprocedure Management
Postprocedure Management
Vascular Sheath Removal
Access Site Management
CABG Surgery
Preoperative Assessment and Preparation
Intraprocedural Management
Cardiopulmonary Bypass
Myocardial Protection
Postoperative Management
COMPLICATIONS OF MI
MANAGEMENT OF THE WORKING DIAGNOSIS OF MINOCA
Spontaneous Coronary Artery Dissection
Systemic Acute Respiratory Syndrome Coronavirus (SARS-CoV or COVID19)
STABLE ISCHEMIC HEART DISEASE
Definition
Diagnostic Evaluation
Guideline-Directed Medical Therapy
Invasive Intervention
Left Main and Multivessel CAD
Chronic Totally Occluded Arteries
Nursing Considerations
30 Peripheral Arterial Disease
INTRODUCTION
Pathogenesis
Carotid Artery Disease
Patient Presentation
Evaluation
Treatment and Management
Operative Management
Renal Artery Stenosis
Patient Presentation
Evaluation
Treatment and Management
Mesenteric Ischemia
Patient Presentation
Evaluation
Management
Lower Extremity Arterial Disease
Patient Presentation
Evaluation
Management
Surgical Management
Open Repair
CONCLUSION
SUBPART II: STRUCTURAL HEART DISEASE
31 Acquired Valvular Heart Disease: Pathophysiology, Diagnosis, and Medical Management
GENERAL PRINCIPLES
Mechanisms of Dysfunction
Duration and Severity of Dysfunction
Patient Education
Shared Decision Making
CAUSES OF ACQUIRED VHD
Rheumatic Heart Disease
Infective Endocarditis
MITRAL STENOSIS
Cause
Pathology
Pathophysiology
Clinical Manifestations
Physical Assessment
Medical Management
MITRAL INSUFFICIENCY
Cause
Pathology
Pathophysiology
Clinical Manifestations
Physical Assessment
Medical Management
TRICUSPID VALVE DISEASE
Cause
Pathophysiology
History and Physical Examination
Medical Management
Tricuspid Stenosis
AORTIC STENOSIS
Cause
Pathology
Pathophysiology
History and Physical Findings
Medical Management
AORTIC REGURGITATION
Causes
Pathology
Pathophysiology
Stages of Chronic AR
Clinical Manifestations
Chronic
Acute
Physical Assessment
Chronic
Acute
Medical Management
CONCLUSION
32 Therapeutic Intervention for Acquired Valvular Heart Disease: Surgical and Catheter-Based Approaches
BACKGROUND
SURGICAL APPROACHES
Overview
Mechanical Valves
Tissue Valves
Minimally Invasive Valve Surgery
Complications of Prosthetic Valves
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
Mitral Regurgitation
Mitral Valve Prolapse
Tricuspid Regurgitation
Priorities for Care
TRANSCATHETER HEART VALVE INTERVENTIONS
Overview
AORTIC STENOSIS
Transcatheter Aortic Valve Replacement
Case Selection
Periprocedure Approach
MITRAL STENOSIS
Percutaneous Mitral Catheter Balloon Valvuloplasty
MITRAL REGURGITATION
Transcatheter Mitral Valve Repair
PRIORITIES FOR CARE
Close Monitoring of Potential Complications
Early Mobilization and Reconditioning
CONCLUSION
33 Adult Congenital Heart Disease
BACKGROUND
HISTORICAL STATE AND CONTEXT
EPIDEMIOLOGY
CURRENT STATE AND CONTEXT
SHUNT LESIONS
Atrial Septal Defects
Description
Pathophysiology
Clinical Manifestations
Management
Ventricular Septal Defects
Description
Pathophysiology
Clinical Manifestations
Management
Patent Ductus Arteriosus
Description
Pathophysiology
Clinical Manifestations
Management
LEFT-SIDED LESIONS
Congenital Aortic Stenosis
Description
Pathophysiology
Clinical Manifestations
Management
Coarctation of the Aorta
Description
Pathophysiology
Clinical Manifestations
Management
RIGHT-SIDED LESIONS
Pulmonic Valve Stenosis
Description
Pathophysiology
Clinical Manifestations
Management
Tetralogy of Fallot
Description
Pathophysiology
Clinical Manifestations
Management
Ebstein Anomaly
Description
Pathophysiology
Clinical Manifestations
Management
COMPLEX LESIONS
Complete Transposition of the Great Arteries (TGA)
Description
Pathophysiology
Clinical Manifestations
Management
Congenitally Corrected Transposition of the Great Arteries
Description
Pathophysiology
Clinical Manifestations
Management
Tricuspid Atresia and Single Ventricle
Description
Pathophysiology
Clinical Manifestations
Management
Truncus Arteriosus
Description
Pathophysiology
Clinical Manifestations
Management
Eisenmenger Syndrome
Description
Clinical Manifestations
Management
CONCLUSIONS
FUTURE CONSIDERATIONS/IMPLICATIONS FOR PRACTICE
34 Pericardial, Myocardial, and Endocardial Diseases: Pathogenesis, Diagnosis, and Treatment
BACKGROUND
PERICARDIAL DISEASE
Pericarditis
Etiology
Symptoms
TESTING
Medical Management
Important Caveat
Complications of Pericardial Disease
Pericardial Effusion
Etiology
Pathophysiology
Assessment Findings
Medical Management
Cardiac Tamponade
Etiology
Clinical Assessment in Cardiac Tamponade
Medical Management of Cardiac Tamponade
Pericardial Disease Management Summary
CARDIOMYOPATHIES
Dilated Cardiomyopathy
Etiology
Pathophysiology
Assessment Findings
Medical Management
HYPERTROPHIC CARDIOMYOPATHY
Etiology
Pathophysiology
Assessment Findings
Medical Management
Restrictive Cardiomyopathy
Etiology
Pathophysiology
Assessment Findings
Medical Management
Arrhythmogenic Right Ventricular Cardiomyopathy
Etiology
Pathophysiology
Assessment Findings
Medical Management
Unclassified Cardiomyopathies
Etiology
Pathophysiology
Assessment Findings
Medical Management
Myocarditis
Etiology
Pathophysiology
Assessment Findings
Medical Management
Patient Education
ENDOCARDIAL DISEASE
Infective Endocarditis
Types of IE
Clinical Findings
Risk Factors
Diagnostic Testing
Prophylaxis
Patient Education
SUBPART III: CARDIAC ARRHYTHMIAS
35 Supraventricular Arrhythmia
BACKGROUND
PATHOPHYSIOLOGY
Mechanism of Normal Impulse Initiation
Alteration of Normal Impulse Initiation
Triggered Activity due to the Afterdepolarization
Mechanism of Reentry Tachycardias
TYPES OF SUPRAVENTRICULAR ARRHYTHMIA
Sinus Tachycardia
Inappropriate Sinus Tachycardia
Atrial Tachycardia
Multifocal Atrial Tachycardia
Sinoatrial Nodal Reentrant Tachycardia
Atrioventricular Nodal Reentrant Tachycardia
Atrioventricular Reentrant Tachycardia
Permanent Junctional Reciprocating Tachycardia
Atrial Flutter
Atrial Fibrillation
DIAGNOSIS AND MANAGEMENT
Supraventricular Tachyarrhythmias
Atrial Flutter
Atrial Fibrillation
The Role of the Cardiac Nurse in Management of Supraventricular Arrhythmias
36 Ventricular Arrhythmias, Cardiac Arrest, and Sudden Cardiac Death
VENTRICULAR ARRHYTHMIAS
Background
Types of Ventricular Arrhythmias
Premature Ventricular Complexes
Accelerated Idioventricular Rhythm
Ventricular Tachycardia
Ventricular Flutter
Ventricular Fibrillation
Ventricular Asystole
Diagnosis of Ventricular Tachycardia
Medical Management and Treatment of Ventricular Tachycardia
Pharmacologic Therapies for Ventricular Arrhythmia and Sudden Cardiac Death
CARDIAC ARREST AND SUDDEN CARDIAC DEATH
Background
Pathogenesis
Sudden Cardiac Death With Structural Heart Disease
Coronary Artery Disease
Cardiomyopathy
Valvular Heart Disease
Sudden Cardiac Death Without Structural Heart Disease
Medical Management and Treatment of Cardiac Arrest and Sudden Cardiac Death
Adult Advanced Cardiac Life Support
Electrical Therapy of Malignant Arrhythmias
Defibrillators
Transthoracic Impedance
Energy Requirements
Electrode Position
Defibrillation Procedure
Management of Cardiac Arrest-ACLS Algorithms
Post-Cardiac Arrest Care
NURSING CARE OF CARDIAC ARREST AND SUDDEN CARDIAC DEATH SURVIVORS
Background
Physiologic Nursing Management
Emotional Support
Patient and Family Education
SUBPART IV: HEART FAILURE
37 Heart Failure: Pathogenesis and Diagnosis
HEART FAILURE
Historic Perspective
Etiologies and Definitions
Stages of HF and Functional Classification
Low and High Cardiac Output Syndromes
Pathogenesis and Pathophysiology
Myocyte Pathophysiology
Ventricular Remodeling
Altered Systemic Perfusion Results in Activation of Neurohumoral, Inflammatory, and Metabolic Processes
Reduced or Preserved Ejection Fraction
Left-Sided Heart Failure
Right-Sided Heart Failure
Clinical Assessment and Diagnosis
History
Physical Examination
Imaging and Laboratory Studies
Prognosis
Approach to Treatment
HFrEF
HFpEF
Disease Management Programs
Acute Decompensated HF
Congestion
Perfusion and Blood Pressure
Diagnosis
Profile-Guided Therapy
Warm and Wet
Wet and Cold
Dry and Cold
Cardiogenic Shock
Compensatory Mechanisms
Initial Stage
Intermediate Stage
Irreversible Stage
Diagnosis and Clinical Manifestations
Monitoring and Diagnostic Tools
Prognosis
Approach to Treatment
Goal 1: Increase Oxygen Supply to the Myocardium
Goal 2: Maximize Cardiac Output
Goal 3: Reduce Myocardial Work
Other Considerations
Transition of Care
38 Heart Failure: Guideline-Directed Medical and Device Therapy
BACKGROUND
Heart Failure Symptoms and Signs
APPROACHES TO TREATMENT
Heart Failure With Reduced Ejection Fraction (HFrEF)
Heart Failure With Preserved Ejection Fraction (HFpEF)
PHARMACOLOGIC MANAGEMENT OF HEART FAILURE
Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS)
Angiotensin-Converting Enzyme Inhibitors (ACE-Is)
Angiotensin Receptor Blockers (ARBs)
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Mineral Receptor Antagonists (MRAs)
ß-Adrenergic Blockers
Diuretics
Vasodilator Therapy
Venous Dilators
Arterial Dilators
Combined Venous Arterial Dilators
Current Inhibitors or Hyperpolarization-Activated Cyclic Nucleotide-Gated (HCN) Channel Blockers
Cardiac Glycosides
Calcium-Channel Blockers (CCBs)
Natriuretic Peptides
Antiarrhythmics
Adjunctive Therapy
Other Important Pharmacologic Considerations
Tachycardia
Thromboembolism
Pharmacologic Agents to Avoid in HF
CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES (CIEDs)
Device Therapy for Primary Prevention of Sudden Cardiac Death in High-Risk Populations
Device Limitations and Considerations
Cardiac Resynchronization Therapy
Implantable Device-Guided Management
Cardiac Contractility Modulation
Device Deactivation at End of Life
Cardiovascular External Electronic Devices
COMPREHENSIVE MANAGEMENT OF HF
Prevention of HF
Comorbidities Related to HF Management and Treatment
Hypertension
Ischemic Heart Disease
Renal Disease
Cognitive Dysfunction
Diabetes Mellitus
Anemia
Depression
Sleep Disturbances
Lifestyle Modifications
Smoking Cessation
Activity and Exercise
Nutrition-Diet, Sodium, and Fluid
Cardiac Rehabilitation
Management With Diagnostic Studies-Serial Echocardiogram or Biomarkers
Heart Failure Disease Management
Patient and Family Education
Self-Care
Social Support
Patient Monitoring-Follow-Up and Remote Technology
Health-Related Quality of Life
Palliative Care
Shared Decision Making
CONCLUSIONS
Future Considerations/Implications
39 Therapeutic Intervention for Cardiogenic Shock and End-Stage Heart Failure: Mechanical Circulatory Support and Heart Transplantation
CARDIOGENIC SHOCK
Pathophysiology
Cardiogenic Shock
Extracardiac Obstructive Shock
Compensatory Mechanisms
Diagnosis and Clinical Manifestations
History
Physical Examination
Cardiovascular Assessment
Pulmonary Assessment
Neuroregulatory Assessment
Gastrointestinal Assessment
Renal Assessment
Integumentary Assessment
Diagnostic Tools
Approach to Treatment
When to Consider Temporary Mechanical Circulatory Assist Devices
Indications and Contraindications
Types of Temporary Devices
Nursing Considerations
END-STAGE HEART FAILURE (STAGE D)
Background
Pathophysiology
Clinical Manifestations and Approach to Treatment
Prognosis
Nursing Considerations
MECHANICAL CIRCULATORY SUPPORT DEVICES FOR END-STAGE HEART FAILURE
Background
Durable Left Ventricular Assist Devices
HeartMate II
HeartMate III
HeartWare
Total Artificial Heart
Complications
Ventricular Recovery and Device Removal
Nursing Considerations
CARDIAC TRANSPLANTATION
Background
Evaluation Process
Listing Process
Surgical Procedure
Postoperative Considerations
Immunosuppression
Complications of Cardiac Transplantation
Rejection
Infection
Malignancy
Cardiac Allograft Vasculopathy
Nursing Implications/Care of the Heart Transplant Recipient
PALLIATIVE CARE AND HOSPICE
Shared Decision Making
Palliative Care and Hospice
Deactivating Devices
Nursing Considerations
40 Therapeutic Intervention for Cardiovascular Disease: Future Advances and Approaches
INTRODUCTION
DIGITAL HEALTH
Mobile Health
Wearable Devices
Health Information Technology
Telemedicine
Synchronous Virtual Visits
Asynchronous Virtual Visits
Telemedicine Goals
Precision Medicine
Challenges Around Digital Health
ARTIFICIAL INTELLIGENCE
Machine Learning
Deep Learning
Predictive Systems
Expert Systems
Speech to Text
Natural Language Processing
Big Data
ARTIFICIAL INTELLIGENCE APPLICATIONS
CLINICAL DECISION SUPPORT SYSTEMS
Introduction
Disease Prevention
Patient Identification and Access to Treatment
Patient Assessment
Patient Treatment
Challenges Around Clinical Decision Support Implementation
Usability
Integration Into Workflow
Relevance and Context in Decision Making
ADVANCED IMAGING
3D Printing
SIMULATION TECHNOLOGIES
CONCLUSIONS
PART V: EXPANDED ROLES FOR THE CARDIAC NURSE
41 Disease Management Models for Cardiovascular Care
BACKGROUND
CHRONIC CONDITIONS AND AGING
COST OF CHRONIC DISEASE
CONTROLLING READMISSIONS
SYSTEM BURDEN
DISEASE MANAGEMENT: DEFINITION AND MODELS
Models of Disease Management in Cardiovascular Care by Nurses
Disease Management in Low-Income Populations
Future Research by Nurses
COMPONENTS OF DISEASE MANAGEMENT SYSTEMS
Identifying a Patient Population
Coordinating Delivery Systems for Disease Management
Education as a Part of Disease Management
Communication With Physicians and Other Personnel
Measuring Clinical and Resource Utilization Outcomes
Training and Role Qualifications
Opportunities
TRAINING AND JOB QUALIFICATIONS FOR DISEASE MANAGEMENT
The Emergence of Nursing Roles and Disease Management
UNRESOLVED ISSUES FOR DISEASE MANAGEMENT
42 Global and Population Health
BACKGROUND
Historical State and Context
Epidemiology and Demographics
Current State and Context
PRIMARY PREVENTION OF CVD AT THE POPULATION LEVEL
Tobacco
Obesity/Diet
Sodium
Sugar-Sweetened Beverages
Trans Fat
Alcohol
Air Pollution
Physical Inactivity
SECONDARY AND TERTIARY PREVENTION OF CVD FROM A POPULATION PERSPECTIVE
Medication Availability and Adherence
mHealth
Cardiac Rehabilitation
CVD IN SPECIAL POPULATIONS
HIV
STRUCTURAL HEART DISEASE
Congenital Heart Disease
Rheumatic Heart Disease
CONCLUSIONS
Future Considerations and Implications
43 Quality in Cardiovascular Care
BACKGROUND
HISTORY OF QUALITY DETERMINANTS
Florence Nightingale
DEFINING QUALITY IN HEALTH CARE
MEASURING QUALITY
DEVELOPING STANDARDS
QUALITY CONTROL THROUGH AUDITS
EVOLUTION OF QUALITY IN HEALTH CARE
THE NEED FOR SURVEILLANCE
The Joint Commission
Centers for Medicare & Medicaid Services
Prospective Payment System
Professional Standards Review Organizations
QUALITY REGISTRIES
ROLE OF THE CARDIOVASCULAR NURSE IN QUALITY
QUALITY IMPROVEMENT MODELS
Total Quality Management
Six Sigma
CONCLUSION
44 Advanced Practice Nursing and Cardiovascular Care
HISTORY
CONSENSUS MODEL FOR APRN REGULATION
INSTITUTE OF MEDICINE: THE FUTURE OF NURSING REPORT
APRN PRACTICE IN CARDIOVASCULAR CARE
HEART FAILURE APRN
CARDIAC TRANSPLANT/VENTRICULAR ASSIST DEVICE APRN
DISEASE APRN
ARRHYTHMIA/ELECTROPHYSIOLOGY APRN
STRUCTURAL HEART APRN
CRITICAL CARE APRN
EDUCATION/RESEARCH APRN
LEADERSHIP
FUTURE
45 Leadership and Team-Based Care
A VISION FOR NURSING LEADERSHIP
DEFINING LEADERSHIP
Overcoming the Nursing Paradoxes
Paradox of Numbers
Paradox of Trust
Navigating the Polarity Trap
Providing Multigenerational Mentorship
LEADERSHIP COMPETENCIES
LEADERSHIP VERSUS MANAGEMENT
LEADERSHIP IN TEAM-BASED CARE
LEADERSHIP STYLES
SKILL SETS FOR LEADERSHIP AND TEAM-BASED CARE
Emotional Intelligence
Dare to Lead
IMPACT OF EFFECTIVE LEADERSHIP AND TEAM-BASED CARE
CALL TO ACTION
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