Cardiac Care A Practical Guide for Nurses

In the newly revised Second Edition of Cardiac Care: A Practical Guide for Nurses, a team of dedicated and widely recognised nursing medical experts from around the world deliver an invaluable and practical guide for nurses who practice in cardiac care environments.

This latest edition includes brand new chapters on structural heart disease, takotsubo syndrome, and non-obstructive coronary artery disease. While also covering the essential topics necessary for the proper provision of cardiac care, this practical guide for nurses provides:

• A thorough introduction to cardiac practice, including the mechanics of the cardiovascular systems and the regulation of cardiac and vascular function
• Comprehensive exploration of cardiovascular disease assessment, including risk factors for cardiovascular disease, laboratory tests, and diagnostic procedures
• Practical discussions of the detection and management of heart rhythm disturbances, including ECG interpretation, cardiac monitoring, and arrhythmias
• In-depth examinations of the detection and management of acute coronary syndromes, including chest pain assessment and discharge planning
• Chapter overviews, key concepts, learning objectives and activities, with critical points intermingled throughout

Perfect for practicing nurses who care for patients with cardiac conditions, Cardiac Care: A Practical Guide for Nurses will also earn a place in the libraries of other allied health professionals in cardiac care settings.

Angela Marie Kucia, Department of Cardiology, The Lyell McEwin Hospital and UNISA Clinical and Health Sciences, University of South Australia, Australia. 

Ian David Jones, School of Nursing and Allied Health, Liverpool John Moores University, United Kingdom. 

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

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