CURRENT TRENDS IN

CARDIO-VASCULAR NURSING

Presented By:
Dr.Prof.Rosaline Rachel
Principal
MMM College of Nursing
 In India, against the estimated population of 1.27
billion about 45 million people suffer from coronary
artery disease
 A study conducted by Safola Life in the year 2013
indicates that over 70 per cent of the urban Indian
population is at the risk of being diagnosed with heart
disease
 Sedentary lifestyle is a major cause for heart disease
 Diabetes and hypertension have further increased
heart disease cases
  Cardiovascular Nurses play a key role in
Trends in the evaluation of Cardiovascular Status,
monitoring the Hemodynamic functions
Cardiac Nursing
and disease management
 Nursing interventions have shown to
reduce patient stress
 Research findings suggest that morbidity
and mortality in cardiac patients can be
improved with a comprehensive
treatment plan which has a Nurse
managed Stress Reduction Plan
MILESTONES IN THE EVOLUTION OF CARDIOLOGY

Treatment of Acute
Acute Cardiac
Coronary Imaging
Myocardial Surgery
Syndromes
infraction

Valvular heart
Arrhythmias Heart Failure Prevention
disease
 BENEFITS OF SUB-SPECIALIZATION

Skilled sub-specialists makes

complicated procedures successfully Disease prevention
and at relatively low risk

Improves patient
Leads to greater Costs of cardiac
care, teaching
expertise care
and research
The present Scenario in the field of CARDIOLOGY

Growth of
cardiovascula
r centers

Rise of
global
cardiology

Evidence
based
cardiology
practice
 Interventional Stem cell
cardiology therapy

Clinical Cardiac
cardiology Recent imaging
Advances &
Future
Trends In
Cardiology
 Clinical Cardiology
Recent advances and Interventional Cardiology
future trends Stem Cell Therapy
Cardiac Imaging
Ultrasound
 Nuclear Medicine imaging
Magnetic Resonance (MR)
imaging
 Computed Tomography
(CT)
 X-ray imaging
Clinical Cardiology Clinical cardiology is never static and lot
of effort is put on development of better
drugs
 The most recent has been the approval
and availability of newer thenopyridine
prasugrel (Inhibits ADP-induced platelet
activation and aggregation)which is
used in treatment of acute coronary
syndromes for those proceeding to
percutaneous interventions.
 For management of angina newer drugs
have come as add on therapy
  Dabigatran an oral
anticoagulant is a very exciting
Clinical Cardiology addition in stroke and embolism
prevention in patients with atrial
fibrillation
 It does not require International Normalised
Ratio ( INR )monitoring as compared to warfarin
 It is superior to warfarin in reducing stroke or
peripheral embolic events
 Less risk of hemorrhage is an added attraction.
 Newer antiarrhythmics
become available which
include drugs like dronedarone
which is indicated in prevention
of recurrence of atrial fibrillation.
Interventional Cardiology

 There have been exciting developments in the field of interventional

cardiology
 On catheterization table, assessment of lesion severity using
Fractional Flow Reserve (FFR) has come into prominence
 FFR represents the maximum achievable blood flow after challenge
with adenosine to myocardium supplied by stenotic artery as a
fraction of normal maximum value
 A value of less than 0.75 identifies stenosis with inducible ischemia
 This has made multi vessel disease angioplasty much more
evidence based and unnecessary stenting in physiologically normal
lesions is avoided
Interventional  Recently lot of interest has
Cardiology… been generated by
concept of thrombus
aspiration in primary
percutaneous intervention
 Thrombectomy is one of the
rare effective preventive
measures against no-reflow
 In a Bayesian meta-
analysis, adjunctive
thrombectomy improves
early markers of reperfusion
Interventional  Local drug delivery viz Drug Eluting
Balloons (DEB) have generated lots of
Cardiology… interest lately
 Rationale for the development of DEB
derives mainly from the limitations of
Drug Eluting Stents (DES)
 DEB may be used in subsets of lesions
where DES cannot be delivered or where
DES do not perform well, such as in
tortuous vessels, small vessels, or long
diffuse calcified lesions, which can result
in stent fracture
 The most appealing indication for
paclitaxel eluting balloons would be for
the treatment of in-stent restenosis (ISR)
 The surface of the polymer-free

Interventional BioFreedom stent. Scanning

electron microscopy

Cardiology…  Percutaneous Coronary

intervention (PCI) with
bioabsorbable stents have
come to usage

 Biodegradable stents
contain a biodegradable
polymer which are
completely biodegradable
Interventional  Now , the potentially for less
Cardiology… invasively replicating these
successful surgical procedures
without the need for thoracotomy or
cardiopulmonary bypass has
generated considerable interest
 The Mitraclip device has proven
relatively safe and effective
 Using a multiaxial transeptal catheter
system, a metallic clip is used to
grasp and approximate the free
edges of the 2 leaflets
Interventional Balloon Aortic
Cardiology… Valvuloplasty replacing
Surgical Aortic Valve
replacement for patients
with symptomatic severe
aortic valve stenosis
Percutaneous Aortic Valve
Replacement (PAVR) using
stent-based prostheses
has emerged as a
promising new option in
recent years
 Recent advancements
 Types of Minimally
Invasive Heart Surgeries
 Minimally Invasive
 Minimally Invasive Valve Surgery
Heart Surgery  Minimally Invasive
CABG Surgery
 Off-pump/beating
heart bypass surgery
Robotically assisted
heart surgery
Robotically assisted Valve

Types surgery
Robotically assisted
Bypass surgery
Robotically assisted ASD
Robotically assisted
Removal of Cardiac
tumors
Benefits of minimally Small incisions
invasive surgical techniques Small scars
Shorter hospital stay
Low risk of infection
Low risk of bleeding and
blood transfusion
Shorter recovery time and
faster return to normal
activities
Division of sternum is not
needed for robotically
assisted heart surgery
Stem Cell  Stem cell therapy as
applied to cardiology has
Therapy shown partial progress
 The angina in so called end
stage coronary artery
disease is refractory to
conventional medical
therapy
 Laboratory and preclinical
studies have provided
evidence for the safety and
potential efficacy of
autologous CD34+ stem cell
therapies as treatment for
angina
Stem Cell
Therapy
Role of stem cells in heart
failure is under evaluation

There appeared to be a
significant decrease in
long-term mortality in the
stem-cell-treated patients
 Nuclear Imaging in
Cardiology
s
Applications of Nuclear
Cardiology
 Coronary Artery Disease
 Assessment of LV /RV function
 Cardiomyopathy /Myocarditis
 Valvular Heart Disease
 Cardiac Shunts
 Secondary Hypertension
 Pulmonary Hypertension
 Assessment of Cardiac Transplant
Cardiac Nurses in different Environments
Coronary
care units
Cardiac (CCU)
Cardiac
medical
catheterization
wards

Cardiovascular Intensive
intensive care care units
units (CVICU) (ICU)

Operating
Cardiac surgery wards
theatres

Cardiac
Clinical
rehabilitation
research
centres
  Cardiac nursing is a nursing
Cardiac Nursing specialty that works with
patients who suffer from various
conditions of the
cardiovascular system
 Cardiac nurses help to treat
conditions unstable
angina,cardiomyopathy,
coronary artery disease,
congestive heart failure
myocardial infarction and
cardiac dysrhythmia under the
direction of a cardiologist
Improving quality of
care in cardiac
 Use checklists in every
Nursing cardiac surgery case
Quality depends on  Implement training involving
all members of the cardiac
operative team on situational
awareness.
Timely action
 Implement formal handoff
Efficiency protocols during transfer of
Efficacy care of cardiac surgical
patients to new medical
Equitability
personnel.
Patient centeredness
 Implementation of policies
regarding professionalism and
quality
Developing Cardiac Research is one form of
care: why research knowledge used to guide
and enhance any
matters professional practice
It follows a specific
methodology and, when
well-written, allows us to
critique the steps and
consider its application to
patient
The two broad research
paradigms—quantitative
and qualitative—are
described, to highlight
their value
Coronary Coronary Angioplasty -
Angioplasty: Patient Nurses need to understand
management and nursing care the rationale for this
treatment option as well as
the risks , so that they
prepare a patient
psychologically for the
procedure
 Lookafter safely and
facilitate ongoing secondary
prevention, discharge advice
and cardiac rehabilitation -
.BMJ Qual Saf 2012;21:807-809
  Randomised controlled trials have
Coronary also demonstrated the benefit of
Nurse-run cinics for secondary
Angioplasty: Patient prevention of Coronary Heart Disease
(Riley, 2003)
management and nursing care  Nurse-Provided or Nurse-Coordinated
Care Management programs using an
integrated or multifactor approach
have been shown to be highly
effective in reducing morbidity and
mortality of high-risk patients (Haskell,
2003)
 Cardiovascular Nurses play a very
important role at different levels, ie the
technical level, where the nurses
carry out diagnostic examinations
and risk assessments; psychological
level where the nurse informs, acts as
a health counsellor and helps in the
patient self care process (Riccio et.al,
2004)
Coronary Angioplasty:
Patient management and nursing  A study to observe secondary
care prevention practice in a
cardiovascular department in
a sample of two hundred and
twenty patients discharged
from the Intensive Coronary
Care Unit, Cardiac Surgery
Unit and Vascular Surgery Unit
has shown that nurses play a
vital role in implementation of
guidelines, risk assessment,
drug treatment and effective
patient education (Steffenino et.al,
2013)
30 Acute Coronary
Syndromes- ACS are the clinical manifestation
of coronary heart disease (CHD),
which involves the development of
atherosclerotic plaques in the
coronary vasculature. The growth
of plaques over time narrows the
lumen of coronary arteries, which
limits blood flow and manifests
clinically as stable angina.

DR.ROSALINE RACHEL 22 February 2018

Acute Coronary
Syndromes- the Role
of CCU Nurse
Acute coronary syndromes (ACS) are the leading cause of death

Classification of Acute Coronary Syndromes (ACS)

ST-segment elevation myocardial infarction (STEMI)

Non–ST-segment elevation (NSTE)
ACS Unstable angina (UA)
NSTE myocardial infarction (NSTEMI)
32
Acute coronary  History : Angina pattern and severity,
eg, accelerating or prolonged at rest
syndromes- the Role History of Coronary heart disease
of CCU Nurse  Physical exam : Signs of cardiac
dysfunction or hemodynamic
instability
Tools for Diagnosis and Risk  Electrocardiogram : ST-segment
Assessment of Patients changes, eg, severe, prolonged
Presenting With Chest elevation; transient elevation; or
Discomfort or Pain depression New Q waves T-wave
inversion
 Cardiac markers : Increase in
creatine kinase-myocardial band
(CK-MB) Increase in cardiac troponin
I and/or T
 Continuous 12-lead ST-segment
changes with or without ST-segment
monitoring corresponding ischemic
symptoms

DR.ROSALINE RACHEL 22 February 2018

33 Thrombolysis in Factor Present (score)
Myocardial Infarction  Aged ≥ 65 years
(TIMI) Risk Score for Stratification  At least 3 risk factors for Coronary
of Patients With NSTE ACS artery disease
 Significant Coronary stenosis (eg,
prior stenosis of 50% or more)
TIMI risk score system is  ST-segment deviation on ECG at
based on seven predictors presentation
 Severe Anginal symptoms (eg, at
least 2 anginal events in the last
24 hours)
 Use of Aspirin in last 7 days
 Elevated Serum cardiac markers

DR.ROSALINE RACHEL 22 February 2018

Risk factor  Framingham Risk category assessment
assessment used in identifying clients with ten year
risk for major coronary event.
 The risk score is based on patient's sex,
level of total cholesterol ,
level of high density lipo protein (HDL)
Systolic blood pressure , history of
cigarette smoking, age
 Depending on the score, the patient is
assessed as low or intermediate or high
risk category.
Interventions Linked to Decreased Heart Failure
Hospitalizations During Ambulatory Pulmonary
Artery Pressure Monitoring

Elevated cardiac filling pressures, which increase

the risk of hospitalizations and mortality, can be
detected using an ambulatory PA pressure
monitoring system before onset of symptomatic
congestion allowing earlier intervention to prevent
HF hospitalizations.

 JCHF. 2016;4(5):333-344. doi:10.1016/j.jchf.2015.

 Self-care and improved outcomes: an
intervention by heart failure nurse specialists
 The aim of this study was to evaluate whether or not an
educational intervention carried out by a team of heart
failure nurse specialists (HFNS), as part of usual care,
enhanced self-care behaviour in patients with chronic
heart failure.
 Results showed Selfcare was improved overall (p=0.011), with five
behaviours demonstrating a statistically significant improvement:
namely, the uptake of flu and pneumonia vaccination (p=0.009),
regular weighing (p=0.001), recognising changes in sleep patterns
(p=0.014), recognising signs of fluid retention (p=0.001), and the
wellbeing dimension of going out as much as possible (p=0.019).
 BJ of Cardiac Vascular Nursing AUG. 2016 | VOLUME 11 | ISSUE 8
 Standard nurse driven PROTOCOL
FOR POSTOPERATIVE ATRIAL FIBRILLATION REDUCES LENGTH OF STAY AND
HOSPITAL COSTS

 Postoperative atrial fibrillation (POAF) is common following

cardiovascular (CV) surgery and is associated with an increase in
complications. Significant variation in the management of POAF
exists, which can cause increased hospital costs and length of stay
(LOS). Prospective use of a real-time, nurse-run POAF management
protocol may improve outcomes and lower cost
 Conclusion: A real-time decision support protocol standardizes
treatment and empowers nurses to effectively manage POAF,
reducing ICU readmissions and LOS, post-operative consults, LOS,
and costs.
New trends in hypertension
management
Monitoring of blood pressure,(AOBP)
ambulatory blood pressure monitoring
Reduce dietary sodium intake
Use of simplified algorithms featuring the
use of low-dose single pill.(combination of
amlodipine with angiotensin-converting
enzyme (ACE) inhibitor
39
Preventive Cardiology
 Optimize management of dyslipidemia
 CVD risk reduction: lifestyle (diet and exercise)
 Hypertension (5 E program: Education, Engagement,
Environment, Evidence, Evaluation)Blood pressure, BMI,
and weight reduction
 Diabetes and hypertension
 Smoking cessation (education, counseling, and follow-
up)
 CVD risk with medication counseling and management
all CVD risk factors lowered; decreased Framingham
score
 CVD risk management cost evaluation
22 February 2018
DR.ROSALINE RACHEL
40 Conclusion
 Critical-care and emergency department nurses as per the
recent trend play a crucial role in the rapid assessment, risk
stratification, and management of individuals
 Skills of nurses in triage aid in the accurate diagnosis, timely
involvement along with physicians, and implementation of
evidence-based interventions
 Admission of patients to Cardiac units implies the need for
continuous professional nursing care.
 Nurses role is essential for facilitating timely and accurate
patient assessment, diagnosis, and management, as well as
evaluation of delivered care.
DR.ROSALINE RACHEL 22 February 2018
41 REFERENCE
 Graves EJ, Kozak LJ. Detailed diagnoses and procedures, National Hospital
Discharge Survey, 1996. Vital Health Stat 13. 1998;i-iii:I-151.
 Armstrong PW, Fu Y, Chang WC, et al. Acute coronary syndromes in the
GUSTO-IIb trial: prognostic insights and impact of recurrent ischemia. The
GUSTO-IIb Investigators. Circulation. 1998;98:1860-1868.
 Rauch U, Osende JI, Fuster V, Badimon JJ, Fayad Z, Chesebro JH. Thrombus
formation on atherosclerotic plaques: pathogenesis and clinical
consequences. Ann Intern Med. 2001;134:224-238.
 Corti R, Fuster V, Badimon JJ. Pathogenetic concepts of acute coronary
syndromes. J Am Coll Cardiol. 2003;41(suppl S):7S-14S.
 Viles-Gonzalez JF, Fuster V, Badimon JJ. Atherothrombosis: a widespread
disease with unpredictable and life-threatening consequences. Eur Heart
J. 2004;25:1197-1207.
42

The best preparation for good work

tomorrow is to do good work today.”
— Elbert Hubbard

DR.ROSALINE RACHEL 22 February 2018