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PRESENTATION 1
CURRENT TRENDS IN THE MANAGEMENT OF CARDIOVASCULAR DISORDERS
My Name is Leonardo Jr Magtaan Uy, not too young and never too old at 33.
I finished my Bachelor’s Degree in Nursing at Our Lady of the Pillar College in
Cauayan City and graduated year 2006 and passed the Local Board Exam
December of the same year.
I’m currently based in United Arab Emirates as a Staff Nurse and Supervisor in
Liwa Healthcare Services, a home healthcare facility here in Abu Dhabi.
I’m expecting that this course Nursing in Cardiovascular Conditions will reiterate
basic principles and will provide learning opportunities in advanced theoretical
concepts and learn everything that is needed in this subject and that I would
likewise effectively make use of them in my practices in the future.
Candidate for Cardiac Catheterization
The primary reason for conducting a cardiac catheterization is to diagnose and manage
persons known or suspected to have heart disease, a frequently fatal condition that leads to
millions of heart attacks annually worldwide. Symptoms and diagnoses that may lead to
performing this procedure include:
• Chest pain, characterized by prolonged heavy pressure or a squeezing pain
• Abnormal treadmill stress test
• Myocardial infarction, also known as a heart attack
• Congenital heart defects or heart problems that originated from birth
• A diagnosis of valvular-heart disease
• A need to measure the heart muscle's ability to pump blood
Before your doctor decides if you need a pacemaker, you'll have several tests done to find out the cause of
your irregular heartbeat. These could include:
Electrocardiogram. In this noninvasive test, sensor pads with wires attached, called electrodes, are placed
on your chest and sometimes your limbs to measure your heart's electrical impulses. Your heart's beating
pattern can offer clues to the type of irregular heartbeat you have.
Holter monitoring. Also known as an ambulatory monitor, a Holter monitor records your heart rhythms
for an entire 24-hour period. Wires from electrodes on your chest go to a battery-operated recording
device carried in your pocket or worn on a belt or shoulder strap.
While you're wearing the monitor, you'll keep a diary of your activities and symptoms. Your doctor will
compare the diary with the electrical recordings to try to figure out the cause of your symptoms.
Echocardiogram. This noninvasive test uses harmless sound waves that allow your doctor to see your
heart without making an incision. During the procedure, a small instrument called a transducer is placed
on your chest. It collects reflected sound waves (echoes) from your heart and transmits them to a
machine that uses the sound wave patterns to compose images of your beating heart on a monitor.
These images show how well your heart is functioning, and recorded pictures allow your doctor to
measure the size and thickness of your heart muscle.
Stress test. Some heart problems occur only during exercise. For a stress test, an electrocardiogram is
taken before and immediately after walking on a treadmill or riding a stationary bike. In some cases, an
echocardiogram or nuclear imaging may be done.
Other types of treadmill exercise tests also can be done to evaluate your heart, including an oxygen
consumption test that measures how much oxygen your body is using.
Management and Aftercare
The Patient will usually stay in the hospital for one day after having a pacemaker implanted.
The pacemaker is programmed to fit depending on patient’s particular pacing needs. A return
visit is often scheduled to make sure pacemaker's settings are correct.
After that, most pacemakers can be checked remotely using wireless technology. Using your
cellphone or radiofrequency signals, your pacemaker transmits and receives information
between you and your doctor's office, where your doctor can access the data — including your
heart rate and rhythm, how your pacemaker is functioning, and remaining battery life.
Remote transmissions can be made at scheduled intervals or at unscheduled times if your
pacemaker sends an alert, or you can send a transmission if you have a concern. Remote
technology means fewer trips to the doctor's office, but you'll still need to be seen by your
doctor in person for scheduled checkups.
After your procedure to implant your pacemaker, your doctor may recommend that you avoid
vigorous exercise or heavy lifting for about a month. You may have some aches and pains near
the area where your pacemaker was implanted. These pains can be relieved with over-the-
counter medicines, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB,
others), but talk to your doctor before taking any pain relievers.
Candidate for Procedure
Catheter ablation is performed in the hospital. Before your procedure begins, a specialist will
insert an intravenous line into your forearm or hand, and you'll be given a sedative to help you
relax. In some situations, general anesthesia may be used instead to place you in a sleep-like
state. What type of anesthesia you receive depends on your particular situation.
After your sedative takes effect, your doctor or another specialist will numb a small area near
a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a
tube (sheath) through the needle.
Your doctor will thread catheters through the sheath and guide them to several places within
your heart. Your doctor may inject dye into the catheter, which helps your care team see your
blood vessels and heart using X-ray imaging. The catheters have electrodes at the tips that can
be used to send electrical impulses to your heart and record your heart's electrical activity.
This process of using imaging and other tests to determine what's causing your arrhythmia is
called an electrophysiology (EP) study. An EP study is usually done before cardiac ablation in
order to determine the most effective way to treat your arrhythmia.
Once the abnormal heart tissue that's causing the arrhythmia is identified, your doctor will
aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the
catheter tips to create a scar or destroy the tissue that triggers your arrhythmia.
In some cases, ablation blocks the electrical signals traveling through your heart to stop the
abnormal rhythm and allow signals to travel over a normal pathway instead.
The energy used in your procedure can come from:
○ Extreme cold (cryoablation) ○ Heat (radiofrequency) ○ Lasers
Preparation for the Procedure
Always tell your provider what drugs you are taking, even drugs or herbs you bought without a
prescription.
Follow the instructions your nurse or doctor gave you. Most people can return to their normal activities
on the day after they leave the hospital.
• Don’t drive for 24 hours after you leave the hospital.
• Don’t drink alcohol for 24 hours after you leave the hospital.
• Avoid heavy physical activity for three days. Ask your doctor when you can return to strenuous
exercise.
• A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top
of it. Have someone call the doctor or hospital.
Candidate for Procedure
A ventricular assist device (VAD) is a mechanical device that supports the lower left heart
chamber (left ventricular assist device, or LVAD), the lower right heart chamber (right ventricular
assist device, or RVAD) or both lower heart chambers (biventricular assist device, or BIVAD).
Your doctor may recommend you have a VAD implanted if:
You're waiting for a heart transplant. You may have a VAD implanted temporarily while you wait
for a donor heart to become available. A VAD can keep blood pumping despite a diseased heart
and will be removed when your new heart is implanted. When a VAD is implanted while you're
waiting for a heart transplant, it's referred to as a "bridge to transplant."
You're not currently eligible for a heart transplant because of other conditions. A VAD may
sometimes be implanted if you have heart failure, but you're not yet eligible for a heart
transplant due to other medical conditions. When a VAD is implanted for this reason, it's called
"bridge to candidacy" or "bridge to decision."
Your heart's function can become normal again. If your heart failure is temporary, your doctor
may recommend implanting a VAD until your heart is healthy enough to pump blood on its own
again. This is referred to as "bridge to recovery."
You're not a good candidate for a heart transplant. VADs are increasingly being used as a long-
term treatment for people who have heart failure but aren't good candidates for a heart
transplant. Generally if you're older than age 65, you may not be eligible for heart
transplantation. In that situation the VAD would be implanted as therapy for heart failure. A VAD
can enhance your quality of life.
When a VAD is implanted as a permanent treatment for heart failure, it's referred to as
"destination therapy."
Description of the Procedure
Ventricular assist device (VAD) surgery usually takes between 4 and 6 hours. The process is similar to that
of other types of open-heart surgery. The team for VAD surgery includes:
• Surgeons who do the operation
• Surgical nurses who assist the surgeons
• Anesthesiologists who are in charge of the medicine that makes you sleep during surgery
• Perfusionists who are in charge of the heart-lung bypass machine
Before the surgery, you're given medicine to make you sleep so you won't feel any pain. During the
surgery, the anesthesiologist checks your heartbeat, blood pressure, oxygen levels, and breathing. A
breathing tube is placed in your lungs through your throat. This tube is connected to a ventilator (a
machine that helps you breathe).
A cut is made down the center of your chest. The chest bone is then cut and your ribcage is opened so
that the surgeon can get to your heart.
Medicines typically are used to stop your heart during the surgery. This allows the surgeon to operate on
your heart while it's not beating. A heart-lung bypass machine keeps oxygen-rich blood moving through
your body during the surgery. (In some cases, LVAD surgeries have been done without using heart-lung
bypass machines.) When the VAD is attached properly, the heart-lung machine is switched off and the
VAD starts working. It supports blood circulation and takes over the pumping function of the heart.
Preparation for the Procedure
Before you get a ventricular assist device (VAD), you'll spend some time in the hospital to prepare for the
surgery. You might already be in the hospital getting treatment for heart failure. During this time, you'll
learn about the VAD and how to live with it. You and your caregivers will spend time with your surgeon,
cardiologist (heart specialist), and nurses to make sure you have all the information you need about the
VAD.
Before and/or after the surgery, you and your caregivers will learn:
• How the VAD works and Safety precautions.
• How to interpret and respond to alarms. How to provide care in case of emergency, such as the loss of
electrical power.
• How to wash and shower. How the VAD may affect travel.
You can ask to see what the device looks like and how it will be attached inside your body. You also may
meet with someone who already has a VAD who can give you information. This person can answer
questions about what it feels like to have a VAD implanted.
Your doctors will make sure that your body is strong enough for the surgery. If your doctors think your
body is too weak, you may need to get extra nutrition through a feeding tube before surgery. You also may
have tests to make sure you're ready for surgery. These tests may include:
• Blood tests. Blood tests are used to check how well your liver and kidneys are working. Blood tests also
are used to check the levels of blood cells and important chemicals in your blood.
• Chest x ray. This test is used to create pictures of the inside of your chest to help your doctor prepare
for surgery.
• EKG (electrocardiogram). This test is used to check how well your heart is working before the VAD
surgery.
• Echocardiography (echo). This test is used to create a detailed picture of your heart. Echo provides
information about the size and shape of your heart and how well your heart's chambers and valves are
working.
Management and Aftercare
After surgery to implant a VAD, you'll stay in the intensive care unit (ICU). You'll be given fluids, nutrition
and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain
fluid and blood from your heart and chest. Your treatment team will monitor you for signs of infection or
other complications.
Your lungs may not work properly immediately after your surgery, so you may need to remain connected
to a ventilator for a few days after surgery until you're able to breathe on your own.
After a few days in the ICU, you'll generally be moved to a regular hospital room. The amount of time
you'll spend in the ICU and in the hospital can vary, depending on your condition before the procedure
and how well you recover after your VAD is placed.
As you recover, your nurses and other members of your treatment team will help you become increasingly
active. They may help you sit up, get out of bed and walk in the hallways of the hospital. You may have
visits with a physical therapist to help you continue to increase your strength and get used to performing
daily life activities.
Your treatment team will work with you to help you gain strength and prepare you for going home. They
may explain how to live with a VAD and care for your VAD after you go home, and they can help answer
your questions about the VAD. Your treatment team may also discuss with you nutrition and cardiac
rehabilitation plans they may recommend during your recovery after you return home.
Management and Aftercare cont.
Your doctor will likely prescribe antibiotics and blood-thinning medications to prevent infection and other
complications while you're in the hospital. You'll usually need to continue to take blood-thinning
medications such as aspirin or warfarin (Coumadin, Jantoven) during the time you have a VAD to prevent
blood clots.
It's very important to follow the instructions for taking these medications carefully. You'll need to have
regular blood tests to monitor the effects of warfarin. Contact your doctor if you have any questions
about your medications or if you experience any side effects. You'll also need to continue to take any
medications you're taking for other conditions.
Your treatment team may encourage you to have visitors, such as family and friends, while you're
recovering in the hospital. Visitors may be able to help you perform some physical activities. Your nurses
and treatment team will also educate your family about many aspects of your care, such as how to care
for your VAD, how to watch for signs of infection after surgery, how to respond to emergencies related to
the VAD and how they can assist you at home.
Once you have recovered and gained your strength, your treatment team will determine when you're
healthy enough to be released from the hospital. If you need more time to recover your strength before
returning home, you may stay at a special care facility, such as a nursing home, for a period of time after
leaving the hospital.
Candidate for Procedure
Heart transplants are performed when other treatments for heart problems haven't worked, leading to
heart failure. In adults, heart failure can be caused by several conditions, including:
• A weakening of the heart muscle (cardiomyopathy)
• Coronary artery disease. Heart valve disease. A heart problem you're born with (congenital heart
defect)
• Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other
treatments. Amyloidosis and Failure of a previous heart transplant
• Ischemic cardiomyopathy
• Congenital heart disease for which no conventional therapy exists or for which conventional therapy
has failed
• Intractable angina or malignant cardiac arrhythmias for which conventional therapy has been
exhausted
In children, heart failure is most often caused by either a congenital heart defect or a cardiomyopathy.
Another organ transplant may be performed at the same time as a heart transplant (multiorgan
transplant) in people with certain conditions at select medical centers. Multiorgan transplants include:
• Heart-kidney transplant. This procedure may be an option for some people with kidney failure in
addition to heart failure.
• Heart-liver transplant. This procedure may be an option for people with certain liver and heart
conditions.
• Heart-lung transplant. Rarely, doctors may suggest this procedure for some people with severe lung
and heart diseases, if the conditions aren't able to be treated by only a heart transplant or lung
transplant.
Description of the Procedure
Heart transplant surgery is an open heart surgery that takes several hours. If you've had
previous heart surgeries, the surgery is more complicated and will take longer. You'll receive
medication that causes you to sleep (general anesthesia) before the procedure. Your surgeons
will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout
your body.
In this procedure, your surgeon will make an incision in your chest. Your surgeon will separate
your chest bone and open your rib cage so that he or she can operate on your heart.
Your surgeon then removes the diseased heart and sews the donor heart into place. He or she
then attaches the major blood vessels to the donor heart. The new heart often starts beating
when blood flow is restored. Sometimes an electric shock is needed to make the donor heart
beat properly.
You'll be given medication to help with pain after the surgery. You'll also have a ventilator to
help you breathe and tubes in your chest to drain fluids from around your lungs and heart.
After surgery, you'll also receive fluids and medications through intravenous (IV) tubes.
Preparation for the Procedure
Preparations for a heart transplant often begin long before the surgery to place a transplanted heart. You
may begin preparing for a heart transplant weeks, months or years before you receive a donor heart,
depending upon the waiting time for transplant. Once you decide where you would like to have your
heart transplant, you'll need to have an evaluation to see if you're eligible for a transplant. During an
evaluation, your doctors and transplant team will conduct a physical examination, order several tests, and
evaluate your mental and emotional health. The evaluation will check to see if you:
• Have a heart condition that would benefit from transplantation
• Might benefit from other less aggressive treatment options
• Are healthy enough to undergo surgery and post-transplant treatments
• Will agree to quit smoking, if you smoke
• Are willing and able to follow the medical program outlined by the transplant team
• Can emotionally handle the wait for a donor heart
• Have a supportive network of family and friends to help you during this stressful time
Your transplant team will also discuss the benefits and risks of a transplant and what to expect before,
during and after a transplant.
When a donor heart becomes available, the donor-recipient matching system considers several factors to
make a match, including:
• Medical urgency of potential recipients
• Blood type (A, B, AB or O)
• Antibodies the recipients may have developed
• Size of the donor
• Time spent on the waiting list
Preparation for the Procedure cont.
Evaluation of the heart transplant candidate includes laboratory tests, imaging studies, and
other tests as appropriate.
Closely monitor the heart transplant candidate for signs of clinical deterioration during the
waiting period for a suitable donor organ. Administer standard therapy for congestive heart
failure (CHF), and offer the patient the alternative of participating in experimental clinical
trials; such participation does not preclude listing for transplantation. Maintain close contact
with the transplant center, keeping the consultants informed of ongoing medical and social
issues pertaining to the candidate.
In the event of clinical deterioration, the transplant center may deem it appropriate to admit
the patient so that he or she can be evaluated for implantation of an artificial cardiac assist
device, an upgrade on the waiting list, or both. At times, the candidate may deteriorate to the
point where transplantation is no longer an option. Carefully discuss these issues with the
treating physicians, the patient, and the family.
Management and Aftercare
After you've had surgery to place your donor heart, you'll stay in the intensive care unit (ICU).
You'll generally be moved to a regular hospital room after a few days in the ICU, and you'll
usually remain in the hospital for a week or two. Endomyocardial biopsies are performed to
assess for allograft rejection. These may be performed as frequently as every week for the first
month, with the frequency decreasing over time. Follow-up visits are frequent for the first
month because regulation of immunosuppression is being adjusted during this time. The
frequency of visits gradually diminishes until the patient is generally seen on an annual basis.
You'll need to make several long-term adjustments after you've had your heart transplant. These
include
Taking immuno-suppressants. These medications decrease the activity of your immune system
to prevent it from attacking your donated heart. Because your immune system will most likely
never completely accept the new organ, you'll take some of these medications for the rest of
your life.
Managing medications, therapies and a lifelong care plan. After a heart transplant, taking all
your medications as your doctor instructs and following a lifelong care plan is important.
Cardiac rehabilitation. Cardiac rehabilitation programs incorporate exercise and education to
help you improve your health and recover after a heart transplant. Staff members trained in
cardiac rehabilitation may help you adjust to healthy lifestyle changes — such as regular exercise
and a heart-healthy diet — after your transplant.
Emotional support. Your new medical therapies and the stress of having a heart transplant may
make you feel overwhelmed. Many people who have had a heart transplant feel this way.