Cardiovascular Module Readings
NUR 941-Spring 2018
Cardiovascular Module Reading Assignments
Learning Outcomes
- Formulate the differential and working diagnosis of patients with acute cardiopulmonary illness through the analysis and synthesis of data from a variety of sources, using critical thinking and diagnostic reasoning skills, previous experience, and best practices.
- Synthesize relevance of cardiopulmonary assessment and diagnostic tests for individual patients.
- Critique the theoretical and scientific basis of cardiopulmonary interventions used to manage the health of patients/families encountered in the critical and acute care settings.
- Formulate an evidence based plan of care from admission to discharge for common acute cardiopulmonary conditions.
- Individualize the diagnostic and treatment process based on age, race, gender, ethnicity, culture, spiritual beliefs, lifestyle, and socioeconomic status.
- Analyze risk factors that may impede optimum cardiopulmonary disease management and contribute to longer length of stay and recidivism.
- Verbally critique cardiopulmonary research articles in a formal style.
Module Completion Activities:
- Assigned Readings
- Review Cardiovascular PowerPoints
- Complete the Study Guide for the Cardiovascular Exam for module to assist in exam preparation.
Assigned Module Readings:
-Current Medical Diagnosis and Treatment 2018 Chapter 10-Heart Disease
All sections as each section will address a component of the cardiac content for the cardiac exam. If you are familiar with the content, review as needed.
http://accessmedicine.mhmedical.com.ezproxy.uky.edu/book.aspx?bookID=1843 Links to an external site.
- Barkley Readings Review as needed Chapter 11 Cardiovascular assessment
- Harrison's Readings Review Harrison's Introduction to Cardiovascular Disorders as needed. These are the Basic Biology of the cardiovascular system; Epidemiology of the Cardiovascular System; Approaches to patients with Cardiovascular Disease; Physical Examination of the Cardiovascular System and Electrocardiography Chapters. Chapters 273-278 are the Rhythm disorder chapters.
- 264: Approach to the Patient with Possible Cardiovascular Disease Links to an external site.
- 265e: Basic Biology of the Cardiovascular System Links to an external site.
- 266e: Epidemiology of Cardiovascular Disease Links to an external site.
- 273e: Principles of Electrophysiology Links to an external site.
- 274: The Bradyarrhythmias: Disorders of the Sinoatrial Node Links to an external site.
- 275: The Bradyarrhythmias: Disorders of the Atrioventricular Node Links to an external site.
- 276: Supraventricular Tachyarrhythmias Links to an external site.
- 277: Ventricular Arrhythmias Links to an external site.
- 278e: Atlas of Cardiac Arrhythmias Links to an external site.
Hyperlipidemia:
Harrisons Readings
Chapter 291- The Pathogenesis, Prevention and Treatment of Atherosclerosis.
Chapter 422- Disorders of Lipoprotein Metabolism
Chapter 422- The Metabolic Syndrome
Ferri’s 2017 Clinical Advisor Readings (use for all Ferri readings is free)—Type Ferri Clinical Advisor, choose the 2017 and then you will see the table of contents. I saw no page numbers, but if you just type in the title at the search window, the chapter will follow.
https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20130126979 Links to an external site.
Hyperlipoproteinemia Chapter
Metabolic syndrome Chapter
Barkley Text:
Chapter 13: CAD and hyperlipidemia
Additional Web-based Readings:
NHI Guidelines for lipid management: http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a Links to an external site.
High Cholesterol Treatment Options: (Beyond the Basics) http://www.uptodate.com/contents/high-cholesterol-treatment-options-beyond-the-basics Links to an external site.
JNC-8 B/P and ACC/AHA Cholesterol Guideline Update Powerpoint—http://academicdepartments.musc.edu/pprnet/downloads/lipid-and-htn-guidelines.pdf Links to an external site.
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a Links to an external site.
Hypertension:
Harrison’s Reading
Chapter 298-- Hypertensive Vascular Disease
Ferri’s: Hypertension Chapter-- www.libraries.uky.edu Links to an external site./MCL (use for all Ferri readings is free)
Barkley Text:
Chapter 12: HTN
Additional Web-based Readings:
JNC 8 at Last! Guidelines Ease up on B/P Threshold and drug choices http://www.medscape.com/viewarticle/817991 Links to an external site.
(For the above article you will need to use your medscape log-in which is free for our UK students and accessible via the UK Library web page if you have not obtained this at this time.)
2014 Evidence based Guidelines for the management of Adults diagnosed with Hypertension. Journal of American Medical Association (JNC 8). http://jama.jamanetwork.com/article.aspx?articleid=1791497 Links to an external site.
Hypertension in 2014: Making sense of the Guidelines. http://journals.lww.com/tnpj/Fulltext/2014/06000/Hypertension_in_2014__Making_sense_of_the.5.aspx?WT.mc_id=HPxADx20100319xMP (Copy and paste the URL into a new browser and the article will open. It is a June 15 2014, Nurse Practitioner Journal Article)
Hypertension Management and Treatment: http://emedicine.medscape.com/article/241381-treatment Links to an external site.
Fuchs, F. (2013). Why Do Black Americans Have Higher Prevalence of Hypertension? An Enigma online before print February 7, 2011
http://hyper.ahajournals.org/content/57/3/379.full
Links to an external site.
There is a YouTube video that was helpful to explain the RAAS if needed. The address is:
http://www.youtube.com/watch?v=fc0_vJCvAx8&feature=related
Links to an external site.
There are apps available thru apple and others from AHA/ACC that are ASCVD risk estimators that maybe helpful.
CAD/MI/12 Lead EKG/Arrhythmia:
Harrison’s Reading Assignments:
Chapter 270&271 Noninvasive Cardiac Imaging: Echocardiography, Nuclear Cardiology, and MRI/CT Imaging
Chapter 272; Diagnostic Cardiac Catheterization and coronary Angiography
Chapter 293; Ischemic Heart Disease
Chapter 294; Unstable Angina and Non-ST Segment Elevation MI
Chapter 295; ST-Segment Elevation MI
Chapter 296; PCI and Other Interventional Procedures
Barkley Text:
Chapter 13: CAD and hyperlipidemia
Chapter 14: Angina and MI
Additional Web-based CAD/MI Readings:
2013 ACCF/ACA Guidelines for the ST elevation Myocardial Infarction.
http://content.onlinejacc.org/article.aspx?articleid=1486115 Links to an external site.
ACC/AHA Guidelines for the Management of Patients with Unstable Angina and Non-ST Elevation Myocardial Infarctions-Executive Summary.
http://circ.ahajournals.org/content/102/10/1193.full Links to an external site.
Guidelines for the management of patients with stable ischemic heart disease. https://www.aacvpr.org/Portals/0/resources/professionals/2012%20Guidelines_StableIschemicHeartDisease_11-20-12.pdf Links to an external site.
Additional Web-based Atrial Fibrillation/Arrhythmia's Readings:
Atrial Fibrillation Guidelines Circulation 2014: Therapeutic master list of trials and anticoagulation therapy
Vascular Disease
Harrison’s Readings Assignments
Chapter 300-302 Vascular Diseases of the Extremities
Chapter 298; Hypertensive Vascular Disease
Chapter 301; Diseases of the Aorta
Chapter 302; Arterial disease of the extremities
Chapter 303; Chronic Venous disease and lymphedema
Chapter 304; Pulmonary HTN
Ferri’s Readings:
https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20130126979 Links to an external site.
Carotid stenosis
PAD
Barkley Text:
Chapter 16: PVD
Chapter 17 Inflammatory Cardiac Disease
Additional Web-based Readings:
Management of Patients with Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Jeffrey L. Anderson, Jonathan L. Halperin, Nancy M. Albert, Biykem Bozkurt, Ralph G. Brindis, Lesley H. Curtis, David DeMets, Robert A. Guyton, Judith S. Hochman, Richard J. Kovacs, E. Magnus Ohman, Susan J. Pressler, Frank W. Sellke and Win-Kuang Shen.
Circulation. Published online March 1, 2013. http://circ.ahajournals.org/content/early/2013/03/01/CIR.0b013e31828b82aa.full.pdf Links to an external site.
2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline). http://content.onlinejacc.org/article.aspx?articleid=1146931 Links to an external site.
The Use of Anticoagulants in Peripheral Arterial Disease http://anticoagulation.cardiosource.org/Hot-Topics/2014/08/The-Use-of-Anticoagulants-in-Peripheral-Arterial-Disease.aspx?w_nav=LN Links to an external site.
*Foot ulcers can have several etiologies. Location is usually a clue to cause.
- Distal toes - usually neuropathic due to poor sensation
- Sole of foot - usually arterial insufficiency
- Ankle - usually venous insufficiency
Disorders of the Heart: Heart Failure and Cardiomyopathies
Harrison’s Reading Assignments:
Chapter 279-280; Heart Failure management and Cor Pulmonale
Chapter 287; Cardiomyopathy and Myocarditis
Chapter 288; Pericardial Disease
Barkley Text:
Chapter 18: Heart Failure
Chapter 20: Cardiomyopathy
Ferri’s:
All chapters on cardiomyopathy (Review as needed)
Heart Failure (Review as needed)
Additional Web-based Readings:
The 2017 Update Heart Failure Guidelines 2017 CIR.0000000000000509.full.pdf Download Heart Failure Guidelines 2017 CIR.0000000000000509.full.pdf 2013 ACCF/AHA Guidelines for the Management of Heart Failure: Executive Summary. http://circ.ahajournals.org/content/128/16/1810 Links to an external site.
Review of the 2013 Heart Failure Guidelines: What you Really Need to know. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_456868.pdf Links to an external site.
Dilated Cardiomyopathy, Treatment and management. http://emedicine.medscape.com/article/152696-treatment#aw2aab6b6b1aa Links to an external site.
ACCF/AHA Diagnosis and Treatment of Hypertrophic Cardiomyopathy. Nov 2011. http://www.cardiosource.org/~/media/Files/Science%20and%20Quality/Guidelines/Pocket%20Guides/HCM_Pocket_Guide.ashx Links to an external site.
Heart rescue: the role of mechanical circulatory support in the management of severe refractory cardiogenic shock.
http://ovidsp.tx.ovid.com.ezproxy.uky.edu/sp-3.13.0b/ovidweb.cgi?WebLinkFrameset=1&S=AMPLFPBJBGDDLNGBNCLKBDMCDPIPAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.22.23%257c0%257c00075198-201210000-00002%26S%3dAMPLFPBJBGDDLNGBNCLKBDMCDPIPAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCMCBDGBBG00%2ffs047%2fovft%2flive%2fgv024%2f00075198%2f00075198-201210000-00002.pdf&filename=Heart+rescue%3a++the+role+of+mechanical+circulatory+support+in+the+management+of+severe+refractory+cardiogenic+shock.&pdf_key=FPDDNCMCBDGBBG00&pdf_index=/fs047/ovft/live/gv024/00075198/00075198-201210000-00002
Links to an external site.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
http://europace.oxfordjournals.org/content/8/9/746.full.pdf
Links to an external site.
Structural Heart Disease
Harrison’s reading:
Chapter 283-286; Valvular Heart Disease
Ferri’s Readings:--Valvular Disorder chapters (review as needed)
https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20130126979 Links to an external site.
Aortic Regurgitation
Aortic Stenosis
Mitral Regurgitation
Mitral Stenosis
Mitral Valve Prolapse
Barkley Text:
Chapter 19: Valvular Disease
ACC/AHA guidelines for management of patients with valvular heart disease: Executive Summary. http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029 Links to an external site.
Pacemakers
Barkley Text:
Chapter 15: adjunct equipment and devices
Additional Web-based Readings:
2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association.
Remote Monitoring Associated with Increased Survival Outcomes in Pacemaker Patients. http://www.cardiosource.org/News-Media/Publications/Cardiology-Magazine/2014/05/Remote-Monitoring-Associated-With-Increase-Survival-Outcomes-in-Pacemaker-Patients.aspx?w_nav=Search&WT.oss=pacemakers&WT.oss_r=792& Links to an external site.
Cardiac Resynchronization Improves survival in Heart Failure Patients. http://www.cardiosource.org/News-Media/Media-Center/News-Releases/2014/03/Goldenberg-Cardiac-Resyc.aspx?w_nav=Search&WT.oss=pacemakers&WT.oss_r=792& Links to an external site.
The ESC 2013 article covers transcutaneous pacing, for those of you more interested in more of a "how to" and "why" on transcutaneous pacing. This Medscape article includes great information and a video. http://emedicine.medscape.com/article/98939-overview Links to an external site.
Additional Pacemaker Information:
I would like to share with you some information regarding follow-ups for patients with pacemaker implantations.
Suture Removal – Patients are usually seen for staple removal within 7-10 days post insertion
Sling - Patients should wear a sling for approx. 2 weeks to prevent the leads from dislodging. Patients can raise their arm to shoulder level after 2 weeks and overhead after 4 weeks.
The first interrogation is usually preformed at 90 days, Medicare won't reimburse for this procedure prior to that date. If a patient calls and has a problem (lightheadedness, dizziness etc.) you would want to interrogate to see if they had an arrhythmia, or if they have had a lead fracture or lead displacement. If there has been an arrhythmia, the trending will show if they have had times where the heart rate has been elevated (high rate events), or low as well. Histograms are created for you to view and can then be attached to the patient’s chart.
Pacemakers should be interrogated usually in the office every 6 months, at the very least yearly to check battery life. Many protocols tell you every 3 months, but offices using these protocols usually have the patients use telephone where a limited interrogation can be performed. The patients place wrist bands on their wrists that are connected to the phone unit and then a hand held phone is placed in the cradle of the unit and the interrogation can be performed with the assistance of someone from their cardiologist office who directs them thru the procedure via the telephone. (Remote device checks).
Biventricular pacing is becoming more and more common place and you may see it while in your clinical rotations.
Also, of course remember in the diagnosis of other co-morbidities, use of an MRI can have a profound effect upon pacemaker functioning and should not be considered.
I hope this gives a little more information regarding care of the patient who has had a pacemaker implanted. Many of these patients remain on anti-arrhythmia medications and still need Qtc levels measured with regularity, so they still require the basic cardiac care as well as the pacemaker interrogation. Many as well have had cardiac events so again may require the routine cardiac evaluations and follow-up for progression of disease.
Cardiac Module application
There are case studies found below that will help you to apply the cardiovascular module information into practice—while these case studies are not assigned for the module completion they may be helpful as a study tool.
http://accessmedicine.mhmedical.com.ezproxy.uky.edu/cases.aspx#tab=5 Links to an external site.
Under case tab go to the resident readiness section
Select inpatient cases—pick appropriate diagnoses from there
STUDY GUIDE: Cardiac Module Study Guide.docx Download Cardiac Module Study Guide.docx