Acute Cardiac Care

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 Features:

  • 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

After completing this course you’ll be able to:

  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.

Course Contents

  1. Mechanisms of the Cardiovascular System
    • Overview
    • Basic Heart Anatomy
    • The Cardiac Cycle
    • Cardiac Output
    • Conclusion
  2. Regulation of Cardiac and Vascular Function
    • Overview
    • Central Nervous System Regulation of the Cardiovascular System
    • Vasomotor Control
    • Baroreceptors
    • Chemoreceptors
    • Humoral Control
    • Electrolytes
    • Conclusion
  3. Cardiac Electrophysiology
    • Overview
    • Cardiac Cells
    • The Action Potential
    • The Action Potential in Non-Pacemaker Cells
    • The Cardiac Conduction System
    • The Electrocardiogram
    • Conclusion
  4. The Coronary Circulation
    • Overview
    • 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
    • Overview
    • Classification of Risk Factors for CVD
    • Biomedical Risk Factors
    • Behavioural Risk Factors
    • Psychosocial Risk Factors
    • Conclusion
  6. Populations at Risk
    • Overview
    • Risk Factors for CVD
    • Clarifying Risk
    • Populations at Increased Risk
    • Targeting Treatment
    • Using What We Know
    • Conclusion
  7. Evidence-Based Practice
    • Overview
    • The Need for Change
    • Evidence-Based Practice
    • Barriers to the Evidence
    • Conclusion
  8. Ethics of Research in Acute Cardiac Care
    • Overview
    • 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
    • Conclusion
  9. Cardiovascular Assessment
    • Overview
    • Health History
    • Physical Examination
    • Conclusion
  10. Electrocardiogram Interpretation
    • Overview
    • 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
    • Conclusion
  11. Cardiac Monitoring
    • Overview
    • ECG Monitoring Systems and Lead Formats
    • Indications for Arrhythmia Monitoring
    • Nursing Considerations in the Care of the Patient with ECG Monitoring
  12. Laboratory Tests
    • Overview
    • Generic Laboratory Tests
    • Electrolytes
    • Renal Function
    • Glucose Measurement
    • Lipid Profiles
    • Complete Blood Examination
    • Clotting Screen
    • Biochemical Markers
    • Marks of Myocardial Necrosis
    • Cardiac Natriuretic Peptides
    • C-Reactive Protein
    • Conclusion
  13. Diagnostic Procedures
    • Overview
    • Chest X-Ray
    • Cardiac Catheterisation (Angiogram)
    • Echocardiography
    • Stress Testing
    • Magnetic Resonance Imaging
    • Computerised Tomography
    • Electrophysiology Studies
    • Conclusion
  14. Sudden Cardiac Death
    • Overview
    • Definitions
    • Burden of Disease and Risk Factors for SCD
    • Sudden Death in the Young (Including Athletes)
    • Structural Abnormalities
    • Cardiomyopathies and SCD
    • Genetic Syndromes and SCD
    • Conclusion
  15. Out-of-Hospital Cardiac Arrest and Automated External Defibrillator
    • Overview
    • Out-of-Hospital Cardiac Arrest
    • Hazards to the Victim and Rescuer
    • Recognition of Cardiac Arrest and BLS
    • Automated External Defibrillation
    • Conclusion
  16. Ethical Issues in Resuscitation
    • Overview
    • Guiding Ethical Principles in Resuscitation
    • Futility
    • 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
    • Overview
    • Acute Coronary Syndrome
    • Atherosclerosis
    • Endothelial Dysfunction
    • Plaque Disruption
    • Inflammation
    • Thrombosis
    • Conclusion
  18. Presentations of Acute Coronary Syndromes
    • Overview
    • 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
    • Conclusion
  19. Risk Stratification in Acute Coronary Syndromes
    • Overview
    • Introduction
    • Risk Stratification
    • Risk Stratification Guidelines
    • Risk Scores
    • Chest Pain Units
    • Conclusion
  20. Reducing Time to Treatment
    • Overview
    • Benefits of Early Reperfusion
    • Identifying and Addressing Delays
    • Conclusion
  21. Reperfusion Strategies
    • Overview
    • 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
    • Conclusion
  22. Adjunct Pharmacological Agents in Acute Coronary Syndromes
    • Overview
    • Anti-Ischaemic Therapies
    • Antiplatelet and Anticoagulant Therapy
    • Inhibitors of the Rennin-Angiotensin-Aldosterone System
    • Statins
    • Conclusion
  23. Arrhythmias
    • Overview
    • Basic Electrophysiology
    • Mechanisms of Errhythmia Generations
    • Cardiac Monitoring
    • Rhythm Interpretation
    • Determining the Rhythm
    • Tachyarrhythmias
    • Asystole
    • Treatment of Arrhythmias
    • Conclusion
  24. In-Hospital Resuscitation
    • Overview
    • Introduction
    • 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
    • Conclusion
  25. Acute Heart Failure
    • Overview
    • Introduction
    • 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
    • Conclusion
  26. Convalescence
    • Overview
    • Introduction
    • 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
    • Conclusion
  27. Discharge Planning and Secondary Prevention
    • Overview
    • Discharge Planning
    • Secondary Prevention
    • Provision of Secondary Prevention
    • Components of Secondary Prevention
    • Cardio-Protective Drug Therapy
    • Challenges in Secondary Prevention
    • Conclusion