Cardiac amyloidosis at a glance.

Amyloidosis can affect any organ in the body by deposition of amyloid fibrils. When these aggregate in the heart, it leads to cardiac amyloidosis a life-threatening and progressive disease. Although considered a rare condition, advances in imaging techniques and raised awareness have shown that it might be more frequent than has been historically estimated. Cardiac amyloidosis can be hereditary or occur as a consequence of the ageing process but, regardless of type, patients experience a heavy symptomatic burden. This article provides an overview of its pathophysiology, signs and symptoms and how any nurse can look for the main red flags in clinical practice. Early referral for specialist care can have a significant impact on disease progression and patient quality of life.

Anthracycline Chemotherapy-Induced Cardiotoxicity in Breast Cancer Survivors: A Systematic Review.

PROBLEM IDENTIFICATION: This review identifies specific cardiotoxicity related to anthracycline chemotherapy, specific risk factors related to increased anthracycline chemotherapy-induced cardiotoxicity, and underlying mechanisms of action of anthracycline chemotherapy-induced cardiotoxicity. LITERATURE SEARCH: PubMed®, CINAHL®, Embase®, and Web of Science were searched in May 2018 using keywords related to heart diseases, anthracycline chemotherapy, and breast cancer. DATA EVALUATION: Data were extracted, and study quality was assessed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. SYNTHESIS: 1,117 articles were identified through the literature search. After a review of the abstracts and articles, 15 clinical studies were identified for the final analysis by using exclusion and inclusion criteria. IMPLICATIONS FOR PRACTICE: Nurses should recognize the critical elements for prevention and early detection of anthracycline chemotherapy-induced cardiotoxicity.

Psychometrics of the Kansas City Cardiomyopathy Questionnaire Adapted for Family Caregiver/Significant Other.

BACKGROUND AND PURPOSE: The Kansas City Cardiomyopathy Questionnaire (KCCQ) was adapted to be administered to the family caregiver/significant other (FC/SO) of hospitalized patients with heart failure (HF). The objective was to examine the psychometrics of the adapted scale (KCCQ-SO). METHODS: Factor analysis, Cronbach's alpha, and correlations were used. RESULTS: A 5-factor solution was found that explained 67.9% of the variance. The internal consistency of the KCCQ-SO factors were all greater than .70. Patient and FC/SO perceived health status scores were significantly related. CONCLUSIONS: Because the scores were found to have high internal consistency and correlated with patient scores on the KCCQ, there is evidence that the FC/SOs' reports may be used in circumstances when the patient is unable or unwilling to answer questions.

Cardiomyopathy During Pregnancy.

Cardiomyopathy is an acquired cardiac disorder that, although rare, accounts for a rising proportion of reported pregnancy-related deaths in the United States. During pregnancy, cardiomyopathy may be divided into 2 groups. The first group is peripartum cardiomyopathy; the second group is stratified according to 3 classically defined pathophysiologic presentations: hypertrophic, dilated, or restrictive. Within this second group, the cardiomyopathy can be either idiopathic or due to a specific identified cause. This disorder poses significant risks of morbidity and/or mortality to the pregnant woman and fetus/neonate. This article describes types of cardiomyopathy during pregnancy, perinatal risks, and general management principles with a focus on intrapartum care. Hemodynamic and oxygen transport data are presented to illustrate interpretation of patient assessment findings and the effects of interventions for abnormal maternal and fetal findings.

Healthcare transition for youth with heart disease: a clinical trial.

OBJECTIVES: Adolescents with heart disease have complex health needs and require lifelong cardiology follow-up. Interventions to facilitate paediatric to adult healthcare transition are recommended, although outcomes are unknown. We sought to determine the impact of a transition intervention on improving knowledge and self-management skills among this population. METHODS: We conducted a clinical trial of 15-17 year olds with moderate or complex congenital heart disease (CHD) or cardiomyopathy. Participants were systematically allocated to either usual care (controls) or a 1 h nurse-led one-on-one teaching session about their heart. Allocation was determined by week of attendance in the cardiology clinic. The primary outcome was change in Transition Readiness Assessment Questionnaire (TRAQ) score at 6 months, possible scores ranging from 1 (low) to 5 (optimal). Cardiac knowledge (MyHeart score, range 0-100) was a secondary outcome. Analysis was intention to treat. RESULTS: Of 58 participants (48% female), 52 had CHD and 6 had cardiomyopathy. 27 were allocated to the intervention group; 3 declined the intervention and received usual care. When comparing the intervention group with the usual care group at 6 months postintervention, the mean self-management TRAQ score was 3.59 (±0.83) vs. 3.16 (±1.05), respectively (p=0.048, adjusted for baseline score); the mean self-advocacy TRAQ score was 4.38 (±0.56) vs. 4.01 (±0.95) (p=0.18) and the mean MyHeart score was 75% (±15) vs. 61% (±25) (p=0.019). CONCLUSIONS: A 1 h nurse-led transition intervention resulted in a significant improvement in self-management and cardiac knowledge scores. An educational intervention should be routine for youth with congenital or acquired heart disease. TRIAL REGISTRATION NUMBER: NCT01286480.

When the usual symptoms become an unusual diagnosis: a case report of trifunctional protein complex.

Disorders of mitochondrial fatty acid b-oxidation should be considered in any infant who presents with unexplained hypoglycemia and/or myopathy. Although disorders of trifunctional protein (TFP) complex including long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) and mitochondrial TFP deficiencies are extremely rare, the combined incidence of mitochondrial fatty acid disorders is quite frequent. With the expansion of newborn screening, what were once considered uncommon disorders are being identified with increasing frequency in asymptomatic infants. The following case scenario presents an infant who developed symptoms prior to the completion of newborn screening. This fairly routine course for a late-preterm infant reveals an extremely rare inborn error of metabolism, LCHAD deficiency. An overview of TFP complex, the differential diagnoses as the case unfolds, diagnostic test results, acute care management, and short-term patient follow-up is presented. With experience, health care providers often become accustomed to and expect to see common things regularly. This case presents a scenario which, as it unfolds, appears to be quite common. It turns out, however, to be very uncommon.

[Five scenarios for five and many more drugs]. / Cinque scenari per cinque e molti di più farmaci.

The report of the National Observatory on drug is the occasion for a reflection on the different perspectives offered from data on populations and the analysis of patients stories. Five scenarios are presented and briefly commented on of real-life drug prescriptions to elderly patients. Irrational-not evidence based prescriptions, open questions related to the compatibility of some drugs associations, and the limitedness of an answer to patients problems based mainly on drugs, are the main take home messages. A close surveillance oriented to problems and not to drugs, could be the strategy for reconsidering and restoring dignity to what should be a priority research area.

Psychometric properties of the Kansas City Cardiomyopathy Questionnaire (KCCQ).

BACKGROUND: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a well-established instrument used to evaluate the health status of heart failure (HF) patients. There has been a lack of clarity about the best way to conceptualize the KCCQ. The purpose of this investigation of the KCCQ was to: (1) explore the factor structure with an exploratory factor analyses; (2) perform reliability and validity testing to determine the best factor solution for item groupings; and (3) determine the most meaningful components of health status captured by the KCCQ. METHODS AND RESULTS: A secondary analysis of data from 280 adults with stage-C HF enrolled from three US northeastern sites was conducted to test the KCCQ subscale structure. Criterion-related validity for the Self-efficacy subscale was tested with the Dutch Heart Failure Knowledge Scale and the Self-care of Heart Failure Index Self-care Confidence Scale. Overall, internal consistency reliability (Cronbach's alpha) for the KCCQ and subscales was 0.92, social interference (seven items, 0.90), physical limitation (four items, 0.84), symptoms (eight items, 0.86), independent care (two items, 0.80), and self-efficacy (two items, 0.63). Two items failed to correspond to a previously identified factor so the independent care subscale was added. Items intending to measure quality of life were loaded in the social interference subscale. CONCLUSIONS: We recommend eliminating the quality of life subscale and including those items in the social interference subscale, and eliminating the self-efficacy items and re-evaluating the items related to independent care.

Health-related quality of life in Brazilian outpatients with Chagas and non-Chagas cardiomyopathy.

PURPOSE: To examine differences in demographic, clinical, and health-related characteristics of quality of life in heart failure patients with Chagas and non-Chagas cardiomyopathy in Brazil. METHODS: This observational study was carried out with 43 Brazilian out-patients with Chagas and 59 non-Chagas cardiomyopathy. RESULTS: No differences were evident between the 2 groups regarding age, sex, mean left-ventricular ejection fraction, and duration of follow-up. Compared with the non-Chagas group, patients with Chagas cardiomyopathy had a higher percentage of participants using artificial pacemakers (P < .001), more symptoms of heart failure as measured by New York Heart Association classes III and IV (P = .02), higher intakes of aspirin and warfarin, a higher use of artificial pacemakers because of bradycardia, and lower health-related quality of life in the Physical Functioning (P = .01) and Role Physical (P = .002) domains of the Medical Outcomes Study Short Form 36-Item Health Status Survey. CONCLUSION: Our study population was limited to one region endemic for Chagas disease in Brazil, and therefore findings need to be confirmed and should not be generalized to other populations without further research.

Cardiovascular nursing on human genomics: what do cardiovascular nurses need to know about congestive heart failure?

This paper presents the main causes of heart failure (HF) and an update on the genetics studies on each cause. The review includes a delineation of the etiology and fundamental pathophysiology of HF and provides rational for treatment for the patient and family. Various cardiomyopathies are discussed, including primary cardiomyopathies, mixed cardiomyopathies, cardiomyopathies that involve altered cardiac muscle along with generalized multiorgan disorders, and various cardiovascular conditions, such as coronary artery disease (ischemic cardiomyopathy) and hypertension (hypertensive cardiomyopathy). A brief review of pharmacogenetics and HF is presented. The application of the genetic components of cardiomyopathy and pharmacogenetics is included to enhance cardiovascular nursing care.

Electrocardiographic evaluation of cardiovascular status.

The electrocardiogram (ECG) is indispensable for the diagnosis and management of patients with a wide variety of cardiac and noncardiac diseases. The purpose of this paper is focused on recent research that used ECG, specifically the long-QT interval and microvolt T wave alternans, for the evaluation of life-threatening ventricular arrhythmias. Although remaining to be validated, QT prolongation along with other emerging electrocardiographic indices such as T wave morphology, T peak-to-T end time, or beat-to-beat QT variability may be sensitive indicators of malignant polymorphic ventricular tachyarrhythmia, torsade de pointes. Microvolt T wave alternans may provide important information in identifying a low-risk group with left ventricular dysfunction who is unlikely to benefit from unnecessary prophylactic implantable cardioverter defibrillator therapy. These ECG markers have the potential to aid in the safe administration of individualized medications, avoidance of sudden cardiac death, and provision of a noninvasive strategy to identify patients who are most and least likely to benefit from expensive prophylactic implantable cardioverter defibrillator placement.

Cardiovascular late effects.

Cancer survivors who have received cardiotoxic chemotherapy or mediastinal radiation have an increased risk of developing cardiovascular late effects. Cardiac functioning should be evaluated during follow-up exams based on the patient's risk factors, cardiac symptoms, and type of cancer treatment received. Signs and symptoms indicative of cardiovascular late effects include dyspnea, fatigue, tachycardia, nonproductive cough, neck vein distention, coarse breath sounds, and pedal edema.

[The nursing process implementation: a post-partum case study]. / Aplicaçõ do Processo de Enfermagem: estudo de caso com uma puérpera.

The study aimed at implementing the nursing process for a post-partum woman with cardiomyopathy after cardiorespiratory arrest. We conducted a clinical case study, in an intensive care unit of Fortaleza, Ceará, Brazil, in the period from September to October, 2005. The data were obtained after evaluation for elaboration of Nursing Diagnoses according to NANDA Taxonomy II, clinical judgment, intervention and goals. The nursing diagnoses found were: impaired verbal communication, decreased cardiac output, inefficient respiratory pattern, excessive volume of fluids, diarrhea, impaired physical mobility and deficit in selfcare. We highlighted the importance of the process as focus of the nurse's work in the clinic, in order to favor the patient's return to his family context as well as give credibility to the nurse's job.

Aplicação do Processo de Enfermagem: estudo de caso com uma puérpera / The Nursing Process implementation: a post-partum case study

O estudo objetivou implementar o processo de enfermagem, no cuidado a uma puerpera portadora de miocardiopatia periparto depois de parada cardiorrespiratória. Realizamos um estudo de caso clínico, em uma unidade intensiva do Município de Fortaleza, no período de setembro a outubro de 2005. Os dados foram obtidos após avaliação para elaboração dos diagnósticos NANDA taxonomia II, julgamento clínico, intervenção e metas. Os diagnósticos de enfermagem encontrados foram: comunicação verbal prejudicada, débito cardíaco diminuído, padrão respiratório ineficaz, volume excessivo de líquidos, diarréia, mobilidade física prejudicada e déficit no autocuidado. Ressaltamos a importância do processo como foco do trabalho do enfermeiro na clínica, na perspectiva de favorecer o retorno dos pacientes ao seu contexto familiar, bem como permitir credibilidade do trabalho de enfermagem.

The study aimed at implementing the nursing process for a post-partum woman with cardiomyopathy after cardiorespiratory arrest. We conducted a clinical case study, in an intensive care unit of Fortaleza, Ceará, Brazil, in the period from September to October, 2005. The data were obtained after evaluation for elaboration of Nursing Diagnoses according to NANDA Taxonomy II, clinical judgment, intervention and goals. The nursing diagnoses found were: impaired verbal communication, decreased cardiac output, inefficient respiratory pattern, excessive volume of fluids, diarrhea, impaired physical mobility and deficit in selfcare. We highlighted the importance of the process as focus of the nurse's work in the clinic, in order to favor the patient's return to his family context as well as give credibility to the nurse's job.

El estudio objetivó implementar el proceso de enfermería, en el cuidado a una parturienta portadora de miocardiopatía peripato después de parada cardiorrespiratoria. Realizamos un estudio de caso clínico, en una Unidad Intensiva del Municipio de Fortaleza, en el período de septiembre a octubre de 2005. Los datos fueron obtenidos después de evaluación para la elaboración de los diagnósticos NANDA taxonomia II, juicio clínico, intervención y metas. Los diagnósticos de enfermería fueron: comunicación verbal perjudicada, débito cardíaco diminuido, padrón respiratorio ineficaz, volumen excesivo de líquidos, diarrea, mobilidad física perjudicada y déficit en el auto cuidado. Resaltamos la importancia del proceso como foco del trabajo del enfermero en la clínica, en la perspectiva de favorecer el retorno de los pacientes al su contexto familiar y también permitir credibilidad del trabajo de enfermería.

Peripartum cardiomyopathy.

Peripartum cardiomyopathy is a rare and potentially lethal cardiac complication of pregnancy occurring in the final month of pregnancy through the first 5 months after birth. It is characterized by the development of congestive heart failure and left ventricular systolic dysfunction, in previously healthy women with no other identifiable cause for heart failure. The etiology of peripartum cardiomyopathy is not well understood. Potential causal mechanisms include infection, autoimmune disease, and abnormal response to the hemodynamic stresses of pregnancy. There is significant risk of reoccurrence in subsequent pregnancies. The purpose of this article is to review the pathophysiology, diagnosis, management, prognosis, and nursing implications of peripartum cardiomyopathy.

Cardiodesfibriladores implantables: una realidad en la prevención primaria de muerte súbita / Implantable cardiodefibrillator: a reality in primary prevention of sudden death

La muerte súbita cardiaca continua siendo unproblema muy serio en cualquier parte del mundo, en los EEUU representa aproximadamente un 50 por ciento de los casos de la mortalidad cardiovascular, siendo las arritmias ventriculares, taquicardia ventricular y la fibrilación ventricular los responsables de la mayoría de estas. Actualmente, hay suficiente evidencia científica para indicar un desfibrilador en pacientes con miocardiopatía dilatada isquémica y no isquémica, con FE mala o disminuida y alto riesgo de presentar muerte súbita cardíaca, por arritmias ventriculares (prevención primaria) debido a que estos dispositivos demostraron ser altamente eficaces en revertir o teminar las mismas. Es importante esperar resultados de estudios randomizados para poder contar con otros elementos de estratificación de riesgo y así mayor eficacia de los desfibriladores implantables para nuestros pacientes. La muerte súbita en pacientes con insuficiencia cardíaca sigue siendo un problema a pesar del progreso significativo de la terapia médica actual. Estudios recientes han demostrado que los cardiodesfibriladores implantables son superiores a las drogas antiarrítmicas (amiodarona) en disminuir la mortalidad total, por disminución de la muerte súbita en pacientes con fracción de eyección disminuida ya sea en miocardiopatía dilatada isquémica y no isquémica. Por lo tanto podemos considerar a estos dispositivos como una realidad en la prevención primaria de muerte súbita