Cardiac Care

Angela M. Kucia, Department of Cardiology, The Lyell McEwin Hospital and UNISA Clinical and Health Sciences, University of South Australia, Australia.Ian D. Jones, School of Nursing and Allied Health, Liverpool John Moores University, United Kingdom.

• List of Contributors xivForeword xviiPreface xviiiPart I Knowledge for Practice 11 Mechanics of the Cardiovascular System 3Brendan Greaney and Angela M. KuciaOverview 3Basic Heart Anatomy 3References 112 Regulation of Cardiac and Vascular Function 12Brendan Greaney and Angela M. KuciaOverview 12Central Nervous System Regulation of the Cardiovascular System 12Vasomotor Control 14Baroreceptors 14Gravity and Venous Return 14Chemoreceptors 15Humoral Control 16Electrolytes 18Conclusion 19References 203 Cardiac Electrophysiology 21Brendan Greaney and Angela M. KuciaOverview 21Cardiac Cells 21The Action Potential 22The Action Potential in Non-Pacemaker Cells 22The Cardiac Conduction System 24The Electrocardiogram 26Conclusion 26References 284 The Coronary Circulation 29Brendan Greaney and Angela M. KuciaOverview 29The Coronary Circulation 29The Left Main Coronary Artery 30The Left Anterior Descending Artery 31The Left Circumflex Artery 31The Right Coronary Artery 31Collateral Circulation 32Microvascular Circulation 32Coronary Venous Circulation 32References 33Part II Cardiovascular Disease Assessment 355 Risk Factors for Cardiovascular Disease 37Angela M. Kucia and Angela HartleyOverview 37Absolute Risk 37Classification of Risk Factors for CVD 38Biomedical Risk Factors 39Behavioural Risk Factors 44Psychosocial Risk Factors 46Conclusion 48References 496 Cardiovascular Assessment 52Jan Keenan and Angela M. KuciaOverview 52Health History 53Physical Examination 54Conclusion 65References 667 Laboratory Tests Used in Acute Cardiac Assessment 67David Barrett and Angela M. KuciaOverview 67Generic Laboratory Tests 67Common Laboratory Tests Used in Cardiovascular Disease 67Laboratory Specimen Collection 73Conclusion 74References 748 Diagnostic Procedures 76Steven A. Unger and Angela M. KuciaOverview 76Purpose of Diagnostic Tests 76Preparation for Diagnostic Procedures 77Medical Imaging Tests 78Electrocardiography Tests 93Physiological Testing 93Stress Testing 95Conclusion 100References 100Part III Detection and Management of Heart Rhythm Disturbances 1039 Electrocardiogram (ECG) Interpretation 105Carol Oldroyd and Angela M. KuciaOverview 105Normal Sequence of Depolarisation and Repolarisation 106Theoretical Basis of Electrocardiography 107ECG Leads 107The Cardiac Axis 110Determination of Heart Rate and Electrocardiographic Intervals 111Chamber Enlargement 112Bundle Branch Block 114ECG Changes Related to Myocardial Ischaemia and Infarction 117Myocardial Infarction 118The ST-Segment 118Pericarditis 118Key Point 119T-Wave Abnormalities 120Q-Waves 120Site of Infarction 121Incremental ECG Leads 121Obtaining a 12-Lead ECG 122Equipment Preparation 122Patient Preparation 123Conclusion 125References 12610 Cardiac Monitoring in the Clinical Setting 128Angela M. Kucia and Carol OldroydOverview 128ECG Monitoring Systems and Lead Formats 129Three-Electrode Monitoring Systems 129Five-Electrode Monitoring Systems 129Twelve-Lead (10 Electrode) Monitoring Systems 130Telemetry Monitoring Systems 131Indications for Arrhythmia Monitoring in the Clinical Setting 132Alarm Fatigue 134References 13811 Arrhythmias 139Angela M. KuciaOverview 139Mechanisms of Arrhythmia Generation 139Ectopy, Aberrancy and Escape Beats 145Sinus Dysrhythmias 147Atrial Dysrhythmias 150Ventricular Rhythms and Tachyarrhythmias 156Heart Block Related to Atrioventricular Nodal Conduction 162Conclusion 169References 17012 Assessment and Management of Cardiac Rhythm Disturbances (Arrhythmias) 173Carolyn E. Shepherd, Jenny Tagney, and Angela M. KuciaOverview 173Assessment 173Taking a Clinical History 174Physical Examination 174Diagnostic Investigations 177Smartphone Technology 180Imaging 180Diagnosis of Cardiac Channelopathies 182Treatment Strategies for Arrhythmia 183Pharmacological Therapy 183Electrical (Direct Current) Synchronised Cardioversion 187Defibrillation 188Cardiac Ablation 189Temporary Pacing 190Temporary Transvenous Pacing 190Transcutaneous Pacing 190Other Forms of Temporary Pacing 191Implantable Cardiac Devices 191Implantable Pacemakers 191Implantable Cardioverter Defibrillators 193Implantation Procedure for Cardiac Devices 194Implantable Device Complications 196Practical Advice for Patients Following Device Implantation 197Advanced Nursing Roles in Arrhythmia Management 199References 199Part IV Detection and Management of Acute Coronary Syndromes 20513 Pathogenesis of Acute Coronary Syndromes 207Angela M. Kucia and John D. HorowitzOverview 207Acute Coronary Syndrome 207Atherosclerosis 208Endothelial Dysfunction 208Inflammation 208Plaque Rupture and Thrombosis 209Pathological Characteristics of Myocardial Ischaemia and Infarction 210Conclusion 213References 21414 Chest Pain Assessment 216Angela M. Kucia, John F. Beltrame, and Jan KeenanOverview 216Background 216Coronary Heart Disease 217Angina Pectoris 217Acute Coronary Syndrome 218Myocardial Infarction with Non-Obstructive Coronaries (MINOCA) 220Presentation with Chest Pain in the Emergency Department 220Typical Clinical Presentation of Ischaemic Chest Pain 221Atypical Presentations 222Chest Pain Assessment 223Physical Examination in ACS Patients 225The 12‑lead Electrocardiogram in ACS 225Troponin 227Clinical Assessment and Risk Stratification in ACS 227Conclusion 228References 22815 Risk Stratification in Acute Coronary Syndromes 231Deborah Wright, Cassandra Ryan, and Angela M. KuciaOverview 231Background 231The Nature of Risk in Cardiovascular Disease 233Risk Stratification for Differentiating Between Likely Cardiac-Related Pain and Non-Cardiac Pain 233Risk Stratification Tools 235The HEART Score 235Rule-in/Rule-out Strategies for NSTE-ACS 236Conclusion 237References 23816 Management of Acute Coronary Syndromes 240Christopher J. Zeitz, Ian D. Jones, and Angela M. KuciaOverview 240Background 240Considerations in Nursing Care of the Patient with Acute Coronary Syndrome 241ST Elevation Acute Coronary Syndrome (STE-ACS) 242ST-segment Myocardial Infarction (STEMI) 242Ischaemic ECG Abnormalities not Meeting STEMI Criteria 245Cardiac Biomarkers in STEMI 245Principles of Reperfusion Strategies 245Mechanical Reperfusion 246Role of the Nurse when Caring for a Patient Receiving Thrombolysis 248Complications of STEMI 249Non-ST-segment Elevation Acute Coronary Syndrome (NSTE-ACS) 252Convalescence and Secondary Prevention 253Conclusion 254References 25517 Discharge Planning and Convalescence 257David R. Thompson, Patricia M. Davidson, and Rosemary A. WebsterOverview 257Hospitalisation 257Patient and Partner Reactions and Needs after an Acute Cardiac Event 258Discharge Planning 258High-Risk Groups 260Convalescence 261Promoting Self-Care and Self-Management in the Convalescent Phase 263Common Concerns of Partners and Family Members 265Facilitating Convalescence 265Home-Based Services 266Nurse-Led Clinics 266Community Health Workers 266Information Technology 267Nursing Strategies to Promote Convalescence 267Palliative Care 267Conclusion 267References 26818 Prevention Strategies in Cardiovascular Disease 272Rosemary A. Webster, Patricia M. Davidson, Praba Rabasse, and Angela M. KuciaOverview 272Prevention Strategies 272Primary Prevention in Cardiovascular Disease 273Secondary Prevention in Cardiovascular Disease 273Target Population for Secondary Prevention 274Cardiac Rehabilitation 274Assessment and Short-Term Monitoring 276Lifestyle/Behavioural Modification 276Psychosocial Risk Factors 283Medication Adherence 283Recovery and Longer-Term Maintenance 284Conclusion 285References 285Part V Cardiac Arrest 28919 Sudden Cardiac Death 291Pete Gregory and Angela M. KuciaOverview 291Background 292Burden of Disease 292Risk Factors for Sudden Cardiac Death 293Screening in the General Population for Risk of Sudden Cardiac Death 294Mechanisms of Sudden Cardiac Death 294Sudden Cardiac Death in Structural Heart Disease 296Cardiomyopathies and Sudden Cardiac Death 297Inherited Primary Arrhythmia Syndromes 298Sudden Cardiac Death Related to Special Populations 300Impact of Sudden Cardiac Death on Families and Loved Ones 300Conclusion 303References 30320 Pre-hospital Management of Cardiac Emergencies 306Pete Gregory and Angela M. KuciaOverview 306Introduction 307Hazards to the Victim and Rescuer 308Scene Safety 308Risks to the Rescuer 308Resuscitation During the COVID-19 Pandemic 308Risks to the Victim 309Circumstances that make OHCA Different from Hospital Resuscitation 310Pauses in Chest Compressions 312Automated External Defibrillation 312Practical Factors Affecting Defibrillation 312Chest Compressions Following Defibrillation 313Conclusion 313References 31421 In-Hospital Resuscitation 317Angela M. Kucia and Melanie RushtonOverview 317Prevention: Systems for Identifying Patients at Risk of Cardiac Arrest 319Recommended Strategies for the Prevention of Avoidable Cardiac Arrest 320Rescuer Safety 323Equipment 325Basic Life Support 325Advanced Life Support 326Post-Resuscitation Care 327Audit and Data Collection 328Conclusion 328References 32922 Ethical Issues in Resuscitation and end of Life Care 332Angela M. Kucia and Annabella S. GlosterOverview 332Guiding Ethical Principles in Resuscitation 332Medical Futility 333Resuscitation Orders 334Advanced Care Planning and Advanced Directives 335Withdrawal of Treatment 336Witnessed Resuscitation 337Organ Donation 337Training and Research with the Newly Dead 338Conclusion 338References 339Part VI Chronic Cardiac Conditions 34123 Heart Failure 343Salimah Hassan, Christopher Nicholson, Robyn Lotto, and Angela M. KuciaOverview 343Definition of Heart Failure 344Heart Failure Terminology 344Epidemiology 346Significance 347Prognosis 347Aetiology 347Diagnosis 348Investigations 353Chronic Heart Failure Management 354Comorbidities in Heart Failure 361Systems of Care 364End of Life 365Acute Heart Failure 365Conclusion 367References 36724 Congenital Heart Disease 372Robyn Lotto, Christopher Nicholson, and Angela M. KuciaOverview 372Background 372Epidemiology 372Risk Factors for the Development of Congenital Heart Disease 373Embryology 374Congenital Heart Disease Classification 375CHD with Shunt Between Systemic and Pulmonary Circulation 376Acyanotic CHD 378Acyanotic CHD with Outflow Obstruction 381Cyanotic CHD 383Dextrocardia 386Conclusion 393References 39425 Structural Heart Disease 399Christopher Nicholson, Salimah Hassan, Robyn Lotto, and Angela M. KuciaOverview 399Valvular Heart Disease 399Cardiomyopathy 404Other Forms of Cardiomyopathy 407The Multidisciplinary Team Caring for Patients with Acquired Structural Heart Disease 408Conclusion 408References 40926 Takotsubo Syndrome 412Angela M. KuciaOverview 412Background 412Epidemiology 413Prognosis 413Pathophysiology 415Triggers for TTS 416Clinical Presentation 417Wall Motion Abnormalities in TTS 419Cardiac Biomarkers 420Diagnostic Criteria 420Diagnostic Imaging 420Clinical Course 421Management 422Conclusion 423References 42427 Non-Obstructive Coronary Artery Disease (MINOCA/INOCA) 428Angela M. Kucia and John F. BeltrameOverview 428Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) 428Management 430Conclusion 434References 435Index 437