percepcion del usuario en angioplastia

1. Can J Cardiovasc Nurs. 2011;21(1):20-30.

Patients' perception of their experience of primary percutaneous intervention for ST segment elevation myocardial infarction.

Young LE, Murray J.

University of Victoria School of Nursing, HSD A422, PO Box 1700 STN CSC,Victoria, BC V8W 2Y2.

Many patients experiencing ST segment elevation myocardial infarction (STEMI) arecurrently treated with primary percutaneous intervention (PCI). This relativelynew procedure has reduced the time patients with the diagnosis of STEMI spend in hospital. In this literature review we explore patients' perceptions of theirexperience of receiving primary percutaneous intervention (PCI) as a treatmentfor STEMI. We critiqued and graded for relevance 10 papers that included originalresearch and other sources. Key findings indicate that there is considerablevariability in how patients treated for STEMI perceive the experience of PCI.Further, there is a misalignment between some patients' perceptions and healthprofessionals' perceptions of this experience related to the event as well as thelanguage used to speak of it. Thus, we recommend that nurses assess patients'perception of the experience and patients' health literacy level, then tailor thecontent and language of patient and family education to ensure an effectiveeducative intervention.

PMID: 21361236 [PubMed - indexed for MEDLINE]

2. Crit Care Nurse. 2010 Oct;30(5):45-54.

Prasugrel as antiplatelet therapy in patients with acute coronary syndromes orundergoing percutaneous coronary intervention.

Fletcher B, Thalinger KK.

Brooks College of Health, School of Nursing, University of North Florida,Jacksonville, Florida 32250, USA. [email protected]

Erratum in Crit Care Nurse. 2011 Feb;31(1):15.


3. J Ren Care. 2010 May;36 Suppl 1:118-26.

Coronary revascularisation in chronic kidney disease. Part II: acute coronarysyndromes.

Seddon M, Curzen N.

Wessex Cardiac Unit, Southampton University Hospitals NHS Trust, Tremona Road,Southampton SO16 6YD, UK.

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease, myocardial infarction and cardiovascular death. Management of patientswith CKD presenting with acute coronary syndromes is more complex than in thegeneral population, due to greater diagnostic uncertainty and the lack of direct evidence for therapeutic interventions in this specific population, coupled with concerns about therapy-related adverse effects. However, these patientspotentially have much to gain from conventional revascularisation strategies usedin the general population. This review summarises the current evidence regarding the treatment of patients with CKD presenting with acute coronary syndromes, inparticular with respect to coronary revascularisation strategies.


4. J Ren Care. 2010 May;36 Suppl 1:106-17.

Coronary revascularisation in chronic kidney disease. Part 1: stable coronaryartery disease.

Seddon M, Curzen N.

Wessex Cardiac Unit, Southampton University Hospitals NHS Trust, Tremona Road,Southampton, SO16 6YD, UK.

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease, myocardial infarction and cardiovascular death. Detection and treatment of coronary artery disease in CKD patients has been hampered by the limitationsof screening tests, the lack of direct evidence for therapeutic interventions in this specific population, and concerns about therapy-related adverse effects.However, these patients potentially have much to gain from conventionalstrategies used in the general population. This review summarises the currentevidence regarding the treatment of coronary artery disease in patients with CKD,with the focus on coronary revascularisation by percutaneous coronaryintervention or coronary artery bypass grafting.


5. Aust Crit Care. 2010 Nov;23(4):177-87. Epub 2010 Apr 21.

Development of clinical practice guidelines for the nursing care of peopleundergoing percutaneous coronary interventions: An Australian & New Zealandcollaboration.

Rolley JX, Salamonson Y, Dennison CR, Davidson PM.

Centre for Cardiovascular and Chronic Care, Curtin Health Innovation ResearchInstitute, Curtin University, Australia. [email protected]

AIM: This paper describes the development of nursing practice guidelines forpercutaneous coronary intervention (PCI).BACKGROUND: Clinical practice guidelines (CPGs) supporting PCI nursing care arelimited.METHOD: The National Health and Medical Research Council's (NH&MRC) health andmedical practice development guidelines were used for the guideline developmentprocess. A panel of experts (clinicians and consumers) attended a consensusconference to review existing evidence. Subsequently, nurses' opinions wereidentified via an online survey. This was followed by a modified Delphi methodwas used to refine a draft set of guidelines over two rounds.RESULTS: The consensus conference was attended by 41 participants (39cardiovascular nurses and 2 consumer representatives). Eight additional membersjoined the panel for the modified Delphi rounds with 27 participants completingthe online survey. The final guideline document consisted of 75 recommendations. Endorsement was then sought from key peak cardiovascular bodies in Australia and New Zealand.DISCUSSION/CONCLUSION: Inconclusive evidence precludes definitiverecommendations. Therefore, consultation and consensus are important indeveloping guidelines to achieve standardised nursing care and monitoring ofoutcomes.IMPLICATIONS FOR PRACTICE: Nurses play a crucial role in PCI care, yet currently there are limited guidelines to inform practice. This paper describes the method developing clinical practice guideline and deriving consensus.


6. AANA J. 2009 Oct;77(5):365-71.

Myocardial infarction and subsequent death in a patient undergoing roboticprostatectomy.

Thompson J.

Hospital of St Raphael, School of Nurse Anesthesia, New Haven, Connecticut, USA. [email protected]

A 52-year-old patient, ASA physical status IV, undergoing a radical prostatectomyfor cancer with a robotic system had a cardiac arrest 3 hours into the case. All attempts to resuscitate were unsuccessful, and several hours later he waspronounced dead. Underlying patient comorbidity and procedural issues contributedto the patient's death. The patient had a history of coronary artery disease thatrequired the placement of drug-eluting stents 2 years before this surgicalprocedure. The preoperative cardiac evaluation and pharmacological management of patients with drug-eluting coronary stents are reviewed. There are a number ofpositional and technical considerations for patients undergoing robotic surgical procedures, especially in relation to the requirement of low-lithotomy and steep Trendelenburg positions. The cardiac and respiratory systems are especiallyvulnerable to the extreme and lengthy head-down position. The needed positioning,combined with the problems associated with insufflation, presents a uniquechallenge in anesthetic management. This course reviews the current literature onthe surgical implications for patients with drug-eluting stents and thephysiologic factors related to position and pneumoperitoneum and their associatedstressors. By using a review of the contemporary literature, a best-evidenceapproach to anesthetic management is reviewed.


7. J Invasive Cardiol. 2009 Aug;21(8 Suppl A):11A-17A.

Starting a transradial vascular access program in the cardiac catheterizationlaboratory.

Cohen MG, Alfonso C.

Cardiovascular Division, Miller School of Medicine, University of Miami,University of Miami Hospital, Miami, FL 33136, USA. [email protected]

Over the past 20 years, since the first reports, transradial vascular access for coronary angiography and intervention has flourished in many countries whilestill accounting for less than 2% of all cases performed in the United Statesdue, in part, to difficulties in introducing change to established practicepatterns. The benefits of transradial access include decreased bleeding risk,increased patient comfort, lessened post-procedure nursing workload, anddecreased hospital costs. A learning curve to gain the specific set of skills fortransradial access has been well described. Although published data suggest that 100-200 cases are necessary to become proficient, the learning curve is likelyhighly individual, and some operators may become proficient sooner. The equipmentto start a transradial program is minimal and includes modified sheaths andcatheters. Patients with morbid obesity, peripheral vascular disease, andanticoagulation clearly benefit from this approach. To establish a transradialprogram and offer the benefits of this approach to most patients, a dedicatedinterventionalist must incorporate peers and hospital staff to create amultidisciplinary team.



Angina following percutaneous coronary intervention: in-stent restenosis.

Throndson K, Sawatzky JA.

Faculty of Nursing, University of Manitoba. [email protected]

Percutaneous coronary intervention (PCI) represents a technical advance in thetreatment of coronary artery disease. However, it is not without risks bothduring and after the procedure. In-stent restenosis (ISR) is the most commoncomplication following PCI. Individuals who experience angina associated with ISRoften fail to recognize its seriousness and, therefore, do not respondappropriately to the situation. Individuals with ISR are vulnerable to theconsequences of angina, including increased morbidity and mortality, as well as adecreased health-related quality of life. In this article, the authors review therisks for developing ISR, the pathophysiology of angina related to ISR, and thechallenges that face patients who develop recurrent angina post-PCI.Cardiovascular nurses play a critical role in the clinical management andeducation of patients following PCI. The provision of post-PCI follow-up care is key to identifying, managing, and supporting patients with recurrent angina.



Improving outcomes following elective percutaneous coronary intervention: the keyrole of exercise and the advanced practice nurse.

Throndson K, Sawatzky JA.

Faculty of Nursing, University of Manitoba. [email protected]

Percutaneous coronary intervention (PCI) is a safe, effective, non-surgicaltreatment for coronary artery disease (CAD). The demand for PCI has increasedexponentially since the 1980s and it has become the treatment of choice for many individuals with CAD. Since PCI is not a cure, secondary prevention strategiesare critical to prevent disease progression. Unfortunately, current strategiesignore the specific needs of the elective PCI population. In this article, theauthors highlight the unique characteristics of these patients, which maycontribute to their lack of engagement in healthy lifestyles. Elective PCIpatients are vulnerable due to limited knowledge and follow-up, and lack ofenrolment in secondary prevention programs. Exercise is a central component ofany cardiac prevention strategy. Individualized exercise programs thatincorporate physical activity and counselling can potentially improve theclinical outcomes of these patients. Advanced practice cardiovascular nurses playa key role in developing, implementing, and evaluating exercise programs in this population.


10. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006043.

Pain relief for the removal of femoral sheath in interventional cardiology adult patients.

Wensley CJ, Kent B, McAleer MB, Price SM, Stewart JT.

School of Nursing, University of Auckland, Auckland, Nelson, New Zealand, [email protected]

BACKGROUND: There is considerable variation in use of pain relief for managingpain or discomfort of femoral sheath removal. Efficacy of pain relief to promote comfort during this procedure or to reduce the incidence of vascular andprocedural complications has not been established.OBJECTIVES: Assess efficacy of pain relief used to manage pain of femoral sheath removal in adults after interventional cardiology.Determine if pain reliefinfluences rate of complications associated with this procedure.SEARCH STRATEGY: Databases searched in August 2007: Cochrane Pain, Palliative andSupportive Care Group Trials Register, Cochrane Heart Group Trials Register,Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL, PubMed, Australia's AustralasianMedical Index, National Research Centre, Web of Knowledge and DigitalDissertations.SELECTION CRITERIA: Randomised studies comparing opioid, local anaesthetic,anxiolytic, no treatment or placebo administered for alleviation of pain ordiscomfort of the femoral sheath removal procedure, were sought.DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality andextracted data. Weighted mean differences (WMD) were calculated wheremeta-analysis of pain score data was feasible. Adverse effects information wascollected.MAIN RESULTS: Four trials involving 971 participants were included. All resultswere reported using a zero to ten pain scale. Three trials (four treatment arms) involving 498 participants compared subcutaneous lignocaine with control; with nosignificant difference between pain scores; WMD 0.12 (95% CI -0.46 to 0.69). Two trials (three treatment arms) involving 399 participants compared intravenouspain regimens with control. A significant reduction in pain score with anintravenous pain regimen (opioid and anxiolytic) was observed when compared with placebo; WMD -0.90 (95% CI -1.54 to -0.27). One study involving 60 participantscompared levobupivacaine with placebo. Longer-acting local anaestheticsignificantly lowered pain score by -1.10 (95% CI -1.26 to -0.94). Data isinsufficient to identify any influence of pain regimens on incidence of vascular and procedural complications. No trials reported appropriate blinding fortreatment arms. The largest trial, comprising 661 participants was unblinded witha quality score of two out of five.AUTHORS' CONCLUSIONS: Intravenous pain regimens and levobupivacaine may havegreater efficacy when compared to control for the management of pain related tofemoral sheath removal. However, a definitive study is still required because theclinical difference is small. There is no evidence to support the use ofsubcutaneous lignocaine for the relief of femoral sheath removal related pain.There is insufficient evidence to determine if pain relief influences the rate ofcomplications.


11. Crit Care Nurse. 2008 Oct;28(5):26-41; quiz 42.

Management of patients after percutaneous coronary interventions.

Shoulders-Odom B.

Tampa VA Hospital, Tampa, Florida, USA. [email protected]


12. Nurs Manage. 2008 Apr;39(4):41-5, quiz 45-6.

Time = MUSCLE the case for STEMI care improvements.

Crowther M.

Saint Joseph's Regional Medical Center, Paterson, N.J., USA.


13. J Cardiovasc Nurs. 2008 Mar-Apr;23(2):159-68.

Using devices for physiologic monitoring in heart failure.

Rathman L, Repoley J, Delgado S, Trupp R.

Heart Failure Program, The Heart Group, Lancaster, Pennsylvania 17603, [email protected]

Heart failure (HF) is a complex and costly disease process associated with highmorbidity and mortality. Implanted cardiac rhythm management devices areincreasingly used in the HF population to provide therapies such as protectionfrom sudden death and cardiac resynchronization therapy. Device-based diagnostic monitoring provides clinicians with information that can assist in identifyingpatients at risk for HF decompensation and subsequent hospitalization. Thisarticle will review the evidence for using diagnostic information from cardiacrhythm management devices in the management of HF patients. Future advancedmonitoring devices will also be discussed.


14. J Natl Black Nurses Assoc. 2007 Dec;18(2):63-74.

Racial disparities in access to care within the cardiac revascularizationpopulation.

Miller PS.

University of California, School of Nursing, Los Angeles, CA 90095-1702, [email protected]

Health disparities and vulnerability are embedded within the context ofhistorical and contemporary dynamics, and are confounded by inequities in access to quality healthcare. Early management and preventive therapy has been thecornerstone of cardiovascular medicine for acute coronary syndromes. Invasivecardiac strategies, including revascularization with percutaneous coronaryintervention or coronary artery bypass grafting have been instituted as methodsto minimize subsequent cardiovascular events and to improve survival benefits.Several studies have described the obstacles and variance involved in thedistribution of access to cardiac catheterization, particularly among vulnerable groups such as African-Americans. There is a paucity of nursing research in thearea of access to care and cardiovascular disease. The purpose of this article isto examine the existing nature of disparities in health-care access among ethnic minority cardiac populations who utilize or require invasive cardiac procedures. This will be followed by an exploration of avenues to which nursing science canmake substantial contributions.


15. J Am Coll Cardiol. 2008 Feb 19;51(7):701-7.

The problem with composite end points in cardiovascular studies: the story ofmajor adverse cardiac events and percutaneous coronary intervention.

Kip KE, Hollabaugh K, Marroquin OC, Williams DO.

College of Nursing, University of South Florida, Tampa, Florida 33612, [email protected]

OBJECTIVES: Our purpose was to evaluate the heterogeneity and validity ofcomposite end points, major adverse cardiac events (MACE) in particular, incardiology research.BACKGROUND: The term MACE is a commonly used end point for cardiovascularresearch. By definition, MACE is a composite of clinical events and usuallyincludes end points reflecting safety and effectiveness. There is no standarddefinition for MACE, as individual outcomes used to make this composite end pointvary by study. This inconsistency calls into question whether use of MACE incardiology research is of value.METHODS: We conducted a 2-phase literature review on the use of MACE as acomposite end point: 1) studies that have compared use of bare-metal versusdrug-eluting stents; and 2) studies published in the Journal in calendar year2006. We subsequently tested 3 different definitions of MACE during 1-year offollow-up among 6,922 patients in the DEScover registry who received at least 1drug-eluting stent.RESULTS: The review identified substantial heterogeneity in the study-specificindividual outcomes used to define MACE. Markedly different results were observedfor selected patient subsets of acute myocardial infarction (MI) (vs. no MI) and multilesion stenting (vs. single-lesion stenting) according to the variousdefinitions of MACE.CONCLUSIONS: Varying definitions of composite end points, such as MACE, can lead to substantially different results and conclusions. Therefore, the term MACE, in particular, should not be used, and when composite study end points are desired, researchers should focus separately on safety and effectiveness outcomes, andconstruct separate composite end points to match these different clinical goals.


16. Nurs Manage. 2001 Sep;32(9):51-4, 56.

Patient care after percutaneous transluminal coronary angioplasty.

Reynolds S, Waterhouse K, Miller KH.

University of Massachusetts/Memorial Health Care, Worcester, USA.

Review several studies that investigate head elevation, early walking, andpatient comfort after percutaneous transluminal coronary angioplasty (PTCA).


17. Nurs Stand. 2007 May 30-Jun 5;21(38):49-56; quiz 58.

Recent advances in angina management: implications for nurses.

Conway B, Fuat A.

Darlington Primary Care Trust, County Durham. [email protected]

This article describes the physiology of the heart and the pathophysiology ofangina. Diagnosis and treatment options, including pharmacological therapies, areoutlined. The authors also discuss cardiac rehabilitation programmes and theextended role of nurses in managing patients with angina.


18. J Cardiovasc Med (Hagerstown). 2007 Apr;8(4):230-7.

Overview of the transradial approach in percutaneous coronary intervention.

Amoroso G, Laarman GJ, Kiemeneij F.

Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam,The Netherlands. [email protected]

Thirteen years have passed since the first percutaneous coronary intervention wasperformed at Onze Lieve Vrouwe Gasthuis in Amsterdam using the transradialapproach (TRA). Since then TRA has spread through the interventional communityand many centres have now adopted TRA as the arterial access of choice. Thisreview is focused on the hot issues and the latest developments in this field.The following subjects will be addressed and discussed: drawbacks and learningcurve, procedural technique, indications (with particular attention to acutecoronary patients), complications, contraindications, nurse workload, patientmanagement, and economics.


19. Crit Care Nurs Q. 2007 Jan-Mar;30(1):12-9.

Percutaneous interventions.

Tarolli KA.

University of Pittsburgh Medical Center, Pittsburgh, PA 15213, [email protected]

The catheterization laboratory is no longer limited to coronary arterialinterventions. Physicians have been striving to make more interventions lessinvasive that now can include carotid, renal, and peripheral arterial stenting,as well as less invasive repair of atrial septal abnormalities. Even cardiacassist devices can be implanted percutaneously to bridge a critically ill patientto other modes of treatment. This article will give a brief overview of eachintervention and identify important nursing care.


20. Nurs Stand. 2006 Nov 29-Dec 5;21(12):48-56; quiz 58.

Primary angioplasty for acute ST-elevation myocardial infarction.

Leahy M.

Hammersmith Hospital, London. [email protected]

This article examines primary percutaneous coronary intervention as a reperfusiontreatment for acute ST-segment elevation myocardial infarction. It discusses the nursing care of patients undergoing this procedure.


21. Crit Care Nurse. 2006 Dec;26(6):38-45; quiz 46.

Decreasing vascular complications after percutaneous coronary interventions:partnering to improve outcomes.

Lins S, Guffey D, VanRiper S, Kline-Rogers E.

Blue Cross/Blue Shield Michigan Cardiovascular Consortium, Oakwood Hospital andMedical Center in Dearborn, Mich., USA. [email protected]


22. Nurs Stand. 2006 May 24-30;20(37):49-56; quiz 58.

Managing patients with non-ST-segment elevation acute coronary syndrome.

Coady E.

Cardiothoracic Centre, St. Thomas' Hospital, London. [email protected]

Acute coronary syndromes (ACSs) can be described as ST-segment elevation ornon-ST-segment elevation, including unstable angina. Traditionally, ST-segmentelevation ACS has been considered to be more serious, but non-ST-segmentelevation ACS has higher mortality rates in the longer term. This articlediscusses diagnosis, including history taking, clinical examination,electrocardiogram and biochemical markers that help to differentiate betweentypes of non-ST-segment elevation ACSs. Risk stratification and treatmentstrategies are examined, as well as pharmacological treatments. The nurse's role in assessment, treatment, ongoing management and discharge practice is discussed.


23. Crit Care Nurse. 2004 Dec;24(6):32-9.

Case studies of ST-segment elevation before and after percutaneous coronaryintervention in patients with acute myocardial infarction.

McAvoy J.

Quality Management Department, Washington Hospital, Washington, Pa, USA.

Erratum in Crit Care Nurse. 2005 Feb;25(1):15.


24. Nurs Clin North Am. 2004 Dec;39(4):829-44.

Nursing care of the client requiring percutaneous coronary intervention.

Vlasic W.

Interventional Cardiology, London Health Sciences Centre, 79 Glenridge Crescent, London N6G 4W6, Ontario, Canada. [email protected]

The scope of interventions for a wide variety of cardiac conditions and theresearch basis for practice are continuing to expand at a phenomenal rate. Nursesneed to be actively engaged in all phases of the research process,to addressongoing questions of interest to continually improve client care. New researchfindings, building on an understanding of the foundations for interventionalcardiology practice, are key to providing the highest quality of nursing care forthis unique client population.


25. J Cardiovasc Nurs. 2004 Nov-Dec;19(6):404-8.

Drug-coated stents: preventing restenosis in coronary artery disease.

Stanik-Hutt JA.

Johns Hopkins University School of Nursing, and Inpatient Cardiology NursePractitioner Service, Department of Nursing, Johns Hopkins Hospital, Baltimore,MD 21205, USA. [email protected]

Since its introduction in 1977, the success of percutaneous interventionalcardiology has been limited by the occurrence of restenosis. Drug-eluting stents,particularly sirolimus- and paclitaxel-coated stents, have been shown inrandomized controlled trials to dramatically reduce restenosis in single, denovo, native coronary arteries. Over the last 2 years, investigators havereported that these stents can also reduce restenosis in more complex patientsituations such as in diabetics, during acute coronary syndromes, in longatherosclerotic lesions and small arteries, and even after in-stent restenosis.These outcomes increase the clinical value of this technology to "real world"practice. This article reviews the current state of our knowledge regardingdrug-eluting stents and identifies areas for further research.


26. J Cardiovasc Nurs. 2004 Nov-Dec;19(6):396-403.

Heal thyself: Potential applicability of stem cell therapy in the management ofheart disease.

Yeo TP.

The Johns Hopkins University School of Nursing and the Sidney KimmelComprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21205, [email protected]

Acute myocardial infarction results in regional necrotic heart tissue that isconsidered irreversible. Although angioplasty and thrombolytic therapy can removethe offending atherosclerotic plaque and thrombi, both therapies are dependentupon timely recognition and initiation of treatment and thus have a limitedwindow of opportunity. No currently available therapy has the capability torestore cardiomyocytes or to replace myocardial scar tissue with contractiletissue. In animal models, use of a wide range of cells such as fetalcardiomyocytes, skeletal myoblasts, and bone marrow stem cells have been shown todifferentiate into functional cardiomyocytes. In addition, transplantation ofadult stem cells directly into the area of infarction has shown clinical promise.This article explores the current data on extramedullary hematopoiesis, stem celldifferentiation, and stem cell therapy and its ability to repair injured orischemic cardiac tissue.


27. J Cardiovasc Nurs. 2004 Sep-Oct;19(5):346-53.

Nursing outcomes: percutaneous coronary interventions.

Leeper B.

Cardiovascular Services, Baylor University Medical Center, Dallas, TX 75246, [email protected]

Percutaneous coronary interventional (PCI) procedures are commonly performed inthe United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature toprovide recommendations for future research. Nursing research on indicatorsrelated to costs of care, morbidity, symptom management, functional status,patient/family knowledge, patient responses, behavior, and home/occupationalfunction following PCI are discussed in this review.


28. Nurs Stand. 2004 May 26-Jun 1;18(37):45-53; quiz 54-5.

Assessment and treatment of chest pain.

Tough J.

James Cook University Hospital, Middlesbrough. [email protected]

Comment in Nurs Stand. 2005 Jan 5-11;19(17):26.

Chest pain is one of the main reasons for emergency admission to hospital in the UK. Jackie Tough examines the causes and treatment of chest pain and offers astructured system for taking the patient's history.


29. Am J Nurs. 2004 Jan;104(1):81-3.

Delays in seeking MI treatment.

Zerwic JJ, Ryan CJ.

College of Nursing, University of Illinois, Chicago, USA. [email protected]


30. Nurs Times. 2003 Jul 8-14;99(27):46-7.

Percutaneous coronary intervention.

Jones I, Goode I.

School of Nursing, University of Salford, Manchester.

Symptoms associated with coronary heart disease include chest pain, dyspnoea,palpitations and collapse (Delahaye, 1999). Percutaneous transluminal coronaryangioplasty (PTCA) has been found effective for relieving some of these symptoms (RITA-2 trial participants, 1997). The National Service Framework for CoronaryHeart Disease (Department of Health, 2000) identified a need to double the numberof these procedures carried out per year by 2010 to provide a service comparable with the rest of western Europe.


31. J Cardiovasc Nurs. 2003 Jan-Mar;18(1):11-6.

Drug-eluting stents to prevent reblockage of coronary arteries.

Schwertz DW, Vaitkus P.

Department of Medical Surgical Nursing, University of Illinois, Chicago,Illinois, USA.

Restenosis limits the success of percutaneous transluminal coronaryinterventions. Coronary artery stenting decreases restenosis, improves outcomes, and is currently the most commonly used percutaneous coronary intervention in theUnited States. However, in-stent restenosis continues to occur at an unacceptablerate. In-stent restenosis is a neointimal hyperplastic response resultingprimarily from vascular smooth muscle cell proliferation. Treatment withanti-proliferative agents presents a logical approach to eradicating restenosis, however, these drugs are highly toxic. Coating stents with anti-proliferativeagents allows local delivery of high doses and avoids systemic side effects. In2001, the results of two clinical trials, RAVEL and ELUTES, using sirolimus- and paclitaxil-coated stents demonstrated nearly complete elimination of in-stentrestenosis. These dramatic results represent a tremendous advance in thetreatment of coronary heart disease.


32. Crit Care Nurs Q. 2002 Nov;25(3):37-47.

Interventions in pediatric cardiac catheterization.

Vincent RN, Diehl HJ.

Cardiac Catheterization Laboratory, Sibley Heart Center, Children's Healthcare ofAtlanta, Emory University School of Medicine, Atlanta, Georgia, USA.

Since its inception in 1929, cardiac catheterization has undergone many changes. In the last two decades we have seen an evolution in cardiac catheterization froma diagnostic (anatomic and physiologic) to a therapeutic modality. This articlehighlights some of the more common and newer interventional procedures nowperformed.


33. Prof Nurse. 2002 Jul;17(11):651-4.

Removal of a femoral sheath following PTCA in cardiac patients.

O'Grady E.

Interventional Cardiology Unit, Leeds General Infirmary, Leeds.

Patients with coronary heart disease may require a percutaneous transluminalcoronary angioplasty, involving the use of a balloon catheter to dilate thearteries introduced via a sheath. It is now increasingly common for the removalof the sheath to be a nursing procedure. This paper reviews the literature, best practice, potential complications and post-removal nursing care.


34. J Invasive Cardiol. 2002 Apr;14 Suppl B:48B-54B.

Increasing benefit, reducing risk: focusing on hemorrhagic complications inpercutaneous coronary intervention.

Aguirre FV, Gill JB.

Prairie Cardiovascular Consultants, Ltd., Southern Illinois University School of Medicine, Springfield, Illinois, USA.


35. Heart Lung. 2002 Mar-Apr;31(2):113-21.

Failed reperfusion after thrombolytic therapy: recognition and management.

Kucia AM, Zeitz CJ.

University of South Australia School of Nursing and Midwifery, Adelaide,Australia.

BACKGROUND: Failed reperfusion after thrombolysis occurs in as many as 30% ofpatients with acute myocardial infarction (MI). Furthermore, some patients haveincomplete tissue perfusion despite reperfusion of the infarct-related artery.Close assessment of the efficacy of thrombolytic administration in people withevolving acute MI is necessary, particularly with regard to myocardial perfusion status, because some patients may benefit from incremental pharmacologic orinvasive reperfusion strategies.PURPOSE AND METHOD: This article reviews a number of strategies to assessinfarct-related artery patency and myocardial tissue perfusion. These includecoronary angiography, continuous ST-segment monitoring, serialelectrocardiography, obtaining serial serum biochemical markers of myocardialnecrosis, monitoring for reperfusion arrhythmias, and assessment of changes inchest pain intensity.CONCLUSION: The early detection of failed reperfusion is critical if incremental strategies to enhance myocardial salvage are to be considered. ContinuousST-segment monitoring is a relatively inexpensive, reliable, and accurate toolfor assessing real-time myocardial perfusion.


36. Crit Care Nurse. 2000 Apr;Suppl:3-14; quiz 15-6.

Acute coronary syndromes: new developments in pharmacological treatmentstrategies.

Gylys K, Gold M.

University of California-Los Angeles School of Nursing, USA.

Comment in Crit Care Nurse. 2000 Oct;20(5):16.


37. Crit Care Nurs Q. 2001 May;24(1):62-8.

New strategies in the prevention of restenosis.

Angerio AD, Fink DA.

School of Nursing and Health Studies, Department of Physiology and Biophysics,Georgetown University, Washington, DC, USA.

Restenosis is a common and serious complication following angioplasty and stentimplantation in patients with arterial vascular disease. Restenosis is a form of intimal hyperplasia. Endothelin-1 (ET-1) and vascular endothelial growth factor(VEGF) stimulate intimal hyperplasia and may play a role in restenosis. ET-1 and VEGF may act in concert in promoting restenosis following mechanical injury tothe vessel wall in angioplasty and stent implantation. An understanding of their mechanism of action may lead to more effective methods for preventing restenosis.ET-1 receptor antagonists may play a prominent role in prophylaxis.


38. J Cardiovasc Nurs. 2000 Oct;15(1):27-42.

Surgical management of unstable angina and symptomatic coronary artery disease.

Weber MM.

Department of Nursing Research and Education, The Cleveland Clinic Foundation,Ohio, USA.

The treatment of coronary artery disease and, in particular, acute coronarysyndromes has evolved from watchful waiting to an early aggressive interventionstrategy. Patients are currently receiving either percutaneous or surgicalrevascularization. Several major clinical trials have identified those patientsmostly likely to benefit from surgical intervention. These patients typicallyinclude those with left-main coronary artery disease, triple vessel disease with decreased left ventricular function, and other clinical risk factors. As a resultof these studies, unique needs and outcomes of special populations have beenidentified. This article will present an overview of surgical treatment ofcoronary artery disease with emphasis on patient selection with particularattention to women, older persons, diabetic patients, and innovations in surgicaltechniques that may improve patient outcomes.


39. Crit Care Nurs Clin North Am. 1999 Jun;11(2):143-57.

Evidence-based clinical outcome management in interventional cardiology.

Parson C.

ViaHealth, Rochester General Hospital, New York, USA.

In conclusion, through the use of pathways and case management, evidence-basedclinical outcome management has occurred. The author's institution now has aprocess that enables it to accomplish three objectives: (1) the ability to track outcomes, (2) the ability to obtain information about opportunities forimprovement and develop action plans for this, and (3) the ability to judgethrough continued variance analysis whether the actions taken made a differenceor whether more changes are necessary. Based on this evidence, supported by theliterature, the author's institution has been able to offer quality patient care at a reasonable cost.


40. Heart Lung. 2000 May-Jun;29(3):161-72.

Perceived learning needs of the patient undergoing coronary angioplasty: anintegrative review of the literature.

Gentz CA.

Graduate School of Nursing, Northern Illinois University, Rockford, Illinois,USA.

OBJECTIVE: This study presents, through an integrative review, a comprehensiveaccount of the perceived concerns and learning needs of patients in the earlyrecovery period after a coronary angioplasty.SCOPE: Nineteen studies involving the patient who has undergone coronaryangioplasty were identified using CINAHL and MEDLINE. These studies were examinedto compare samples, methods, findings, implications, and suggestions for futureresearch.FINDINGS: Overall the subjects believed that undergoing coronary angioplasty was positive and beneficial, and they viewed it as a minimally invasive, routineprocedure. Informational knowledge, such as risk factor education and survivalmanagement, were considered of high importance. The majority of subjects modifiedtheir behavior, and the most common modification was in diet. Both learnedknowledge and lifestyle changes decreased over time. Self-efficacy expectationsand levels of anxiety were predictors of behavior changes and knowledge retentionin the early recovery period after the coronary angioplasty procedure.IMPLICATIONS: Health professionals must emphasize the seriousness and long-termoutcomes of untreated heart disease. Education programs should be individualized and streamlined. Spouses and significant others have informational needs andshould be included in education programs. Learning needs in the acute caresetting differ from those in the outpatient setting. Continuing education andresources need to be available for patients who are recovering from percutaneous transluminal coronary angioplasty and their families, and should build uponknowledge obtained during hospitalization.


41. Aust Nurs J. 1999 Aug;7(2):suppl 1-4.

Acute myocardial infarction.

McVeigh JP, Musto J.

NSW College of Nursing.

Current statistics reflect that cardiovascular disease (CVD) continues to be the greatest health problem affecting the Australian population, accounting forapproximately 42% of all deaths recorded. Of all cardiovascular disorders,ischaemic heart disease is associated with highest mortality rates.


42. J Cardiovasc Nurs. 1999 Apr;13(3):46-59.

Thrombolytic therapy versus primary angioplasty in the treatment of acutemyocardial infarction.

McErlean ES.

Acute Coronary Syndromes, Cleveland Clinic Foundation, Ohio, USA.

The quest to identify the acute interventional approach that will achieve thelowest mortality rate with the fewest adverse events has led to a continuedcontroversy surrounding the relative merits of thrombolytic therapy compared withprimary angioplasty in the setting of acute myocardial infarction. This articlesummarizes the benefits and limitations of each reperfusion strategy andhighlights adjunctive therapies that will enhance either treatment strategy.


43. Adv Nurse Pract. 1998 Aug;6(8):28-32, 35.

Quick thinking needed. Early management of acute myocardial infarction.

Buhse M.

School of Nursing, State University of New York, Stony Brook, USA.


44. Heart Lung. 1998 Sep-Oct;27(5):308-14.

Perceived side effects and benefits of coronary angioplasty in the early recoveryperiod.

Kimble LP, King KB.

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322,USA.

OBJECTIVE: To examine patients' perceptions of the side effects and the treatmentbenefit of percutaneous transluminal coronary angioplasty (PTCA) in the earlypostdischarge recovery period, and to determine whether selected demographic and clinical variables were associated with perceptions of side effects and treatmentbenefit.DESIGN: Descriptive, correlational study.SAMPLE: Convenience sample of 62 subjects, with a mean age of 62 years (SD 11years), 77% of whom were men, who had undergone successful, elective PTCA.RESULTS: Fifty-two percent of subjects reported side effects 2 weeks after PTCA. The most frequently reported side effect (22.5%), was discomfort in the groinsite. Seventy-nine percent of subjects reported PTCA made things better, and 5%reported that PTCA made things worse. The most commonly reported benefit of PTCA was relief of chest pain. Age, sex, and a history of previous PTCA were notrelated to reported side effects or reported benefits. Subjects who experiencedchest pain since the time of hospital discharge were less likely to report thatPTCA was beneficial.CONCLUSION: More emphasis should be placed on helping patients who are candidatesfor a PTCA to predict and to manage treatment side effects and to have realistic expectations concerning the trajectory of recovery from PTCA. Further research isneeded to examine the impact of patients' uncertainty concerning treatmentbenefit or perceptions of no treatment benefit in the early recovery period onintermediate and long-term PTCA recovery outcomes.


45. Crit Care Nurse. 1998 Apr;18(2):29-37.

Abciximab, a novel platelet-blocking drug: pharmacology and nursing implications.

Mayer DM, Docktor WJ.

Montana State University-Bozeman, College of Nursing, Missoula, USA.

Erratum in Crit Care Nurse 1998 Jun;18(3):27.


46. Crit Care Nurs Clin North Am. 1997 Dec;9(4):497-509.

Coronary revascularization in women.

Allen JK, Xu X.

School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.

Women who undergo revascularization with CABG or PTCA may experience morenegative acute outcomes compared with men. These gender differences in acuteoutcome are partly explained by the size of coronary arteries, baselinedifferences in clinical risk factors, and the unfavorable cardiovascular profilesseen in women. However, once women have survived the revascularization procedure,long-term outcomes are generally similar to those of men. Risk factoridentification and modification is an important approach to enhance our abilityto reduce long-term restenosis and progression of atherosclerosis followingrevascularization in women as well as men. After these interventions, only one inthree patients benefits from comprehensive risk factor intervention. Nurses arein key positions to approach patients and their families at the time of thesemajor interventions when they are likely to be more receptive to the idea of riskfactor modification.


47. Home Healthc Nurse. 1997 Apr;15(4):247-53; quiz 254-5.

Scaffolding the coronary arteries: intracoronary stenting.

Forsha B.

South Hills Health System Home Health Agency, Pittsburg, Pennsylvania, USA.

Stenting is a new method for treating coronary artery stenosis. This articlepresents an overview of the rationale for the implantation of stents, the varioustypes of stents available, and roles the home care nurse assumes in caring forthese patients.


48. Can Nurse. 1997 Mar;93(3):32-4.

Intracoronary stents: expanding options for patients with angina.

Vlasic W.

Interventional Cardiology, London Health Sciences Centre.

Cardiovascular disease remains the leading cause of death in canada. It isresponsible for 40 per cent of all deaths and is the leading cause of prematuredeath in people aged 35 to 64. In addition, symptoms of coronary disease have asignificant impact on the health status of individuals and families, oftennegatively affecting quality of life and ability to work.


49. Heart Lung. 1997 Mar-Apr;26(2):118-27.

Vascular complications of coronary interventions.

Davis C, VanRiper S, Longstreet J, Moscucci M.

Cardiac Step-down Unit, University of Michigan Hospitals, Ann Arbor, USA.

Vascular complications such as hematoma, pseudoaneurysm, and arteriovenousfistula that occur after intracoronary or intracardiac procedures are responsiblefor considerable morbidity and some mortality. In addition, many of thesecomplications result in considerable increases in hospital stays and in the costsassociated with the procedures. A number of risk factors for vascularcomplications after coronary interventions have been identified. They includeexcessive anticoagulation, use of femoral sheaths for extended lengths of time,multiple interventions during the same hospitalization, catheter insertion in thesuperficial or deep femoral artery larger catheter size, and complexinterventions such as stent deployment or atherectomy. Specific interventionshave been identified that help to decrease procedural risk, improve earlydetection and prompt treatment of the vascular injury, and prevent long-termdisability.



Diagnostic and functional exercise testing: test selection and interpretation.

Franklin BA.

Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital,Detroit, Michigan, USA.

Exercise stress tests are useful in many areas of medical practice and research. The results extend the clinical significance of information obtained from othersources (ie, detailed history, thorough physical examination, restingelectrocardiogram, chest radiograph, and basic laboratory analyses) and serve as a diagnostic, prognostic, and therapeutic guide. Leg or arm ergometry is commonlyused to assess a patient's functional status, diagnose relative myocardialischemia, and investigate physiologic mechanisms of cardiac symptoms. Theresponses may also be used to determine the effects of interventions such ascoronary artery bypass surgery, percutaneous transluminal coronary angioplasty,medications, or exercise training.


51. AACN Clin Issues. 1995 Aug;6(3):387-97.

Primary angioplasty in the acute myocardial infarction setting.

Coombs VJ, Brinker JA.

Management of patients experiencing an acute myocardial infarction has evolveddramatically during the past 2 decades. The role and timing of percutaneoustransluminal coronary angioplasty in patients experiencing a myocardialinfarction has remained controversial and under investigation. In recent studies,it was revealed that direct use of percutaneous transluminal coronary angioplastyin the presence of an acute myocardial infarction appears to be a safe,effective, and economical method of reperfusion.


52. Am J Crit Care. 1995 Jul;4(4):272-7; quiz 278-9.

Research review: use of activated clotting time to monitor heparin therapy incoronary patients.

Noureddine SN.

School of Nursing, University of California at Los Angeles, USA.

Comment in Am J Crit Care. 1995 Sep;4(5):414-5.

Successful management of patients after coronary angioplasty requires carefulmonitoring of the coagulation status in order to titrate heparin therapy andprevent thrombosis or bleeding. Traditionally, the activated partialthromboplastin time was used to monitor heparin therapy. Recently, however, useof activated clotting time is gaining more support because it can be performed atthe bedside and is cost-effective. This article reviews the research on the useof activated clotting time in titrating heparin therapy in angioplasty patients. Although the literature supports the use of activated clotting time inangioplasty, limitations of the studies and the different methodologies usedpreclude generalization of results. More research is needed to confirm theefficiency and effectiveness of the activated clotting time in monitoring heparintherapy.


53. Patient Educ Couns. 1995 Feb;25(1):1-8.

Cardiac patient teaching: application to patients undergoing coronary angioplastyand their partners.

Tooth L, McKenna K.

Education is accepted as a key component of cardiac rehabilitation for patientsfollowing myocardial infarction and bypass graft surgery. Recently, there hasbeen a call for rehabilitation to be uniformly offered to partners and familiesof cardiac patients, and for the expanding boundaries of rehabilitation toinclude patients who undergo coronary angioplasty. This paper aims to highlightpatient education strategies for cardiac patients and partners with a focus onassessment of their educational needs. The unique needs of patients undergoingcoronary angioplasty and their partners will then be discussed with existingcardiac educational strategies expanded to encompass this group of patients.


54. AACN Clin Issues Crit Care Nurs. 1993 May;4(2):219-27.

Surgical myocardial revascularization in the 1990s.

Rosborough D.

Substantial changes in the practice of cardiology ultimately produce a change in the types of patients who become candidates for surgery. This has been especiallytrue for patients with coronary artery disease. The primary goals of coronaryartery bypass graft (CABG) surgery are to relieve symptoms, prolong survival, andimprove the quality of life. Because of recent improvements in pharmacologictherapy and medical interventions, the criteria used to select patients for CABG surgery has changed secondary to the clinical characteristics of the patientpopulation.



Intracoronary stents: a new approach to coronary artery dilatation.

Bevans M, McLimore E.

Percutaneous transluminal coronary angioplasty (PTCA) is a low-risk treatment forproximal and localized coronary artery disease. Two major complicationsassociated with angioplasty are abrupt closure and restenosis of the treatedvessel. Abrupt closure requiring intervention occurs in approximately 3.6% ofpatients; the average restenosis rate reported in the literature is 30%. Thesedifficulties can produce profound hemodynamic compromise requiring additionalintervention. PTCA research focuses on methods to treat or prevent abrupt closureand restenosis of the stenotic segment. One new approach to this goal is the use of intracoronary stents after balloon angioplasty to maintain the luminaldiameter of the coronary artery. The effectiveness of intracoronary stents iscurrently being evaluated. This article describes the purpose and design ofintracoronary stents and reviews clinical trial results and nursing management ofpatients with such stents.


56. Nurs Clin North Am. 1992 Mar;27(1):231-42.

Management of the patient undergoing myocardial revascularization: percutaneoustransluminal coronary angioplasty.

McKenna M.

Cardiovascular Diagnostic Laboratory, Johns Hopkins Hospital, Baltimore,Maryland.

In 1990 approximately 250,000 PTCAs were done in the United States. The procedurehas developed into a technique heavily relied on for the management of coronaryartery disease. PTCA has a high primary success rate; however, given therelatively high degree of restenosis, it should not be viewed as a panacea.Further research is needed to evaluate the future of PTCA, in conjunction withthe use of newer therapeutic measures, including atherectomy, stents, andlaser-assisted balloon dilatation. Nurses will continue to play an important rolein the education and care given to patients undergoing these procedures.


57. Heart Lung. 1991 Nov;20(6):610-23.

Bedside electrocardiographic monitoring: state of the art for the 1990s.

Drew BJ.

Department of Physiological Nursing, University of California, San Francisco94143-0610.

Recent evidence indicates that misdiagnosis of cardiac arrhythmias is a commonoccurrence in critical care and telemetry units. The present article addressesthe problem by reviewing electrocardiographic criteria for diagnosing thearrhythmias and ischemic conditions of major importance in the critically illpatient including wide QRS complex tachycardias, bundle branch blocks, and STsegment monitoring after thrombolytic therapy and balloon angioplasty. Inaddition, the advantages and disadvantages of various monitoring leads arediscussed with recommendations regarding the most ideal leads for detecting thesearrhythmias of interest. Finally, practical suggestions are offered for improvingthe quality of bedside electrocardiographic monitoring.


58. Crit Care Nurs Clin North Am. 1991 Sep;3(3):507-14.

Renal artery occlusive disease.

Aaberg RA, Flaherty R, Smith RB.

Renal artery occlusive disease, from either atherosclerosis or fibrous dysplasia,may cause hypertension or renal insufficiency. Hypertension results fromincreased activity of the renin-angiotensin-aldosterone system. There are severalways to evaluate this system as well as several pharmacologic agents that willintervene and modulate the hypertension that results. Percutaneous transluminalangioplasty or surgical revascularization will be necessary in some patients tocontrol blood pressure or improve renal function. Successful evaluation andtreatment of these patients are based on clinical experience, an understanding ofthe natural history of the various disease processes involved, and acomprehensive team approach.


59. AACN Clin Issues Crit Care Nurs. 1990 May;1(1):87-109.

Techniques in cardiac care: lasers, stents, and atherectomy devices.

Halfman-Franey M, Coburn C.

Various new technologies are currently being investigated to treat cardiovasculardisease less invasively than with conventional open heart surgery. Althoughlasers have been used in other health disciplines, their use in thecardiovascular field is relatively new. Even newer is the use of atherectomydevices and endovascular stents. It is important for the critical care nurse tobe knowledgeable concerning these techniques in order to provide optimal patient care.


60. Crit Care Nurs Clin North Am. 1989 Jun;1(2):339-57.

Percutaneous balloon valvuloplasty in adult patients with valvular heart disease.

Daily EK.

Percutaneous balloon valvuloplasty is a new, nonsurgical technique for treatment of acquired mitral or aortic valvular stenosis. The procedure is stillinvestigational and performed following approved research protocols. Althoughtechnically more difficult and at times impossible to perform, percutaneous BV ofthe mitral valve has been shown to be both safe and effective for increasing the mitral valve orifice area and for relief of symptoms associated with severerheumatic mitral stenosis. Because of the relative infancy of the procedure,long-term data are available for only 1 to 2 years following BV. Thus far,however results obtained with mitral BV are similar to those obtained usingsurgical commissurotomy. From a long-term perspective, results of aortic BV inthe elderly population are less impressive. The procedure appears to be onlypalliative and is associated with high rates of restenosis occurring fairly soon after the procedure. However, in the very elderly patient who is a nonsurgicalcandidate, aortic BV can provide improvement in aortic valve orifice size and in relief of debilitating symptoms associated with severe aortic stenosis. As withsurgical aortic valve replacement, aortic BV also provides improvement over thenatural course of the disease. More data are needed to aid in better definitionand selection of patients who are suitable candidates for this procedure.


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