Acute Cardiac Care (Test Only)

Angela M. Kucia
Tom Quinn

Course Outline

Acute Cardiac Care provides nurses with a comprehensive understanding of the current practice and principles underlying the care and management of acute cardiac conditions. It addresses the management of acute coronary syndromes (ACS) with an emphasis on evidence-based pharmacological management, cardiac emergencies (cardiac arrest, arrhythmia, acute pulmonary oedema, cardiogenic shock), current diagnostic and interventional modalities for the management of ACS, including risk stratification, and the ethical, political, social and economic factors that impact upon the provision of acute cardiac services in Australia and the UK.

Edited by renowned academics and clinicians in the field, this practical text will encourage nurses to think critically about evidence and management of acute coronary conditions, and provide a guide on how and where to look for up-to-date evidence and guidelines.

Key Fetures:

  • A comprehensive and practical guide to the current practice and principles underlying the nursing care of acute cardiac conditions
  • Edited by leading authorities in the field with a wealth of experience in acute cardiac care and resuscitation
  • Has an emphasis on evidence-based practice, encouraging nurses to critically think about their practice
  • Contains learning objectives, key points and activities and further reading guidelines

About Authors

Angela M. Kucia is a Clinical Practice Consultant in Acute Cardiac Assessment at the Queen Elizabeth and Lyell McEwin Hospitals in Adelaide, South Australia. Angela also lectures in postgraduate cardiovascular nursing at the University of South Australia and has been involved in acute cardiac nursing for twenty years.

Tom Quinn is Professor of Clinical Practice at the University of Surrey and also Visiting Professor of Cardiac Nursing at Coventry University, UK. Tom has extensive clinical experience both in and out of hospital, and was closely involved in developing and implementing the National Service Framework for Coronary Heart Disease and related policies in England.

Learning Objectives

  1. Describe the seven phases of the cardiac cycle.
  2. Define cardiac output, preload, afterload, and contractility.
  3. Compare chemoreceptors and baroreceptors.
  4. Describe several chemicals in the body that affect heart action.
  5. Describe myocytes and autorhythmic cells.
  6. Describe the sinoatrial node.
  7. Compare the left anterior descending artery and the left circumflex artery.
  8. List the three major systems that drain the capillary bed.
  9. List the various risk factors for cardiovascular disease.
  10. Discuss the effects of hypertension.
  11. Describe populations at risk for coronary vascular disease.
  12. Discuss psychosocial health as related to cardiovascular disease.
  13. Discuss the six steps of evidence-based practice.
  14. Describe the clinical audit as a means of evaluating evidence.
  15. Define an ethical dilemma.
  16. State why genetic research is vital.
  17. Describe the method for measuring jugular venous pressure.
  18. Compare a pulsus alternans and a pulsus paradoxus.
  19. Describe adventitious breath sounds according to Table 9.4.
  20. Describe the theoretical basis for doing a 12-lead ECG.
  21. Describe the normal waveforms and their significance according to Table 10.2.
  22. Describe patient preparation for an ECG.
  23. Compare the three-electrode monitoring system, five-electrode monitoring system, and the ten-electrode monitoring system.
  24. Define telemetry and discuss drawbacks.
  25. Describe the various generic laboratory tests.
  26. Describe commonly used markers of myocardial necrosis.
  27. Describe a cardiac catheterization procedure including peri-procedural and post-procedural care.
  28. Compare transthoracic and transesophageal echocardiography.
  29. Describe magnetic resonance imaging and list the risks.
  30. List structural abnormalities and arrhythmias seen in sudden cardiac death.
  31. Describe the types of cardiomyopathies.
  32. List several hazards to the victim and rescuer when an out-of-hospital arrest occurs.
  33. Describe the basic life support flow chart. (Figure 15.2)
  34. Define ethical principles in resuscitation.
  35. Describe the advanced directive.
  36. Describe several contributing factors to myocardial ischemia or infarction.
  37. Compare patients with an elevated ST segment and non-ST elevation during a myocardial infarction.
  38. Discuss triage nurse guidelines for identification of acute coronary syndrome patients. (Table 18.6)
  39. Discuss the findings of Pollack and Gibler 2001, regarding risk factors for CAD.
  40. Discuss the value of exercise tolerance tests when biomarkers are negative.
  41. Describe the steps of the “4 D’s.”
  42. State the key goal of reperfusion strategy.
  43. List the limitations and benefits of lytic therapy.
  44. List the three critical time periods when seeking to reperfuse in STEMI.
  45. Compare the use of nitrates, beta blockers, and calcium channel blockers as anti-ischemic therapies.
  46. Compare unfractionated heparin and low-molecular-weight heparin according to Table 22.3.
  47. Describe the three types of heart block.
  48. Compare atrial fibrillation and atrial flutter.
  49. Discuss the findings of Peberdy et al. 2003, regarding in-hospital cardiac arrest and strategies to facilitate early detection.
  50. Describe the ABCDE approach during post-resuscitation care.
  51. Describe a simple “2-minute” bedside tool for clinical assessment of a patient’s hemodynamic status in acute heart failure, according to Nohria et al. 2003.
  52. Describe treatments for “refractory” in acute heart failure.
  53. Describe the Chronic Care Model which was adapted by the World Health Organization.
  54. Describe secondary prevention.

Table of Contents

1. Mechanisms of the Cardiovascular System
Basic Heart Anatomy
The Cardiac Cycle
Cardiac Output
2. Regulation of Cardiac and Vascular Function
Central Nervous System Regulation of the Cardiovascular System
Vasomotor Control
Humoral Control
3. Cardiac Electrophysiology
Cardiac Cells
The Action Potential
The Action Potential in Non-Pacemaker Cells
The Cardiac Conduction System
The Electrocardiogram
4. The Coronary Circulation
The Coronary Circulation
The Left Main Coronary Artery
The LAD Artery
The LCX or CX Artery
The Right Coronary Artery
Collateral Circulation
Microvascular Circulation
Coronary Venous Circulation
5. Risk Factors for Cardiovascular Disease
Classification of Risk Factors for CVD
Biomedical Risk Factors
Behavioural Risk Factors
Psychosocial Risk Factors
6. Populations at Risk
Risk Factors for CVD
Clarifying Risk
Populations at Increased Risk
Targeting Treatment
Using What We Know
7. Evidence-Based Practice
The Need for Change
Evidence-Based Practice
Barriers to the Evidence
8. Ethics of Research in Acute Cardiac Care
Evidence-Based Medicine and Clinical Trials
Informed Consent for Trial Participation
What is an Ethical Dilemma?
Genetic Research
Considering an Offer for the Unit to Participate in a Clinical Trial
Ethical Issues in Marketing and Pricing of New Pharmaceutical Agents
9. Cardiovascular Assessment
Health History
Physical Examination
10. Electrocardiogram Interpretation
Normal Sequence of Depolarisation and Depolarisation
Theoretical Basis of Electrocardiography
Determining the Cardiac Axis
Determination of Heart Rate and Electrocardiographic Intervals
Chamber Enlargement
Bundle Branch Block
ECG Changes Related to Myocardial Ischaemia and Infarction
Obtaining a 12-Lead ECG
11. Cardiac Monitoring
ECG Monitoring Systems and Lead Formats
Indications for Arrhythmia Monitoring
Nursing Considerations in the Care of the Patient with ECG Monitoring
12. Laboratory Tests
Generic Laboratory Tests
Renal Function
Glucose Measurement
Lipid Profiles
Complete Blood Examination
Clotting Screen
Biochemical Markers
Marks of Myocardial Necrosis
Cardiac Natriuretic Peptides
C-Reactive Protein
13. Diagnostic Procedures
Chest X-Ray
Cardiac Catheterisation (Angiogram)
Stress Testing
Magnetic Resonance Imaging
Computerised Tomography
Electrophysiology Studies
14. Sudden Cardiac Death
Burden of Disease and Risk Factors for SCD
Sudden Death in the Young (Including Athletes)
Structural Abnormalities
Cardiomyopathies and SCD
Genetic Syndromes and SCD
15. Out-of-Hospital Cardiac Arrest and Automated External Defibrillator
Out-of-Hospital Cardiac Arrest
Hazards to the Victim and Rescuer
Recognition of Cardiac Arrest and BLS
Automated External Defibrillation
16. Ethical Issues in Resuscitation
Guiding Ethical Principles in Resuscitation
Rights of the Individual Versus the Needs of Society
Patient Perceptions of Resuscitation
Introducing the DNR Conversation
Witnessed Resuscitation
Withdrawal of Treatment
Organ Donation
Training and Research with the Newly Dead
17. Pathogenesis of Acute Coronary Syndromes
Acute Coronary Syndrome
Endothelial Dysfunction
Plaque Disruption
18. Presentations of Acute Coronary Syndromes
Angina Pectoris
Stable Angina
The Acute Coronary Syndromes
Global Trends in ACS Patients
The 12-lead Electrocardiogram in ACS
Cardiac Markers in ACS
Clinical Assessment and Risk Stratification in ACS
19. Risk Stratification in Acute Coronary Syndromes
Risk Stratification
Risk Stratification Guidelines
Risk Scores
Chest Pain Units
20. Reducing Time to Treatment
Benefits of Early Reperfusion
Identifying and Addressing Delays
21. Reperfusion Strategies
Pathogenesis of STEMI
Principles of Reperfusion Strategies
Options for Reperfusion
Strategies for Reducing Treatment Time Delays
Detecting and Managing Failed Reperfusion
Preventing and Detecting Re-Occlusion
22. Adjunct Pharmacological Agents in Acute Coronary Syndromes
Anti-Ischaemic Therapies
Antiplatelet and Anticoagulant Therapy
Inhibitors of the Rennin-Angiotensin-Aldosterone System
23. Arrhythmias
Basic Electrophysiology
Mechanisms of Errhythmia Generations
Cardiac Monitoring
Rhythm Interpretation
Determining the Rhythm
Treatment of Arrhythmias
24. In-Hospital Resuscitation
Prevention: Systems for Identifying Patients at Risk of Cardiac Arrest
Early Recognition and Management of Critically Ill Patients
In-hospital Resuscitation
Working Within your Scope of Practice
Audit and Data CVollection
25. Acute Heart Failure
Establishing the Diagnosis
Management Specifics
Refractory AHF
Dignity, Communication and Preventing Complications: “Back to Basics”
Managing Chronic Heart Failure Better to Reduce the Need for Re-Hospitalization
26. Convalescence
Assessment and Identification of Patient Needs
High-Risk Groups
Promoting Self-Management in the Convalescent Phase
Particular Concerns of Spouses and Family Members
Accommodating Convalescence and Discharge Planning Following an Acute Cardiac Event
Models of Intervention to Facilitate Convalescents and Secondary Prevention
Nursing Strategies to Promote Convalescents
Palliative Care
27. Discharge Planning and Secondary Prevention
Discharge Planning
Secondary Prevention
Provision of Secondary Prevention
Components of Secondary Prevention
Cardio-Protective Drug Therapy
Challenges in Secondary Prevention