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Cardiovascular Module Readings

NUR 941

Cardiovascular Module Reading Assignments

 

Learning Outcomes

  1. 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.
  2. Synthesize relevance of cardiopulmonary assessment and diagnostic tests for individual patients.
  3. 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.
  4. Formulate an evidence based plan of care from admission to discharge for common acute cardiopulmonary conditions.
  5. Individualize the diagnostic and treatment process based on age, race, gender, ethnicity, culture, spiritual beliefs, lifestyle, and socioeconomic status.
  1. Analyze risk factors that may impede optimum cardiopulmonary disease management and contribute to longer length of stay and recidivism.
  2. 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 & Treatment 2019 (available on Access Medicine)

https://accessmedicine-mhmedical-com.ezproxy.uky.edu/book.aspx?bookid=2449 Links to an external site.

-Current Medical Diagnosis and Treatment 2019 Chapter 10-Heart Disease 

https://accessmedicine-mhmedical-com.ezproxy.uky.edu/content.aspx?bookid=2449&sectionid=194435482 Links to an external site.

 

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.

- 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 238-250 are the Rhythm disorder chapters.

Hyperlipidemia:

Harrisons Readings

Chapter 291- The Pathogenesis, Prevention and Treatment of Atherosclerosis. 

Chapter 400: Disorders of Lipoprotein Metabolism Links to an external site.

Chapter 401: The Metabolic Syndrome Links to an external site.

 

Ferri’s 2019 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:

Multi-society  Guidelines for lipid management: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol Links to an external site.

https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Guidelines/2018/Guidelines-Made-Simple-Tool-2018-Cholesterol.pdf 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. Links to an external site.

 

Hypertension:

Harrison’s Readings:

 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:

       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.

      Links to an external site.http://content.onlinejacc.org/article.aspx?articleid=1486115

      Links to an external site.

      ACC/AHA Guidelines for the Management of Patients with Non-ST Elevation Myocardial Infarctions

      https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000134 Links to an external site.

      Guidelines for the management of patients with stable ischemic heart disease.

      https://www.acc.org/education-and-meetings/products-and-resources/guideline-education/stable-ischemic-heart-disease Links to an external site.

       Additional Web-based Atrial Fibrillation/Arrhythmia's Readings:

      2014 Guidelines on Management of Patients with Atrial Fibrillation

      https://www.ahajournals.org/doi/10.1161/cir.0000000000000041 Links to an external site.

      2019 Focused Update

      https://www.ahajournals.org/doi/10.1161/CIR.0000000000000665 Links to an external site.

      Vascular Disease

      Harrison’s Readings Assignments

      Chapter 273: Deep Venous Thrombosis and Pulmonary Thromboembolism Links to an external site.

      Chapter 274: Diseases of the Aorta Links to an external site.

      Chapter 275: Arterial Diseases of the Extremities Links to an external site.

      Chapter 271: Hypertensive Vascular Disease Links to an external site.

      Chapter 274: Diseases of the Aorta Links to an external site.

      Links to an external site.Chapter 275: Arterial Diseases of the Extremities Links to an external site.

      Chapter 276: Chronic Venous Disease and Lymphedema Links to an external site.

      Chapter 277: Pulmonary Hypertension Links to an external site.

       

      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.

      2016 AHA/ACC Guideline on Management of Patietns with Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

      https://www.ahajournals.org/doi/10.1161/CIR.0000000000000470 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. 

      1. Distal toes - usually neuropathic due to poor sensation
      2. Sole of foot - usually arterial insufficiency
      3. Ankle - usually venous insufficiency

      Disorders of the Heart: Heart Failure and Cardiomyopathies

      Harrison’s Reading Assignments:

      Chapter 252: Heart Failure: Pathophysiology and Diagnosis Links to an external site.

      Chapter 253: Heart Failure: Management Links to an external site.

      Links to an external site. Links to an external site.Chapter 254: Cardiomyopathy and Myocarditis Links to an external site.

      Chapter 265: Pericardial Disease Links to an external site.

        Links to an external site. 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 Download Heart Failure Guidelines 2017 CIR.0000000000000509.full.pdf

       

      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.

      2017 ACC/AHA/HRS  guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

      https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549 Links to an external site.

      Structural Heart Disease

      Harrison’s reading:

      Chapter 256: Aortic Valve Disease Links to an external site.

      Links to an external site.Chapter 257: Aortic Regurgitation Links to an external site. Links to an external site.

      Chapter 258: Mitral Stenosis Links to an external site.

      Chapter 259: Mitral Regurgitation Links to an external site.

      Chapter 260: Mitral Valve Prolapse Links to an external site.

      Chapter 261: Tricuspid Valve Disease Links to an external site.

      Chapter 262: Pulmonic Valve Disease Links to an external site.

      Chapter 263: Multiple and Mixed Valvular Heart Disease Links to an external site.

       

      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

      2014 AHA/ACC guidelines for management of patients with valvular heart disease: Executive Summary. Links to an external site.http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029

      Links to an external site.2017 AHA/ACC Focused Update of the 2014 AHA./ACC Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

      https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000503 Links to an external site.

      Pacemakers

      Barkley Text:

                  Chapter 15: adjunct equipment and devices

      Additional Web-based Readings:

      2018 ACC/AHA/HRS Guideline on Bradycardia and Cardiac Conduction Delay

      https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/05/15/12/2018-acc-aha-hrs-guideline-on-bradycardia Links to an external site.

      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.

      (EHRA). http://eurheartj.oxfordjournals.org/content/early/2013/06/13/eurheartj.eht150.full Links to an external site.

      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.

      Wound Checks – Patients are usually seen for a wound check within 7-10 days post insertion.  Rarely are staples placed over the suture line.  Most modern implanters use a dermabond type of skin glue.
      Sling - Patients should wear a sling for approx. 2 weeks to prevent the leads from dislodging.  The sling is a reminder to not raise their arm above shoulder level for 4 weeks.  Avoid extremes of motion on the affected side.  However, careful instruction should be given to use the arm to avoid a frozen shoulder. 

      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).   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).  These telephone checks are almost obsolete with the introduction of radiofrequency remote monitoring used currently. 

      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 be considered only in MRI compatible devices or those not dependent on pacing in non-compatible devices.  Many smaller hospitals refuse to do MRIs in pacemaker patients as it has been a complete contraindication for years.

      New guidelines were released in 2017 and are available at the link below.

      https://www.hrsonline.org/2017-hrs-expert-consensus-statement-magnetic-resonance-imaging-and-radiation-exposure-patients Links to an external site.


      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:  Download Cardiac Module Study Guide.docx