Using the Trajectory Framework: reconceptualizing cardiac illness.

Cardiac disease is known to be the leading cause of premature morbidity and mortality in the United States. Nursing management of cardiac illnesses, as such, is a primary concern for most practicing nurses. Dramatic changes in cardiac patient populations and associated technology available for treatment indicate a need to reconceptualize the nature of cardiac illness and to consider alternative approaches to guide the care of these patients. Traditional care, to a large degree, has focused upon acute illness, consequently limiting needed attention to the increasing group of patients suffering chronic illness and disability. In the present paper, the major changes in the cardiac patient population and in utilization of available technology are presented. The application of the Corbin and Strauss trajectory framework as an appropriate and useful framework for conceptualizing cardiac illness and care is then discussed. Five characteristics of the framework which render the model particularly well suited to address cardiac care are identified and discussed. These characteristics are: 1) comprehensiveness of care, 2) patient-centered care, 3) gender issues in care, 4) family-focused care, 5) technology and cardiac care.     

The examination of the heart: the importance of initial screening

The screening examination of the heart and blood vessels require the use of the history, physical examination, electrocardiogram, and chest x-ray film. The relevant anatomy, pathology, and physiology responsible for the abnormalities found by using these methods of examination must be understood. The abnormalities that can be detected by the use of these methods of examination are discussed in this monograph. The techniques themselves are referred to as being low technology. The skill required in the use of these methods must be developed to its fullest. The data collected by using the history, physical examination, electrocardiogram, and chest x-ray film must be carefully analyzed in order for the examiner to diagnose the patient's cardiac problem. When possible, a complete cardiac diagnosis should be made according to guidelines formulated by the New York Heart Association. The four elements of a complete diagnosis are: Etiology, anatomy, physiology, and cardiac status and prognosis. In many cases, no additional data are needed and no additional data should be collected. When it is not possible to create a complete cardiac diagnosis from this information, the examiner must determine if it is wise and proper, given the patient's other health problems, to collect additional data that would permit a complete cardiac diagnosis. This effort hones the judgmental skill of the physician. When the cardiac diagnosis remains incomplete, or when a complete cardiac diagnosis is made but additional information is needed for follow-up purposes, carefully selected high technology should be used. With the unanswered questions in mind, the procedure used should be the one that answers the question with a predictive value that permits a defensible clinical decision. A complete medical problem list should be created for every patient. The cardiovascular problem must always be viewed in the context of other medical problems; there is no other way to make a sound judgment regarding the care of the patient with heart disease. When low technology, consisting of the history, physical examination, electrocardiogram, and chest x-ray film, is used poorly it is very likely that high technology will be used poorly. It is not possible to take a second step (high technology) without taking a well placed first step (low technology).     

Quality of life among patients with a left ventricular assist device: what is new?

As more patients have a diagnosis of end-stage heart failure, nurses are more likely to encounter the use of left ventricular assist devices (LVADs). Currently, LVADs are used as a bridge to cardiac transplantation. However, current research suggests that LVADs may be used as destination therapy for those unable to undergo cardiac transplantation. The technology has been developed to sustain life, but what is the impact of technology on the quality of life? This article reviews current research on the quality of life with an LVAD.     

Arterial pressure-based technologies: a new trend in cardiac output monitoring

New trends in cardiovascular monitoring use the arterial pulse as a less invasive means of assessing cardiac output. When adopting a new technology into practice, three questions need to be answered: (1) is the method technologically sound?, (2) is it based on physiologic principles?, and (3) are the applications clinically important? This article provides a clinical review on the technology, physiology, and applications of a new arterial pressure-based method of determining cardiac output and stroke volume variation as an additional parameter for fluid status assessment.     

体外充电植入式人工心脏起搏器的设计

背景:人工心脏起搏器长期植入人体,使用寿命至关重要,目前尚没有可充电的植入式人工心脏起搏器问世.目的:探讨植入式人工心脏起搏器体外充电技术,以期降低人工心脏起搏器寿命对电池能量的依赖.方法:利用某种对人体无创、无害的介质,把体外能量隔离传输给植入体内的接收转换装置,进而对人工心脏起搏器可充电电池的能量给予补充,以延长使用寿命.结果与结论:试制了可充电人工心脏起搏器实验样机,完成了一期动物实验,同时以超声波为能量传输载体进行了隔离无创充电试验,对相关技术做了探讨.     

心肌组织工程支架材料:从研究到应用还有多远?

目的:寻求在心肌组织工程中,能为培养的种子细胞提供可靠的仿生型心肌细胞外基质材料.方法:应用计算机检索CNKI和PubMed数据库中1996-01/2007-08关于组织工程支架材料的文章.结果:具有良好的生物相容性和机械性能的天然生物支架材料是心肌组织工程支架快速成形技术的首选材料.天然生物材料如胶原、壳聚糖等机械性能较差,可塑性不强,但生物相容性好,可用于心肌支架的快速成形.三维打印、激光烧结、立体印刷技术、选择性激光烧结快速成形技术制备出的支架均具有高的孔隙率,高的表面积体积比,孔与孔之间完全通透,宏观形状可控,孔隙率和孔径独立控制等优点.结论:采用离散,堆积成型原理,利用计算机和纳米高分子技术等高科技,结合传统心肌组织工程支架生物材料,对生物材料应用表面修饰或改性技术,有望为心肌组织工程提供较理想的支架材料.     

先天性心脏病介入治疗的常见并发症分析

多年来外科手术一直是先天性心脏病（先心病）治疗的金标准。随着介入器材及技术的不断发展,先心病的介入治疗被广泛接受并成为很多患者的首选治疗方法。虽然大多情况下介入治疗能顺利完成,但并发症时有发生,介入手术仍存在相当大的风险。先心病介入治疗常见并发症有心脏、大血管穿孔、心包压塞、心律失常、封堵器脱落、瓣膜关闭不全、残余分流与溶血、血管并发症和拔管综合征等。该文分析了介入治疗常见并发症的发生原因、诊断、处理和预防。     

Cardiac troponins in intensive care

The cardiac troponins are integral components of the myofibrillary apparatus and they regulate muscle contraction. The measurement of cardiac troponins has replaced other biomarkers for the specific detection of myocardial necrosis and for the diagnosis of myocardial infarction. The tissue specificity plus sensitivity of the measurement technology has meant that cardiac damage can be detected in circumstances other than conventional acute coronary syndromes. The ability to specifically detect cardiac damage as part of multiple organ failure in intensive care patients has been shown to provide prognostic information, but it is unclear whether this is a dependent or an independent marker of outcome.     

Assessment of cardiac function by electron-beam computed tomography

The measurement of parameters relating to the assessment of cardiac function and morphology are critically important prognostic determinates in patients with known or suspected cardiac disease, such as coronary artery disease and myocardial infarction. Similarly, the measurement of indices, such as ejection fraction and myocardial mass, are key in assessing the efficacy of therapy in patients with valvular, coronary artery and intrinsic myocardial diseases. Electron-beam computed tomography has been proven to be a reliable and accurate modality for measuring a host of parameters relating to cardiac function. This article reviews the unique technologic design of the electron-beam computed tomography scanner and specifically addresses how this technology has enabled electron-beam computed tomography to become the gold standard for the quantification of cardiac function.     

Assessment of cardiac function by electron-beam computed tomography

The measurement of parameters relating to the assessment of cardiac function and morphology are critically important prognostic determinates in patients with known or suspected cardiac disease, such as coronary artery disease and myocardial infarction. Similarly, the measurement of indices, such as ejection fraction and myocardial mass, are key in assessing the efficacy of therapy in patients with valvular, coronary artery and intrinsic myocardial diseases. Electron-beam computed tomography has been proven to be a reliable and accurate modality for measuring a host of parameters relating to cardiac function. This article reviews the unique technologic design of the electron-beam computed tomography scanner and specifically addresses how this technology has enabled electron-beam computed tomography to become the gold standard for the quantification of cardiac function.     

The Hemopump temporary cardiac assist system

The Hemopump temporary cardiac assist system is currently in clinical trials at several centers across the United States and abroad. Patients with postcardiotomy low cardiac output or patients with cardiogenic shock secondary to acute myocardial infarction may greatly benefit from this device. Theory of pump operation, patient selection, and nursing management is discussed. Presentation of a case study demonstrating the effect of Hemopump support will be provided. A detailed nursing care plan as well as application of research findings to clinical practice will be outlined. As cardiovascular technology progresses, the critical care nurse must continue to be involved in all aspects of patient care. The Hemopump may prove to be a highly beneficial mode of ventricular assistance for patients with inadequate cardiac function.     

体外充电植入式人工心脏起搏器的设计

背景：人工心脏起搏器长期植入人体,使用寿命至关重要,目前尚没有可充电的植入式人工心脏起搏器问世。目的：探讨植入式人工心脏起搏器体外充电技术,以期降低人工心脏起搏器寿命对电池能量的依赖。方法：利用某种对人体无创、无害的介质,把体外能量隔离传输给植入体内的接收转换装置,进而对人工心脏起搏器可充电电池的能量给予补充,以延长使用寿命。结果与结论：试制了可充电人工心脏起搏器实验样机,完成了一期动物实验,同时以超声波为能量传输载体进行了隔离无刨充电试验,对相关技术做了探讨。     

血流向量成像技术在心脏瓣膜病中的研究进展

心脏瓣膜病是较常见的心脏病,随着病情进展可导致心脏血流动力学发生显著变化,血流向量成像技术(VFM)既可用于观察心腔内血流流场的变化,又可用于评估心脏局部和整体功能的改变。本文就VFM技术对于心脏瓣膜疾病的研究进展做一综述。     

Using QRS morphology and QTc interval to prevent complications and cardiac death

Prevention of cardiac complications including death is influenced by the availability of diagnostic tools and technological advances. Cardiac telemetry as a diagnostic tool is widely used in hospitals because of an increased severity of illness and complex modality of treatments. QTc interval abnormalities in the electrocardiogram have been long recognized as a predictive precursor for life-threatening cardiac arrhythmias and cardiac arrest. QRS morphology has also been recognized as a reliable marker to prevent cardiac events in outpatient settings. However, the QTc and QRS morphology as electrocardiogram predictors are not routinely assessed in daily practice for hospitalized patients because of the slow advancement of technology in bedside monitoring systems and inadequate staff preparation. This article discusses the role of QRS morphology and QTc interval assessment in predicting risk of complications. The article also explores the need for further research and advancement in technology to overcome barriers to integrating these predictors into routine nursing practice.     

Transthoracic electrical bioimpedence cardiac output: comparison with multigated equillibrium radionuclide cardiography

Introduction  

Thoracic electrical bioimpedance (TEB) for measuring cardiac output (CO) is being explored increasingly as an alternative to pulmonary artery catheter. The major advantage of this technology is that it is non-invasive and easy to perform. Several studies have compared it to thermodilution cardiac output using PA catheter, with variable correlation. Multigated radionuclide equilibrium cardiography (RNEC) method of cardiac output measurement is known to be reliable.     

The postmodern heart: war veterans' experiences of invasive cardiac technology

Background. The consequences of war and medical discourse have historical connections to pacemaker technology. Understanding these consequences is important because war veterans, medicine and cardiac technology have a shared history that continues into the present. The incidence of Australian war veterans needing cardiac pacemakers has increased many‐fold in recent years, due to advancing age. This need was recognized by the Australian Department of Veteran Affairs and a cardiac programme was established in the veteran hospital that was the setting for this study. Aim. This paper reports on a study aimed at capturing the interest and sensitizing the practice of nurses involved in the care of war veterans and other health care consumers who have been diagnosed as requiring a cardiac pacemaker. The study sought to answer the question, ‘How does the war veteran experience his body in relation to invasive cardiac technology?’. Method. The research was guided by the principles of interpretive interactionism, and used unstructured interviews with eight male war veterans. The data were collected in 2000. Findings. Thematic and content analysis revealed five themes: emotional knowing; the medical encounter; belief in the myth of miracle; technological constraint; and the altered heart. The findings indicated that the human dimension was characterized by experiences of ambivalence, inner conflict, powerlessness and suffering. Conclusion. Nursing is at the interface of science and patient care, and this study contributes to nursing knowledge by focusing on a previously unresearched topic, namely embodied interactions between war veterans and invasive cardiac pacemakers. Within a highly technical area such as cardiology, nurses can still work around the technology and keep patients as their primary focus, thus promoting quality care. A humanistic rather than a technological focus locates nurses between patients and cardiac technology. In this in‐between location, nurses are not an extension of cardiac technology but a valuable source of information, education, and counselling.     

Signal-averaged electrocardiography. Promising tool for predicting sudden cardiac death

Signal-averaged electrocardiography has shown great promise as an adjunct in identifying patients at risk for sudden cardiac death. Clearly, much research remains to be done. Methods and criteria must be standardized so studies can be compared and the most effective ways in which to use this technology can be determined.     

Gene and Cell Therapy for Cardiac Arrhythmias

PurposeIn the last decade, interest in gene therapy as a therapeutic technology has increased, largely driven by an exciting yet modest number of successful applications for monogenic diseases. Setbacks in the use of gene therapy for cardiac disease have motivated efforts to develop vectors with enhanced tropism for the heart and more efficient delivery methods. Although monogenic diseases are the logical target, cardiac arrhythmias represent a group of conditions amenable to gene therapy because of focal targets (biological pacemakers, nodal conduction, or stem cell–related arrhythmias) or bystander effects on cells not directly transduced because of electrical coupling.MethodsThis review provides a contemporary narrative of the field of gene therapy for experimental cardiac arrhythmias, including those associated with stem cell transplant. Recent articles published in the English language and available through the PubMed database and other prominent literature are discussed.FindingsThe promise of gene therapy has been realized for a handful of monogenic diseases and is actively being pursued for cardiac applications in preclinical models. With improved vectors, it is likely that cardiac disease will also benefit from this technology. Cardiac arrhythmias, whether inherited or acquired, are a group of conditions with a potentially lower threshold for phenotypic correction and as such hold unique potential as targets for cardiac gene therapy.ImplicationsThere has been a proliferation of research on the potential of gene therapy for cardiac arrhythmias. This body of investigation forms a strong basis on which further developments, particularly with viral vectors, are likely to help this technology progress along its translational trajectory.     

电生理相关心房解剖结构CT成像研究进展

随着心脏电生理检查、导管消融和植入器械等技术的开展日益增多，电生理相关心房解剖愈发受到心血管医师的关注。随着心脏CT技术的不断进展，其逐渐被用于心房结构个体化解析，为临床诊治提供更详细的依据。本文围绕左心房、右心房、房间隔及与心房关系密切的冠状静脉窦等电生理结构的心脏CT解析相关研究作一综述，以期提高医师和科研工作者对心房相关解剖与新成像方法的认识，从而助力心血管疾病的精准诊疗。     

Anastomotic devices for coronary surgery

Proximal and distal anastomotic devices will play different roles in advancing minimally invasive cardiac surgery. In the wake of the first experiences with the St. Jude Symmetry?, data will be needed to support new technology adoption. The value of anastomotic technology will be greater in the off‐pump and small access coronary techniques. When coronary vascular connectors provide the same or better patency than suture cardiac surgeons will use them for most cases because they will be faster and more reliable. This burgeoning field of anastomotic connectors is already beginning to spill over into other specialties. There is promise for these devices in vascular procedures. It is predicted that similar devices will also be used for bowel anastomoses. With continued evolution of anastomotic devices, it is easy to visualize that in the near future the majority of anastomoses may be performed with a manual or automatic device as opposed to the current conventional suture technique.