Compensatory mechanism Renin-Angiotensin-Aldosterone-System (RAAS) Neurohormonal response – RAAS Endothelin release (contractility) Cytokine release (Hypertrophy) Inadequate stroke volume and CO –  (Epi and NoreEpi) Ventricular remodeling

Pathophysiology Systolic heart failure HFrEF – HF with reduced EF Inability to pump blood forward Caused by Impaired contractile function Increased afterload Cardiomyopathy Mechanical abnormalities

Gender differences Men Men experience systolic failure more frequently than women. Men with asymptomatic systolic failure experience greater mortality benefit from ACE inhibitor therapy than

Heart Failure Complex clinical syndrome resulting in insufficient blood supply/oxygen to tissues and organs Involves diastolic or systolic dysfunction Ejection fraction (EF) is amount of

Role of Nursing Personnel Registered Nurse (RN) Pre-procedure Assess for allergies, especially to contrast dye. Perform baseline assessment, including vital signs, pulse oximetry, heart and

Sudden cardiac death Nursing/Interprofessional care Diagnostic workup to rule out or confirm MI Cardiac biomarkers ECGs Treat accordingly Cardiac catheterization PCI or CABG 24-hour Holter

Coronary revascularization: PCI Monitor for recurrent angina Frequent VS, including cardiac rhythm Monitor catheter insertion site for bleeding Neurovascular assessment Bed rest per institutional policy

Nursing diagnoses Decreased cardiac output related to altered contractility and altered heart rate and rhythm Acute pain related to an imbalance between myocardial O2 supply

Nursing management Nursing Assessment: Subjective Data Health history CAD/chest pain/angina/ MI Valve disease Heart failure/cardiomyopathy, Hypertension, diabetes, anemia, lung disease, hyperlipidemia Drugs Use of anti-platelets

Acute coronary syndrome Minimally invasive direct coronary artery bypass (MIDCAB) For patients with disease of left anterior descending or right coronary artery Does not involve

Interprofessional care Acute Coronary Syndrome Initial interventions 12-lead ECG Upright position Oxygen – keep O2 sat > 93% IV access Nitroglycerin (SL) and ASA (chewable)

Nursing management Nursing Assessment Subjective Data Important Health Information Past health history: Known duration and past workup of high BP; cardiovascular, cerebrovascular, renal, or thyroid