Abstract This paper reviews the five major tests of cardiac function. The paper begins by discussing how the tests are performed. Next the paper discusses what each test assesses. The paper concludes by stating the risks to the patient of undergoing the tests.
From the Paper "The cardiac stress test is an exercise tolerance test given to see how well the heart functions under physical stress. The test is carried out in a clinic, hospital or the doctor's office. It consists of riding a bicycle or using a treadmill while ...."
Tags: echocardiography, cardiac angiogram, technetium scan, cardiac stress test
Abstract Catheterization as a medical technique has been in practice for more than two millennia. While it first began as an experimentation with animals, it gradually became part of human treatments. The procedure of cardiac catheterization in humans was first put to clinical use more than five decades ago and has undergone many changes since then. What was once a purely experimental technique is now one of the most common invasive medical procedures in Europe and North America, with more than eighty-percent of those procedures performed to diagnose suspected heart disease. Animal cardiac catheterization was first accomplished in 1844 with a horse. The characterization of the human heart was first accomplished by a German medical student in 1929. By the 1940's, the practice had become improved and was starting to become common practice in a few hospitals in North America and Europe. By entering a catheter through an arm vein, surgeons were able to reach the atrium of the heart. Today, cardiac catheterization is accomplished with a great deal of skill and technology, but is much easier and less dangerous than when it first was being used. It is the purpose of this paper to examine the history of cardiac catheterization and its import to medicine today.
Abstract This paper explains that some surgeons have suggested that cardio pulmonary bypass surgery in and of itself activates an inflammatory response that results in a stress reaction. The author points out that the role of the anesthesiologist in cardiac surgery is, as much as possible, to reduce the stress response that results form cardiac surgery. The paper relates that the stress response can be mitigated by a variety of anesthetic techniques, including use of opioids and epidural anesthesia.
Table of Contents
Introduction
Synopsis
Stages of Anesthesia for Cardiac Patients
Implications for Practice
From the Paper "The job of an anesthesiologist during a CBS procedure includes minimizing the autoimmune and stress response. Studies have shown that "greater fear or distress prior to surgery" is typically associated with slower and more complex and complicated post-operative recovery (Glaser, et. al, 1998). Stress response in fact delays healings. The body naturally perceives surgery as a "threatening" experience, and thus a variety of stress factors are involved in the surgical process (Glaser, et. al, 1998). Among these stress concerns include worries related to survival and recovery, as well as separation from family (Glaser, et. al, 1998); these factors are especially prevalent among cardiovascular patients, who face at bets long postoperative periods and "delicate" recovery prognosis."
Abstract This paper discusses how CPR administration methods since the 1950's have largely remained unchanged, although medical understanding of how the human body reacts to sudden cardiac reperfusion has greatly advanced. The writer describes a recent change in CPR procedure by the American Heart Association, and the use of advanced external defibrillators (AED's). The writer explains some of the medical advances in cardiac reperfusion methods, such as total liquid ventilation (TLV), and describes studies that were carried out to find the best reperfusion techniques. This paper contains a table.
From the Paper "First responders are always trained to provide the latest protocol for administering CPR. However, most people fall into three categories: never trained in CPR, fully trained and current, or fully trained but not current. A lot of people are turned off by the nature of administering CPR instead opting to do nothing rather than face a possible lawsuit if it is done improperly. Still others fear getting a disease from contact with mucus/saliva or blood born pathogens. With all of the infectious diseases carried throughout our society it is little wonder that a person would hesitate to perform resuscitation on a total stranger. As to the liability issue of performing CPR, most if not all states have a "Good Samaritan" law which precludes anyone receiving CPR from suing if they are injured as a result of the act. Chest compressions during CPR almost always result in broken ribs even when administered by first responders who do it for a living."
Abstract This paper examines the importance of cardiac surgery and the strides it has made in recent history. It specifically examines three articles "Changes in Mitral Regurgitation After Replacement of the Stenotic Aortic Valve" by E.C. Waisbren et al, "Impact of Cardiac Intraoperative Precursor Events on Adverse Outcomes" by D.R. Wong et al and "Surgical Management of Infective Endocarditis: Early Predictors of Short-Term Morbidity and Mortality" by D.S. Jassal et al.
From the Paper "Cardiac surgery is an essential treatment for many that is often thought of as a last resort to treat heart diseases and acute cardiac medical events. Non-surgical interventions are the preferred methods of treatment in most cases and yet cardiac surgery is an essential and necessary specialized branch of medicine that has made significant scientific strides toward efficacy and care. Cardiac surgery is in fact more highly specialized and more effective than many other surgical specialties as it has been given monumental emphasis, as heart disease is the most common cause of death among most adult populations. In the United States significant research emphasis has been placed on cardiac surgery and non-surgical cardiac treatment and for this reason there are many more alternatives for those suffering from acute cardiac event and chronic heart disease than ever before. In short there is no better time in human history to have heart disease and acute cardiac events and live to tell about it. The strong emphasis on cardiac health has created a system which supports thousands of highly qualified and well trained physicians and surgeons who are highly versed in the most up to date specialized treatments for all the varied cardiac events and conditions."
Abstract This paper explains that the new technology heart pumps, such as Left Ventricular Assist Devices (LVAD), assist the heart permanently instead of temporarily as the traditional pumps were used. The paper describes the use of animal parts for transplants especially the pig heart, which closely resembles the human heart, and the problems of organ rejection. The author believes that successful cardiac technological developments will lead to further developments for other parts of the body.
From the Paper "Traditional pumps were meant to be temporary solutions to most heart problems. These small pumps were implanted into the chest cavity of patients with the sole function of assisting the heart's own pumps. They helped to keep the rhythm of the heart's beat, regulating the pumping of blood throughout the body, and helping the heart in times of need. Traditional heart pumps were expected to help the heart recover to the points at which they could be removed and the heart would operate properly on its own. Their other function was to help keep the patient alive until they eventually moved up the waiting list for donor hearts and got a heart transplant. "
This paper reviews the qualitative research method used by K.K. Baird and L.L. Pierce as reported in their article 'Adherence to Cardiac Therapy for Men with Coronary Artery Disease' in "Rehabilitation Nursing".
Abstract This paper explains that the purpose of the reviewed study was to find out why these men with coronary artery disease were not taking care of themselves so that new and better ways can be found for these people. The author reports that the qualitative method consisted of one hour interviews with five informants that were involved in a cardiac therapy program. The paper states that the qualitative method is far more appropriate for this type of study than the quantitative method would have been and the researchers used bracketing to shield the data that they collected and analyzed from their own preconceived ideas, which could have greatly affected the results of the study; however, one possible limitations is that the study sample was not large enough.
From the Paper "The way that the subjects for this study were obtained was very appropriate, since they were all older men between 60 and 70 years old that were involved in a cardiac therapy program as a result of CAD. They had all been diagnosed within the past two years, and they were willing participants. The sample size was also adequate. Although the study could have certainly been conducted with more individuals, the fact that there were only five patients interviewed allowed the researchers to have a lot of time with each person. This helped the patients feel that they could actually talk about what they needed and wanted, as well as what they had difficulty with."
Abstract This paper examines three diverse individuals to assess risk and develop appropriate plans. Three case studies are presented, all with different variables, such as age, gender, blood pressure, cholesterol, etc. A separate plan for reducing risk is also presented for each. Although many variables have a direct bearing on cardiac risk assessment, this paper limit risk factors to blood pressure, total cholesterol, reported HDL and whether or not the individual is diabetic or a smoker.
An analysis of the quantitative research article "Sleep is Related to Physical Function and Emotional Well-Being after Cardiac Surgery" by Nancy S. Redeker, Jeanne S. Ruggiero and Christine Hedges.
Abstract This paper explains that the research question, reported in the "Nursing Research" article "Sleep is Related to Physical Function and Emotional Well-Being after Cardiac Surgery" by Redeker e.al., is "What is the relation of daytime napping to physical function and emotional well-being?" The author points out that this reported study has a multi-center, nonrandomized, prospective design. The paper also reports that the weaknesses of the study are that preoperative data on sleeping patterns were not available, dropout caused issues of internal validity and the sample was not representative. The author concludes that a randomized, case-control design would afford more validity.
Table of Contents:
Study
Problem
Study Purpose
Research Question
Hypotheses
Study Variables
Review of Related Literature
Study Design
Sample and Setting
Identification and Control of Extraneous Variables
Study Instruments/Tools
From the Paper "The hypotheses examined by the study were based on two theoretical models that regulate sleep patterns, namely: a) the chronobionic or circardian rhythm model of sleep regulation, and b) homeostatic model of sleep regulation. The circadian rhythm regulates the need for sleep according to the time of day while physiological homeostasis regulates the need for sleep in response to the body's tiredness due to physical exertion or extended wake periods."
Abstract This paper reviews the use of internal defibrillators in cardiology patients. Cardiac patients form a diverse population, many of whom are at high risk for cardiac arrest. This paper reports that numerous clinical trials demonstrate the efficacy of internal defibrillators over all other therapies and drugs to prevent cardiac arrest. Internal defibrillators represent preventive measures which promote health and longevity in patients. The paper carries on to discuss how the cardiology unit itself is the environment that is most conducive to cardiac arrest and therefore in need of internal defibrillators.
Abstract This paper provides a business plan to outline the structure, goals and financial aspects of creating a new cardiac catheterization lab and heart treatment center in central Florida. This center is to be called "CardioCenter," and will extend its message of expert urgent cardiac care within a 25-mile radius. The paper covers how such a center should be built, what are its fundamental goals, and how it can compete against established centers in the area. The goal of the new cardiac catheterization center is to provide services to primary care physicians and first-level cardiologists, and to provide faster and more-targeted services to patients who require catheterization and may not be close enough to a major catheterization center.
Outline:
Executive Summary
Mission of the New Center
Strategies of CardioCenter
Mission Statement
Vision Statement
Organizational Structure
Financial Structure
Debt Policy
Assumptions for Growth of the Business
Governance Model
Possible Mergers and Acquisitions
Personnel Needed
Facilities
Program Development
HCIT (Healthcare Information Technology)
SWOT Analysis
Longer-Term Plans
From the Paper "Within central Florida, centered around Orlando, there are three major heart centers with round-the-clock facilities available for cardiac catheterization. These centers advertise their availability, and can tout their ability to improve patients' outcomes by improving "door to balloon" time down to less than 60 minutes. Such a strategy of rapid catheterization has been shown to significantly improve the morbidity and mortality of patients (Bradley, 2006). Although many existing facilities have attempted to adapt their workflow to improve "door to balloon time," many have not, as the structural and schedule changes involved in a general-care hospital pose difficulties. "
Abstract This paper examines research on the involvement of the heart and its processes in relation to sleep apnea. The reviewed material begins with a definition of sleep apnea and discusses the stages and prevalence of the disease along with cardiac complications associated with the different types of the disease. This is followed by a discussion of respiratory and hemodynamic changes associated with sleep apnea. The final section discusses methods and treatments for sleep apnea and the effects of these on cardiac effects.
From the Paper "Sleep apnea can be classified as obstructive, central, or mixed, depending on the presence or absence of respiratory muscle effort (Imran & Khawaja, 1998). According to Imran and Khawaja (1998), with each type of apnea, airflow at the nose or the mouth is absent for at least 10 seconds. The authors also note that in obstructive apnea, ribcage and abdominal movements are still present while in central apnea, both types of movement are absent. In mixed apneas, both central and obstructive patterns occur during the same apneic event. The magnitude of any associated decrease in oxygen saturation depends on the degree and duration of apnea (Imran & Khawaja, 19980)."
Abstract Amersham Health has developed a product for the next technological advance in cardiac diagnostic testing, MYOVIEW with Rapid Clearance, for myocardial perfusion imaging. This paper explains how the product works and examines how MYOVIEW will help the medical industry and cardiac patients.
From the Paper "Myocardial perfusion imaging is the answer to the challenges felt by many physicians when patients may have a suspected myocardial infarction. Oftentimes a physician may feel that a patient is not having an MI, however, as a precautionary measure, will have the patient admitted for observation. If it turns out that they were not having an MI, the patient has now spent unneeded time at the hospital, taking up valuable bed space and staff time, at often over crowded hospitals, that could have been better used by patients who truly needed it. In fact, Udelson states that ?missed MI is one of the most common causes of litigation against ED personnel, and this test may also facilitate an earlier diagnosis in such patients(Glow; Udelson, 2003).?"
Abstract This paper examines the standards set by the National Service Framework for coronary heart disease regarding emergency cardiac care for patients presenting to the accident and emergency system at a hospital. The paper explains that these standards place a priority on aggressive management and providing early thrombolysis and that this type of treatment is controversial because it is questionable whether, given the suggested timeline and the need to differentiate from non-cardiac causes of chest pain, an adequate history and physical can be performed to prevent the administration of thrombolytics in patients where they are contraindicated. To further examine this topic, the paper gives a clear definition of acute myocardial infarction, looks at how to diagnose a patient with acute chest pain, explores the history, indications, and contraindications of thrombolysis, and reviews a multidisciplinary approach to thrombolytic administration.
From the Paper "The definitive diagnosis of AMI is best obtained by following a standard chest pain protocol. Most accident and emergency wards have these in place. It is standard to initially obtain a 12 lead electrocardiogram (ECG) and begin cardiac monitoring. Patient's routine laboratory studies include electrolytes, blood urea nitrogen (BUN), complete blood count (CBC) and markers for myocardial injury (Creatinine Kinase isoenzyme-myocardial (CK-MB) or troponin). Normal serial CK values rule out an acute infarction but are negative in the setting of acute unstable angina. A slight rise in CK-MB or troponin indicates myocardial injury but is not specific for ischemic syndromes. Troponin assay is highly sensitive for identifying acute coronary syndromes. Troponin has longer half life in the system than CK-MB but is less specific for the identification of infarction as opposed to repeated episodes of myocardial ischemia. As the total CK greater than two times the upper ranges of normal is indicative of infarction it can be used as an adjunct in diagnosis ischemia versus infarction and also in determining the relative efficacy of reperfusion. Serum troponin may take up to six hours to become diagnostically sensitive enough (Dougan, 2001)."
Abstract In this article, the writer discusses the Mediterranean diet, which is a nutritional model inspired by the traditional diets of the Mediterranean area of Europe. The writer explains that the traditional Mediterranean diet includes a lot of fruits and vegetables, breads and whole grains, olive oil, fish and that the Mediterranean diet does not include a lot of meat or dairy. The writer then discusses that although some people are concerned about adequate nutrient levels of this diet, as well as concerns about the speculated weight gain from the olive oil, clinical trials have repeatedly shown that this is a healthful dietary choice. Further, the writer notes that from the perspective of cardiac rehabilitation, it is important to note the significant findings from many studies show that a Mediterranean-type diet is likely to reduce the risk of cardiac problems.
From the Paper "Over three thousand men and women from Attica, Greece, were studied to determine the effect of the Mediterranean diet on the incidents of both heart disease and cancer, as related to the total antioxidant capacity of these individuals who do not show any clinical signs of cardiovascular disease. The difference between this study and the majority of studies that had been completed previously is that in previous studies, individual nutrients or foods were analyzed. In this study, however, the complete Mediterranean dietary pattern is taken into consideration for analysis, giving more insight into the potential benefits of this dietary style. Each of the participants in the study was first assessed using a diet score to determine how strictly each set of personal eating habits follow the traditional Mediterranean diet. According to the study by Pitsavos, there was a direct correlation between how closely an individual followed the "inherent characteristics of this diet" and cardiovascular health; specifically, the Mediterranean diet is shown to encourage high levels of total antioxidant capacity, as well as lower oxidized LDL-cholesterol concentrations. Total antioxidant capacity is positively correlated with the consumption of olive oil, red wine, and fruit and vegetables. On the other hand, diets high in animal fats and saturated fats induce atherosclerotic diseases. These factors help to explain why the Mediterranean diet is healthful, though these are not necessarily the only factors involved."
