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. However, it is important that nurses keep themselves updated in the use of drugs by reading research papers and international, national, and local guidelines. For doses of drugs, methods of administration, contraindications, and side effects, use a recognized formulary, in addition to any local policy.

Tachycardias

This chapter looks at the diagnosis and management of tachycardias, including both narrow complex tachycardias and broad complex tachycardias. Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting 1–2% of the general population (5–15% of those over 80 years). There have been a number of developments in arrhythmia care over the last few years in particular in relation to AF and there are now more specialist arrhythmia nurses and nurse-led arrhythmia services than before. AF, arrhythmias, and sudden cardiac death are priority areas of NHS improvement. Recent guidelines for the management of tachycardias are discussed including pharmacological measure, cardioversion, and implantable cardioverter-defibrillator (ICD) insertion.

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 was one of the few areas of the National Service Framework for Coronary Heart Disease where targets were not all met. It is now one of the priority areas for NHS Improvement Heart. A new pathway has been devised for cardiac rehabilitation and this is included here.

Congenital heart disease and inherited cardiac disorders

‘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. Most conditions are a result of the heart, its valves, or its vessels not being properly formed. Some congenital heart defects are diagnosed in utero or soon after birth, whereas others might not be noted until later in life when symptoms become troublesome. Defects can be simple (requiring little or no intervention), moderate (requiring episodic intervention), or complex (with serious outcomes that require lifelong treatment and follow-up). The majority of children with congenital heart disease are managed in specialist paediatric centres, and as more children with congenital heart disease survive into adulthood, services that cater for adults with congenital heart disease (ACHD) have been developed. 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

Electrophysiology

Electrophysiology (EP) is concerned with electrical problems of the heart. This subspecialty of cardiology focuses on the diagnosis and treatment of arrhythmias. Electrophysiologists could be described as heart electricians. Electrophysiologists treat patients with slow arrhythmias (bradycardia) and fast arrhythmias (tachycardia). This chapter focuses on tachycardia diagnosis and treatment. Some tachycardias are considered simply a nuisance for the patient while others, specifically ventricular tachycardia, can be lethal. The EP study (EPS) is a powerful diagnostic tool at the electrophysiologist’s disposal. This invasive procedure uses catheters and recording systems to pinpoint the cause of a tachycardia which helps direct treatment. This may involve such measures as medications but in many cases can take the form of ablation. Ablation is a curative form of treatment, similar to an EPS, where the cardiac cells causing the tachycardia are destroyed using heat or cold. This short chapter is intended for cardiac nurses who require a brief introduction to the highly complex specialty of cardiac EP.

Cardiac surgery

The most common cardiac surgical procedures in the UK are coronary artery bypass grafting (CABG), with over 25 000 operations performed each year and heart valve surgery with approximately 8000 heart-valve operations each year. Other surgical procedures that nurses may come across include surgery for AF, cardiomyopathy, and congenital heart defects. The principles of care for 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 more than 40 years. During this time, some techniques have changed and now minimally invasive surgery and ‘off-pump’ surgery is 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. While length of stay for routine surgery has decreased, 25% of patients having CABG are over 75 years and are likely to have more severe cardiac disease and other comorbidities, which can lead to increased length of stay, with potential problems. The aim of this chapter is to discuss 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. In many centres roles that were traditionally performed by doctors may now be done by either specialist nurses or surgical care practitioners (who may or may not be nurses).

Interventional cardiology for coronary heart disease

Interventional cardiology is concerned with a number of invasive diagnostic and interventional procedures including coronary angiography and percutaneous coronary intervention (PCI). Coronary angiography is a definitive test to diagnose the presence of absence of coronary artery disease, in addition to nonatherosclerotic causes of stable angina, such as coronary artery spasm. PCI is a term that collectively describes a group of procedures that aim to restore or improve blood flow to the myocardium following a period of ischaemia or injury and includes: percutaneous transluminal coronary angioplasty (PTCA), intracoronary stenting, coronary atherectomy, and thrombectomy devices. The aim of this chapter is to provide a description, indications, and pre- and postprocedure care related to common diagnostic and interventional cardiology procedures. Sheath removal and vascular closure devices are also discussed.

Acute coronary syndromes

Acute coronary syndromes (ACS) refers to a clinical spectrum of the same disease process, and includes unstable angina, non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI). Treatment for this group of patients may be initiated and then continued across a variety of areas which include the pre-hospital/community setting, emergency department, coronary care unit, cardiac catheter laboratory, general ward, and chest pain unit. Nurses will encounter patients with both ST-segment elevation ACS and non-ST-segment elevation ACS at various points in their journey, thus clear and effective communication between healthcare providers across the different areas is imperative. The aim of this chapter is to outline the pathophysiology, methods for rapid diagnosis, and appropriate clinical management of ACS so that it may applied within any area and at any point in the patient’s journey.

Infective endocarditis

Infective endocarditis (IE) is a condition that most commonly occurs in patients with pre-existing valve disease. Nurses working in the cardiac arena should be aware of those patients who are at risk of developing IE and its clinical management. The aim of this chapter is to discuss the aetiology, diagnosis, treatment, nursing considerations, and specific educational issues that are relevant to the overall management and prevention of IE.