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
