Acute Cardiac Care provides nurses with a comprehensive understanding of the current practice and principles underlying the care and management of acute cardiac conditions. It addresses the management of acute coronary syndromes (ACS) with an emphasis on evidence-based pharmacological management, cardiac emergencies (cardiac arrest, arrhythmia, acute pulmonary oedema, cardiogenic shock), current diagnostic and interventional modalities for the management of ACS, including risk stratification, and the ethical, political, social and economic factors that impact upon the provision of acute cardiac services in Australia and the UK.
Edited by renowned academics and clinicians in the field, this practical text will encourage nurses to think critically about evidence and management of acute coronary conditions, and provide a guide on how and where to look for up-to-date evidence and guidelines.
A comprehensive and practical guide to the current practice and principles underlying the nursing care of acute cardiac conditions
Edited by leading authorities in the field with a wealth of experience in acute cardiac care and resuscitation
Has an emphasis on evidence-based practice, encouraging nurses to critically think about their practice
Contains learning objectives, key points and activities and further reading guidelines
Angela M. Kucia is a Clinical Practice Consultant in Acute Cardiac Assessment at the Queen Elizabeth and Lyell McEwin Hospitals in Adelaide, South Australia. Angela also lectures in postgraduate cardiovascular nursing at the University of South Australia and has been involved in acute cardiac nursing for twenty years. Tom Quinn is Professor of Clinical Practice at the University of Surrey and also Visiting Professor of Cardiac Nursing at Coventry University, UK. Tom has extensive clinical experience both in and out of hospital, and was closely involved in developing and implementing the National Service Framework for Coronary Heart Disease and related policies in England.
Contributors vii Foreword ix Preface xi 1 Mechanics of the Cardiovascular System 1 B. Greaney & A.M. Kucia Overview 1 Basic heart anatomy 1 The cardiac cycle 2 Cardiac output 6 Conclusion 7 2 Regulation of Cardiac and Vascular Function 8 B. Greaney & A.M. Kucia Overview 8 Central nervous system regulation of the cardiovascular system 8 Vasomotor control 9 Baroreceptors 10 Chemoreceptors 10 Humoral control 11 Electrolytes 13 Conclusion 13 3 Cardiac Electrophysiology 15 B. Greaney & A.M. Kucia Overview 15 Cardiac cells 15 The action potential 16 The action potential in non-pacemaker cells 17 The cardiac conduction system 18 The electrocardiogram 20 Conclusion 20 4 The Coronary Circulation 21 B. Greaney & A.M. Kucia Overview 21 The coronary circulation 21 The left main coronary artery 22 The LAD artery 23 The LCX or CX artery 23 The right coronary artery 23 Collateral circulation 23 Microvascular circulation 24 Coronary venous circulation 24 5 Risk Factors for Cardiovascular Disease 26 A.M. Kucia & E. Birchmore Overview 26 Classification of risk factors for CVD 26 Biomedical risk factors 27 Behavioural risk factors 32 Psychosocial risk factors 34 Conclusion 35 6 Populations at Risk 39 T. Wachtel, R. Webster & J. Smith Overview 39 Risk factors for CVD 39 Clarifying risk 40 Risk assessment tools 40 Populations at increased risk 41 Targeting treatment 45 Using what we know 46 Conclusion 46 7 Evidence-Based Practice 50 D. Evans & T. Quinn Overview 50 The need for change 50 Evidence-based practice 51 Barriers to the evidence 56 Conclusion 57 8 Ethics of Research in Acute Cardiac Care 59 B.F. Williams & A.M. Kucia Overview 59 Evidence-based medicine and clinical trials 60 Informed consent for trial participation 60 What is an ethical dilemma? 62 Genetic research 63 Considering an offer for the unit to participate in a clinical trial 63 Ethical issues in marketing and pricing of new pharmaceutical agents 64 Conclusion 64 9 Cardiovascular Assessment 67 A.M. Kucia & S.A. Unger Overview 67 Health history 67 Physical examination 70 Conclusion 79 10 Electrocardiogram Interpretation 81 A.M. Kucia & C. Oldroyd Overview 81 Normal sequence of depolarisation and repolarisation 81 Theoretical basis of electrocardiography 83 Determining the cardiac axis 85 Determination of heart rate and electrocardiographic intervals 86 Chamber enlargement 88 Bundle branch block 88 ECG changes related to myocardial ischaemia and infarction 91 Obtaining a 12-lead ECG 94 Conclusion 97 11 Cardiac Monitoring 99 A.M. Kucia & C. Oldroyd Overview 99 ECG monitoring systems and lead formats 100 Indications for arrhythmia monitoring 103 Nursing considerations in the care of the patient with ECG monitoring 103 12 Laboratory Tests 109 D. Barrett, L. Jesuthasan & A.M. Kucia Overview 109 Generic laboratory tests 109 Electrolytes 110 Renal function 110 Glucose measurement 111 Lipid profiles 111 Complete blood examination 111 Clotting screen 112 Biochemical markers 112 Markers of myocardial necrosis 112 Cardiac natriuretic peptides 113 C-reactive protein 114 Conclusion 114 13 Diagnostic Procedures 116 L. Belz, K. Mishra, S.A. Unger & A.M. Kucia Overview 116 Chest X-ray 116 Cardiac catheterisation (angiogram) 118 Echocardiography 124 Stress testing 125 Magnetic resonance imaging 130 Computerised tomography 132 Electrophysiology studies 132 Conclusion 133 14 Sudden Cardiac Death 137 T. Quinn & P. Gregory Overview 137 Definitions 138 Burden of disease and risk factors for SCD 138 Sudden death in the young (including athletes) 139 Structural abnormalities 140 Cardiomyopathies and SCD 141 Genetic syndromes and SCD 141 Conclusion 143 15 Out-of-Hospital Cardiac Arrest and Automated External Defibrillation 145 P. Gregory & T. Quinn Overview 145 Out-of-hospital cardiac arrest 146 Hazards to the victim and rescuer 146 Recognition of cardiac arrest and BLS 147 Automated external defibrillation 149 Conclusion 150 16 Ethical Issues in Resuscitation 152 A.M. Kucia & B.F. Williams Overview 152 Guiding ethical principles in resuscitation 152 Futility 153 Rights of the individual versus the needs of society 153 Patient perceptions of resuscitation 154 Introducing the DNR conversation 154 Witnessed resuscitation 154 Withdrawal of treatment 156 Organ donation 157 Training and research with the newly dead 157 17 Pathogenesis of Acute Coronary Syndromes 161 A.M. Kucia & J.D. Horowitz Overview 161 Acute coronary syndrome 162 Atherosclerosis 162 Endothelial dysfunction 162 Plaque disruption 162 Inflammation 163 Thrombosis 164 Vasoconstriction 164 Conclusion 164 18 Presentations of Acute Coronary Syndromes 167 A.M. Kucia & J.F. Beltrame Overview 167 Angina pectoris 167 Stable angina 168 The acute coronary syndromes 168 Global trends in ACS presentations 170 Clinical history in ACS 170 Physical examination in ACS patients 172 The 12-lead electrocardiogram in ACS 173 Cardiac markers in ACS 174 Clinical assessment and risk stratification in ACS 174 Conclusion 175 19 Risk Stratification in Acute Coronary Syndromes 178 A. Day, C. Ryan & T. Quinn Overview 178 Introduction 178 Risk stratification 179 Risk stratification guidelines 180 Risk scores 181 Chest pain units 182 Conclusion 183 20 Reducing Time to Treatment 185 T. Quinn & A. Day Overview 185 Benefits of early reperfusion 185 Identifying and addressing delays 186 Conclusion 190 21 Reperfusion Strategies 193 C.J. Zeitz & T. Quinn Overview 193 Pathogenesis of STEMI 193 Principles of reperfusion strategies 194 Options for reperfusion 194 Strategies for reducing treatment time delays 199 Detecting and managing failed reperfusion 199 Preventing and detecting re-occlusion 200 Conclusion 201 22 Adjunct Pharmacological Agents in Acute Coronary Syndromes 204 A.M. Kucia & J.D. Horowitz Overview 204 Anti-ischaemic therapies 205 Antiplatelet and anticoagulant therapy 209 Inhibitors of the renin-angiotensinaldosterone system 215 Statins 216 Conclusion 216 23 Arrhythmias 222 C. Oldroyd & A.M. Kucia Overview 222 Basic electrophysiology 223 Mechanisms of arrhythmia generations 223 Cardiac monitoring 225 Rhythm interpretation 225 Determining the rhythm 227 Tachyarrhythmias 232 Asystole 238 Treatment of arrhythmias 239 Conclusion 241 24 In-Hospital Resuscitation 243 C. Oldroyd, T. Quinn & P. Whiston Overview 243 Introduction 244 Prevention: systems for identifying patients at risk of cardiac arrest 245 Early recognition and management of critically ill patients 246 In-hospital resuscitation 248 Working within your scope of practice 250 Audit and data collection 253 Conclusion 253 25 Acute Heart Failure 257 T. Quinn Overview 257 Introduction 257 Establishing the diagnosis 258 Management specifics 261 Refractory AHF 264 Dignity, communication and preventing complications: back to basics 265 Managing chronic heart failure better to reduce the need for re-hospitalisation 266 Conclusion 266 26 Convalescence 269 P. Davidson & R. Webster Overview 269 Introduction 270 Assessment and identification of patient needs 272 High risk groups 272 Promoting self-management in the convalescent phase 272 Particular concerns of spouses and family members 273 Accommodating convalescence and discharge planning following an acute cardiac event 274 Models of intervention to facilitate convalescence and secondary prevention 274 Nursing strategies to promote convalescence 275 Palliative care 276 Conclusion 276 27 Discharge Planning and Secondary Prevention 280 R. Webster & P. Davidson Overview 280 Discharge planning 280 Secondary prevention 281 Provision of secondary prevention 282 Components of secondary prevention 283 Cardio-protective drug therapy 289 Challenges in secondary prevention 290 Conclusion 291 Index 297