Cardiovascular drugs

The aim of this chapter is to give the reader a brief overview of the main groups of drugs used in the field of cardiac nursing. For each group of drugs, there is a brief description of why they are used, their mechanism of action, examples commonly used in clinical practice, and nursing considerations.

Cardiac rehabilitation

This chapter looks at the role of cardiac rehabilitation for those at risk of cardiac disease or who have sustained a cardiac event. Cardiac rehabilitation has been a priority area for a long time in the National Service Framework for Coronary Heart Disease, NHS Improvement Plan, and now features in the NHS Long Term Plan. The introduction of certification for cardiovascular prevention and rehabilitation programmes (CPRP) has meant that their quality can be measured. The introduction of more technology-based interventions has opened up the opportunity for more people to participate, particularly for individuals who could not, or did not want to attend a traditional CPRP.

Bradycardias and blocks

This chapter covers bradycardia, heart blocks, and cardiac pacing. Bradyarrhythmias that require pacing can be caused by a range of aetiologies and early identification of possible reversible causes is the first stage of treatment. Although a degree of bradycardia and heart blocks might not have any clinical significance, it is always important to assess the patient for signs of adverse effects. Generally, pacing is only indicated for symptomatic sinus bradycardia. In contrast, patients with asymptomatic atrioventricular block may require pacing for prognostic purposes.

Chronic heart failure

Heart failure is a complex clinical syndrome of signs and symptoms that suggest the ability of the heart to pump effectively has been impaired. It is distinguished by dyspnoea, effort intolerance, fluid retention, and poor survival. The prevalence of heart failure is around 1–2% in the adult population in developed countries, and 920 000 people in the UK have heart failure. The incidence of heart failure has decreased; however, the number of people newly diagnosed with heart failure has increased. This is thought to be largely due to an ageing population, improvement in the management and survival of people with ischaemic heart disease, and effective treatment of heart failure. The condition can occur in all age groups; however, the incidence and prevalence steeply increase with age. The average age at first diagnosis is typically 77yrs. Chronic heart failure (CHF) has a poor prognosis, the mortality rate for CHF being worse than for many cancers. It is estimated that 70% of those hospitalized for the first time with severe heart failure will die within 5yrs. However, this has been improving, with 6mth mortality rate ↓ from 26% in 1995, 15% in 2009, to 8.9% in 2016. This chapter will outline the aetiology, pathophysiology, and management of CHF, including considerations for palliative care.

Infective endocarditis

Infective endocarditis (IE) is a condition that most commonly occurs in patients with pre-existing valve disease. It affects one in 30 000 people in the UK and is associated with a high mortality rate (15–30% in hospital mortality). Nurses working in the cardiac arena should be aware of those patients who are at risk of developing IE and its clinical management. This chapter covers the aetiology, diagnosis, complications, treatment, nursing considerations, and specific educational issues that are relevant to the overall management and prevention of IE.

Valvular disease

Valvular disorders such as regurgitation or stenosis can affect any of the four heart valves, although they are more likely to cause problems in the valves on the left side of the heart than the right, due to higher pressures on the left side. In many cases the symptoms of valvular disease take many years to develop and may be gradual in onset and severity. The patient can be managed medically but may eventually require valve replacement or repair. Over the past few years newer techniques have been developed for replacing or repairing valves. This chapter covers the causes, signs and symptoms, and management of valvular disorders.

Cardiac assessment

It is essential that the cardiac nurse can carry out a comprehensive cardiac assessment of their patient. The nursing assessment aims to describe the patient’s condition and help determine an accurate diagnosis, so that an effective and timely clinical management plan is implemented. The focus of the initial assessment varies according to the setting and clinical presentation of the patient. However, the priority is always to determine whether the patient is haemodynamically stable, whether they are suffering from an acute cardiac event that would benefit from time-dependent therapy, and the need for symptom management. A thorough cardiac assessment requires the nurse to use a wide range of interpersonal, observational, and technical skills. Additionally, the nurse needs an in-depth knowledge of cardiac anatomy, physiology, and pathophysiology to determine the significance of the findings. This chapter outlines how to assess key symptoms and signs of cardiac disease. Symptoms are things that the patient reports as troublesome issues; signs are associated physiological changes that the health professional might discover during the course of their assessment.

Congenital heart disease and inherited cardiac conditions

‘Congenital heart disease’ is a term used to cover a wide range of cardiac conditions that result from an abnormality of cardiac structure or function present at birth. The majority of children with congenital heart disease are managed in specialist paediatric centres. Not all will require further treatment as they grow older, but if they do the importance of a smooth transition to adult services is important. Some patients will be cared for in specialist units that cater for adults with congenital heart disease (ACHD), whereas others may not. Most cardiac nurses working in the cardiac arena can be expected to care for adult patients with congenital heart disease at some time in their career. They might also care for patients who present for the first time in adulthood with inherited disorders that have significant cardiovascular problems. The focus of this chapter is to highlight some of the issues that ACHD patients might present with in cardiac areas that do not specialize in ACHD.

Tachycardias

This chapter looks at the diagnosis and management of tachycardias, including both narrow complex tachycardias and broad complex tachycardias. Atrial fibrillation is the most common sustained arrhythmia, affecting about a million people in the UK. Tachyarrhythmias may be as a result of structural, acquired, congenital, or inherited cardiac conditions. Arrhythmia care continues to be an important priority in particular in relation to the prevention of sudden cardiac death and complications such as stroke and heart failure.

Cardiac surgery

This chapter covers the care of patients who require cardiac surgery, from placement on the waiting list to discharge. Although this involves the whole healthcare team, the focus of the chapter will be on the role of the nurse. The most common cardiac surgical procedures in the UK are coronary artery bypass grafting (CABG), with >16 000 operations performed each year, and heart valve surgery, with 78 000 heart valve operations each year. Other surgical procedures that nurses may come across include surgery for atrial fibrillation (AF), cardiomyopathy, aortic dissection, aneurysm repair, heart transplantation, and congenital heart defects. The principles of care for some of these operations are similar, so they will be discussed at the same time; where there are differences, these will be clarified. In the UK, CABG has been performed for >50yrs. During this time, some techniques have changed and now minimally invasive surgery and ‘off-pump’ surgery are more common. Changes in techniques for valve repair or replacement have meant that those previously at high risk for open heart valve replacement now have other options open to them.