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Cardiac Intensive Care - E-Book

Cardiac Intensive Care - E-Book

David L. Brown

(2018)

Additional Information

Book Details

Abstract

Using a multidisciplinary, team-oriented approach, this unique title expertly covers all the latest approaches to the assessment, diagnosis, and treatment of patients with critical cardiac illness. Led by Dr David L. Brown, a stellar team of authoritative writers guides you through cardiac pathophysiology, disease states presenting in the CICU, and state-of-the-art advanced diagnosis and therapeutic techniques. A visually appealing format, new chapters, and thorough updates ensure that you stay on the cutting edge of this rapidly advancing field.

  • Discusses recent changes in cardiac intensive care, including new care paradigms, new mechanical support modalities, and new therapies and interventions.
  • Contains 11 new chapters: Palliative Care, Temporary Pacemaker Insertion, Pericardiocentesis, Distributive Shock, Electrical Storm, Cardiopulmonary Cerebral Resuscitation after Cardiac Arrest, Temporary Mechanical Circulatory Support Devices, Cardiorenal Syndrome, Fulminant Myocarditis, Stress-Induced Cardiomyopathy, Diagnosis and Treatment of Unstable Supraventricular Tachycardia.
  • Concisely yet thoroughly covers acute and severe heart failure, chronic pulmonary hypertension, life-threatening dysrhythmias, aortic dissection, and other cardiac conditions as they relate to intensive care.
  • Explains drug therapy for key cardiac drugs, such as inotropes, vasodilators, anti-arrhythmics, diuretics, anticoagulants, and anti-platelets, and discusses important drug interactions.
  • Ideal for all healthcare professionals involved in cardiac intensive care, including intensivists, cardiologists, cardiac surgeons, residents, fellows, cardiac nurses, respiratory therapists, physical therapists, and nutritionists.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Cardiac Intensive Care i
Copyright Page iv
Dedication v
Foreword vii
Preface ix
Contributors xi
Table Of Contents xv
Audio and Video Contents xvii
Second half title page xix
I Introduction 1
1 Evolution of the Coronary Care Unit 2
Keywords 2.e1
Outline 2
Origins of the Coronary Care Unit 2
Early Days of Resuscitation 2
A Paradigm Shift—Prevention of Cardiac Arrest 3
Validating the Benefit of the Coronary Care Unit 4
Economic Impact of the Cardiac Intensive Care Unit 4
Patient Selection in the Cardiac Intensive Care Unit 4
Defining the Contemporary Cardiac Intensive Care Unit 4
Ongoing Evolution of Cardiac Intensive Care Units 5
Multidisciplinary Clinical Integration and the Cardiac Intensive Care Unit Model 5
Management Algorithms 7
Education and Training in the Cardiac Intensive Care Unit 7
Technology Needs in Contemporary Cardiac Intensive Care Units 8
Research in the Cardiac Intensive Care Unit 8
Research Processes 9
Informed Consent 10
Developing an On-site Research Program 10
Conclusion 10
Acknowledgment 10
References 10.e1
2 Ethical Issues in the Cardiac Intensive Care Unit 11
Outline 11
Western Bioethics 12
Principlism 12
Patient Autonomy. 12
Beneficence. 13
Nonmaleficence. 13
Justice. 13
Consequentialism 14
Casuistry 14
Practical Guidelines for Ethical Decision Making 15
Patient Partnership 15
Authority or Medical Decision Making 15
Communication 16
Determining Patients’ Values and Preferences 17
Withholding and Withdrawing of Life Support 17
Legal Precedents 17
Patients With Decision-Making Capacity. 17
Patients Lacking Decision-Making Capacity. 17
Advance Directives 18
Living Wills and Medical Powers of Attorney. 19
Patient Self-Determination Act. 19
Deciding to Withhold or Withdraw Life Support 19
Withholding and Withdrawing Basic Life Support. 20
Withholding Advanced Life Support. 20
Withdrawing Advanced Life Support. 21
Cross-Cultural Conflict 23
Conclusion 24
References 26.e1
3 Physical Examination in the Cardiac Intensive Care Unit 27
Keywords 27.e1
Outline 27
General Assessment 27
Vital Signs 27
Temperature 28
Respiration 28
Pulse 29
Blood Pressure 30
Weight 31
Head, Eyes, Ears, Nose, and Throat Examination 31
Jugular Venous Pulse and Abdominojugular Reflux 31
Chest and Lung Examination 32
Thorax and Heart Examination 33
Auscultation of the Heart 34
S1, S2, S3, and S4 34
Heart Murmurs: Static and Dynamic Auscultation 35
Abdominal Examination 37
Neurologic Examination 38
Vascular Examination 40
Musculoskeletal and Integument Examination 40
Conclusion 40
References 40.e1
II Scientific Foundation of Cardiac Intensive Care 41
4 Role of the Cardiovascular System in Coupling the External Environment to Cellular Respiration 42
Keywords 42.e1
Outline 42
Cardiovascular Function and Pulmonary Gas Exchange 42
Total Pulmonary Blood Flow and Oxygen Exchange 42
Pulmonary Transit Time 44
Distribution of Blood Flow Within the Lungs 45
Left Ventricular Dysfunction and Lung Fluid Exchange 46
Ventricular Function and Lung Disease 47
Cardiovascular Function and Systemic Gas Exchange 47
References 51.e1
5 Regulation of Cardiac Output 52
Outline 52
Arteriovenous Oxygen Difference 52
Reflex Control of Cardiac Output 53
Left Ventricular Performance 54
Pressure-Volume Loop 54
Effect of Alterations in Preload on the Pressure-Volume Loop 54
End-Systolic Pressure-Volume Relationship 54
Effect of Changes in Contractile State 55
Effect of Afterload Change 55
Pressure-Volume Approach Applied to Pathologic Conditions 56
Acute Systolic Dysfunction 56
Diastolic Dysfunction 57
Aortic Stenosis 57
Mitral Stenosis 58
Valvular Regurgitation 58
Dilated Cardiomyopathy 58
Limitation of the Pressure-Volume Approach 59
Conclusion 59
References 59.e1
6 Coronary Physiology and Pathophysiology 60
Outline 60
Determinants of Myocardial Oxygen Consumption 60
Metabolic Control 60
Autoregulation 60
Vessel Wall and Local Control of Coronary Blood Flow 61
Coronary Arterial System 61
Extravascular Compression of Coronary Blood Supply 62
Neural Control and Reflexes 62
Pathophysiology 63
Atherosclerosis 63
Coronary Microvascular Dysfunction 63
Collateral Blood Vessels 63
Myocardial Ischemia 64
Acknowledgment 67
References 67.e1
7 Pathophysiology of Acute Coronary Syndromes 68
Outline 68
Atherogenesis 68
Development 68
Fatty Streak. 68
Plaque Formation. 69
Progression of Atherosclerosis 73
Chronic Endothelial Injury. 73
Recurrent Thrombosis. 74
Plaque Disruption 74
Vulnerability 74
Core Size and Content. 74
Cap Thickness and Content. 75
Inflammation. 75
Rupture Triggers 75
Cap Tension. 75
Cap and Plaque Compression. 76
Circumferential Bending. 76
Longitudinal Flexion. 76
Hemodynamic Factors. 76
Thrombosis 76
Platelet Biology 76
Platelet Adherence. 77
Platelet Activation and Aggregation. 77
Coagulation Cascade 77
Fibrinolysis 78
Factors That Influence Thrombus Formation 79
Local Factors 79
Degree of vessel wall injury. 79
Degree of stenosis. 79
Residual thrombosis. 79
Systemic Factors. 79
Integrated Pathogenesis of Acute Coronary Syndromes 79
Conclusion 80
References 80.e1
8 Regulation of Hemostasis and Thrombosis 81
Keywords 81.e1
Outline 81
Overview and Definitions 81
Hemostasis 81
Necessary Components 81
Vascular Bed. 81
Extravascular Tissues. 82
Platelets. 82
Coagulation Proteins. 82
Process of Hemostasis 84
Step 1: Initiation of Coagulation on TF-Bearing Cells. 84
Step 2: Amplification of the Procoagulant Signal by Thrombin Generated on the TF-Bearing Cell. 84
Step 3: Propagation of Thrombin Generation on the Platelet Surface. 85
Regulatory Mechanisms to Control Coagulation 86
Plasma Protease Inhibitors 86
Endothelial Antithrombotic Mechanisms 87
Fibrinolysis 87
Clinical Laboratory Testing 87
What Can Go Wrong With Hemostasis? 88
Hemorrhage 88
Consumption of Coagulation Components. 88
Excessive Fibrinolysis. 88
Hypothermia. 88
Acidosis. 88
Thrombosis 88
Venous Thrombosis. 89
Arterial Thrombosis. 89
What Happens After the Bleeding Stops? 89
References 89.e1
III Coronary Artery Disease 90
1 Acute Myocardial Infarction 91
9 Diagnosis of Acute Myocardial Infarction 91
Keywords 91.e1
Outline 91
History 91
Definition of Myocardial Infarction 92
Biochemical Markers of Acute Myocardial Infarction 92
Troponin 93
Diagnosis. 93
Prognosis. 94
Risk Stratification. 94
Creatine Kinase MB 94
Myoglobin 94
Adjunctive Biomarkers 94
Novel Cardiac Markers 95
Clinical Evaluation 95
Physical Examination 96
Electrocardiogram 96
Bundle Branch Block Patterns and Acute Myocardial Infarction. 97
Imaging Techniques 98
Reinfarction 98
Conclusion 98
Acknowledgment 98
References 98.e1
10 Use of the Electrocardiogram in Acute Myocardial Infarction 99
Keywords 99.e1
Outline 99
Introduction 99
Inferior Myocardial Infarction 99
Right Ventricle Myocardial Infarction 99
Anterior Myocardial Infarction 100
Left Main Occlusion 100
Diagnosis in Bundle Branch Block 101
Absence of ST Elevations 101
References 102.e1
11 Reperfusion Therapies for Acute ST Elevation Myocardial Infarction 103
Keywords 103.e1
Outline 103
Introduction 103
Historical Perspective 103
Coronary Thrombosis and the Pathogenesis of Acute Myocardial Infarction 103
Thrombolysis and Reperfusion 104
Thrombolytic Agents: The First Pathway to Coronary Reperfusion 104
Streptokinase. 105
Tissue-Type Plasminogen Activator. 105
Tenectaplase and Reteplase. 105
Magnitude and Timing 105
Pivotal Trials 106
Adjunctive Therapy 106
Bleeding and the Elderly 107
Primary Percutaneous Coronary Intervention 108
Primary Percutaneous Coronary Intervention for STEMI 108
Rationale and Feasability. 108
Key Clinical Trials. 108
Adjunctive Therapy and Approach 108
Oral Antiplatelet Agents: Aspirin, Clopidogrel, Prasugrel, and Ticagrelor. 109
Intravenous Antiplatelet Agents. 110
Antithrombins. 110
Radial, Femoral, and Multivessel Primary PCI. 110
Thrombectomy and Route of Drug Administration. 112
Pharmacoinvasive Therapy for STEMI 112
Regional Systems in STEMI Care 113
Conclusions 116
References 116.e1
12 Adjunctive Pharmacologic Therapies in Acute Myocardial Infarction 117
Keywords 117.e1
Outline 117
Antiplatelet Therapy 118
Aspirin 118
Recommendations 119
P2Y12 Platelet Antagonists 120
Clopidogrel 120
Prasugrel 122
Ticagrelor 122
Cangrelor 122
Recommendations 123
Glycoprotein IIb/IIIa Antagonists 123
Abciximab 123
Tirofiban 124
Eptifibatide 124
Recommendations 124
β-Blockers 124
Recommendations 126
Nitrates 127
Recommendations 127
Angiotensin-Converting Enzyme Inhibitors and Other Renin-Angiotensin-Aldosterone System Inhibitors 127
Angiotensin-Converting Enzyme Inhibitors 128
Angiotensin Receptor Blockers 129
Aldosterone Antagonists 130
Adverse Effects of ACE Inhibitors, ARBs, and Aldosterone Blockers 130
Recommendations 131
Calcium Channel Blockers 131
IV Noncoronary Diseases: Diagnosis and Management 179
18 Acute Heart Failure and Pulmonary Edema 180
Keywords 180.e1
Outline 180
Introduction 180
Pathophysiologic Considerations 181
Chronic Progressive Fluid and Water Retention 181
Pulmonary Edema 181
Left Ventricular Pump Performance in Acute Heart Failure 182
Chamber Stiffness 182
Compensatory Mechanisms in Acute Heart Failure 183
Mechanistic Considerations in Acute Heart Failure Syndromes 183
Clinical Presentation of Acute Heart Failure 185
Group 1: Acute-on-Chronic Decompensated Heart Failure 185
Group 2: Hypertensive Acute Heart Failure 186
Group 3: Acute Heart Failure With Severe Pulmonary Edema 187
Group 4: Cardiogenic Shock and Low-Output Syndrome 187
Group 5: High-Output Heart Failure 187
Group 6: Right-Sided Heart Failure 188
Diagnosis of Acute Heart Failure 188
Differentiating Cardiogenic From Noncardiogenic Pulmonary Edema 188
Evaluation and Triage of Patients With Acute Heart Failure 189
Step 1: Define Clinical Severity of Acute Heart Failure. 189
Step 2: Establish Etiology of Acute Heart Failure. 190
Step 3: Identify Precipitating Causes of Acute Heart Failure. 190
Step 4: Decide on Disposition of Patient. 190
Ongoing Evaluation of the Patient 190
Pulmonary Artery Catheter. 191
Treatment of Acute Heart Failure 191
General Measures 191
Oxygenation. 191
Deep Venous Thrombosis Prophylaxis. 191
Diabetes. 191
Medications 191
Treatment of Triggers of Decompensation 191
Acute Coronary Syndrome. 191
Rapid Arrhythmias and Severe Bradycardia. 191
Acute Mechanical Instability. 192
Hemodynamic Goals of Treatment 192
Specific Interventions 192
Vasodilators. 192
Nitroglycerin 192
Actions. 192
V Pharmacologic Agents in the Cardiac Intensive Care Unit 367
35 Anticoagulation 368
Keywords 368.e1
Outline 368
Hemostasis and the Coagulation Cascade 368
Cell-Based Model of Coagulation 369
Arterial Thrombosis 369
Antithrombins: Mechanism of Action 369
Unfractionated Heparin 369
Pharmacokinetics, Metabolism, and Administration 369
Adverse Effects 370
Clinical Evidence 370
Low-Molecular-Weight Heparins (Enoxaparin) 371
Pharmacokinetics, Metabolism, and Administration 371
Clinical Evidence 371
Synthetic Pentasaccharides (Fondaparinux) 373
Pharmacokinetics, Metabolism, and Administration 373
Clinical Evidence 374
Direct Thrombin Inhibitors (Bivalirudin) 374
Pharmacokinetics, Metabolism, and Administration 374
Clinical Evidence 375
Conclusion 378
Acknowledgment 378
References 378.e1
36 Antiplatelet Therapy 379
Keywords 379.e1
Outline 379
Platelet and Acute Coronary Syndromes 379
Non–ST Segment Elevation Acute Coronary Syndrome 381
Acetylsalicylic Acid (ASA or Aspirin) 381
Adenosine Diphosphate Receptor Antagonists 382
Clopidogrel. 382
Prasugrel. 383
Ticagrelor. 384
Cangrelor. 385
Vorapaxar 385
Glycoprotein IIb/IIIa Receptor Antagonists 385
Abciximab. 386
Eptifibatide. 386
Tirofiban. 387
ST Segment Elevation Myocardial Infarction 387
Aspirin 388
ADP Receptor Antagonists 388
Clopidogrel. 388
Prasugrel. 389
Ticagrelor. 389
Cangrelor 390
Vorapaxar. 390
Glycoprotein IIb/IIIa Inhibitors and Primary Percutaneous Coronary Intervention. 390
Glycoprotein IIb/IIIa Inhibitors and Thrombolytic Therapy. 391
Antiplatelet Therapy and Bleeding Complications 391
Aspirin 391
Clopidogrel 391
Prasugrel 392
Ticagrelor 392
Glycoprotein IIb/IIIa Receptor Antagonists 392
Conclusions and Future Directions 393
References 393.e1
37 Inotropic and Vasoactive Agents 394
Keywords 394.e1
Outline 394
Sympathomimetic Agents 394
Dopamine 394
Dobutamine 396
Isoproterenol 396
Epinephrine 397
Norepinephrine 397
Phosphodiesterase Inhibitors 397
Inamrinone 398
Milrinone 398
Calcium-Sensitizing Agents 398
Levosimendan 398
Other Parenteral Inotropes 399
Digoxin 399
Vasodilators 399
Nitroprusside 399
Nitroglycerin 399
Nesiritide 401
Hydralazine 401
Enalaprilat 401
References 401.e1
38 Intensive Diuresis and Ultrafiltration 402
Keywords 402.e1
Outline 402
Diuretics 402
Types of Diuretics and Physiologic Efficacy 402
Indications for Intensive Diuresis 402
Decompensated Congestive Heart Failure 402
Acute Decompensated Heart Failure 403
Chronic Kidney Disease 403
Chronic Liver Disease 403
Diuretic Resistance and Medical Management of Refractory Edema 404
Combination of Diuretics 404
Intravenous Bolus Versus Continuous Infusion Therapy 404
Combination With Albumin 404
Ultrafiltration 405
Rationale for Mechanical Fluid Removal 405
Options for Ultrafiltration 405
Benefits of Ultrafiltration 405
Indications for Mechanical Fluid Removal 406
Clinical Studies 406
Ongoing Limitations 408
Use of Ultrafiltration in Clinical Practice 408
Future of Extracorporeal Fluid Removal 408
Conclusions 408
References 408.e1
39 Antidysrhythmic Electrophysiology and Pharmacotherapy 409
Keywords 409.e1
Outline 409
Cardiac Action Potential 409
Sinoatrial Node and Atrioventricular Node Action Potential 410
His-Purkinje Action Potential 410
Classification of Antidysrhythmic Medications 410
Class I Antidysrhythmic Medications 411
Class II Antidysrhythmic Medications 413
Class III Antidysrhythmic Medications 413
Class IV Antidysrhythmic Medications 413
Atypical Antidysrhythmic Medications 413
Pharmacokinetics of Antidysrhythmic Drugs 413
Antidysrhythmic Medications of Clinical Relevance in the Critical Care Setting 414
Class IA 414
Indications. 414
Electrocardiographic Effects. 415
Side Effects. 415
Administration. 415
Class IB 415
Indications. 415
Electrocardiographic Effects. 416
Side Effects. 416
Administration. 416
Class IC 416
Class II 416
VI Advanced Diagnostic and Therapeutic Techniques: Indications and Technical Considerations 446
42 Central Venous Access Procedures 447
Outline 447
Peripheral Intravenous Cannulation 447
Equipment 447
Technique 447
Clinical Pearls 448
Complications 448
Central Venous Access General Principles and Preparation 449
Seldinger Technique 449
Clinical Pearls 449
Internal Jugular Vein 449
Relevant Anatomy 449
Landmark Technique 450
Ultrasound-Guided Technique 450
Appendix US and European Cardiology Society Guidelines e1
Atrial Fibrillation e1
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation e1
Congenital Heart Disease e1
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease e1
Coronary Artery Disease e1
2017 ESC Focused Update on Dual Antiplatelet Therapy in Coronary Artery Disease Developed in Collaboration With EACTS e1
Acute Coronary Syndromes e1
2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation e1
Heart Failure e1
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure e1
2013 ACCF/AHA Guideline for the Management of Heart Failure e1
2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure e1
Infective Endocarditis e1
2015 ESC Guidelines for the Management of Infective Endocarditis e1
Percutaneous Coronary Intervention e2
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention e2
Pericardial Diseases e2
2015 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) e2
Acute Pulmonary Embolism e2
2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism e2
Pulmonary Hypertension e2
2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension e2
ST Elevation Myocardial Infarction e2
2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction e2
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction e2
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease e2
2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation e2
Valvular Heart Disease e2
2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease e2
2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease e2
Ventricular Arrhythmias e3
2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death e3
ACC/AHA/ESC 2006 Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death e3
2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death e3
Index 587
A 587
B 590
C 591
D 594
E 594
F 595
G 596
H 596
I 597
J 598
K 598
L 598
M 599
N 600
O 600
P 600
Q 603
R 603
S 604
T 605
U 606
V 606
W 607
Z 607
Inside Back Cover ibc1