9781405163613

Table of Contents


	Contributors	vii
	Foreword	ix
	Preface	xi
1	Mechanics of the Cardiovascular System B. Greaney and A.M. Kucia	1
	Overview	1
	Basic Heart Anatomy	1
	The Cardiac Cycle	2
	Cardiac Output	6
	Conclusion	7
2	Regulation of Cardiac and Vascular Function B. Greaney and A.M. Kucia	8
	Overview 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 B. Greaney and A.M. Kucia	15
	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 B. Greaney and A.M. Kucia	21
	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 A.M. Kucia and E. Birchmore	26
	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 T. Wachtel, R. Webster and J. Smith	39
	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 D. Evans and T. Quinn	50
	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 B.F. Williams and A.M. Kucia	59
	Overview	59
	Evidence-Based Medicine and Clinical Trials	60
	Informed Consent for Trial Participation	60
	What is an Ethical Dilemma?	62
	Generic 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 A.M. Kucia and S.A. Unger	67
	Overview	67
	Health History	67
	Physical Examination	70
	Conclusion	79
10	Electrocardiogram Interpretation A.M. Kucia and C. Oldroyd	81
	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 A.M. Kucia and C. Oldroyd	99
	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 D. Barrett, L. Jesuthasan and A.M. Kucia	109
	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 L. Belz, K. Mishra, S.A. Unger and A.M. Kucia	116
	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 T. Quinn and P. Gregory	137
	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 P. Gregory and T. Quinn	145
	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 A.M. Kucia and B.F. Williams	152
	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 A.M. Kucia and J.D. Horowitz	161
	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 A.M. Kucia and J.F. Beltrame	167
	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 A. Day, C. Ryan and T. Quinn	178
	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 T. Quinn and A. Day	185
	Overview	185
	Benefits of Early Reperfusion	185
	Identifying and Addressing Delays	186
	Conclusion	190
21	Reperfusion Strategies C.F. Zeitz and T. Quinn	193
	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 A.M. Kucia and J.D. Horowitz	204
	Overview	204
	Anti-Ischaemic Therapies	205
	Antiplatelet and Anticoagulant Therapy	209
	Inhibitors of the Renin-Angiotensin-Aldosterone System	215
	Statins	216
	Conclusion	216
23	Arrhythmias C. Oldroyd and A.M. Kucia	222
	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 C. Oldroyd, T. Quinn and P. Whiston	243
	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 T. Quinn	257
	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 P. Davidson and R. Webster	269
	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 R. Webster and P. Davidson	280
	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