Handheld echocardiographic screening for rheumatic heart disease by non-experts.

OBJECTIVES: Handheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening. METHODS: Two nurses received training on HAND and a simplified screening approach. Consented students at two schools in Uganda were eligible for participation. A simplified approach (HAND performed and interpreted by a non-expert) was compared with the reference standard (standard portable echocardiography, performed and interpreted by experts according to the 2012 World Heart Federation guidelines). Reasons for false-positive and false-negative HAND studies were identified. RESULTS: A total of 1002 children were consented, with 956 (11.1 years, 41.8% male) having complete data for review. Diagnoses included: 913 (95.5%) children were classified normal, 32 (3.3%) borderline RHD and 11 (1.2%) definite RHD. The simplified approach had a sensitivity of 74.4% (58.8% to 86.5%) and a specificity of 78.8% (76.0% to 81.4%) for any RHD (borderline and definite). Sensitivity improved to 90.9% (58.7% to 98.5%) for definite RHD. Identification and measurement of erroneous colour jets was the most common reason for false-positive studies (n=164/194), while missed mitral regurgitation and shorter regurgitant jet lengths with HAND were the most common reasons for false-negative studies (n=10/11). CONCLUSIONS: Non-expert-led HAND screening programmes offer a potential solution to financial and workforce barriers that limit widespread RHD screening. Nurses trained on HAND using a simplified approach had reasonable sensitivity and specificity for RHD screening. Information on reasons for false-negative and false-positive screening studies should be used to inform future training protocols, which could lead to improved screening performance.

Heart sounds: are you listening? Part 2.

The first of this two-part article on heart sounds was in the Spring 2013 issue of the Canadian Journal of Cardiovascular Nursing (Reimer-Kent, 2013). Part 1 emphasized the importance of all nurses having an understanding of heart sounds and being proficient in cardiac auscultation. The article also focused on an overview of the fundamentals of cardiac auscultation and basic heart sounds. This article provides an overview of the anatomy and pathophysiology related to valvular heart disease and describes the array of heart sounds associated with stenotic or regurgitant aortic and mitral valve conditions.

Cardiovascular genomics: implications for acute and critical care nurses.

As genomic health care becomes commonplace, nurses will be asked to provide genomic care in all health care settings including acute care and critical care. Three common cardiac conditions are reviewed, Marfan syndrome, bicuspid aortic valve, and hypertrophic cardiomyopathy, to provide acute care and critical care nurses with an overview of these pathologies through the lens of genomics and relevant case studies. This information will help critical care nursing leaders become familiar with genetics related to common cardiac conditions and prepare acute care and critical care nurses for a new phase in patient diagnostics, with greater emphasis on early diagnosis and recognition of conditions before sudden cardiac death.

Estudio de caso en adulto joven con formación anómala congénita de válvula aórtica / Case study of young adult with congenital abnormal formation in aortic valve", "_i": "

El modelo conceptual de Virginia Henderson permite, a través de la valoración de enfermería, identificar necesidades alteradas en una persona con estenosis valvular aórtica congénita; en este estudio de caso en particular, se detectaron problemas relacionados con la necesidad de oxigenación, seguridad/protección, higiene, alimentación e hidratación, descanso y sueño, eliminación, movilidad y comunicación. Con base en estas alteraciones, se estableció un plan de cuidados especializados que describe las intervenciones para cada uno de los diagnósticos identificados con una orientación a la recuperación de la independencia de la persona.

The conceptual model of Virginia Henderson allows, through nursing assessment, to identify needs in a person affected with congenital aortic stenosis, in this particular case study, problems were detected with the need for oxygenation, safety/security, hygiene, nutrition and hydration, rest and sleep, elimination, mobility and communication. Based on these changes, established a specialized care plan that describes the interventions for each of the diagnoses identified with an orientation to the recovery of the independence of the individual.

Mitral valve repair.

Diseases that affect the mitral valve include mitral regurgitation, mitral stenosis, rheumatic heart disease, and cardiomyopathy. The results of diagnostic procedures are used to identify and confirm mitral valve disease, evaluate the patient's anatomy, and determine the severity of the disease. After the patient is prepared for surgery, the surgeon performs an intraoperative transesophageal echocardiogram and the patient is placed on cardiopulmonary bypass. A repair procedure (eg, annuloplasty, slidingplasty, chordal repair/transfer/replacement, valve replacement) is performed depending on the patient's specific anatomical abnormalities.

Surgical management of aortic and mitral valve disease: an overview.

This paper examines aortic and mitral valve disease. It considers how nurses can treat patients with these conditions and provide support and education to help them understand their disease and the risks and benefits of surgery. Nurses also have a role in secondary prevention and in helping patients adapt to living with a prosthetic valve.

Plethysmography: the new wave in haemodynamic monitoring--a review of clinical applications.

The plethysmograph, a useful, non-invasive circulatory assessment capability featured on most modern pulse oximeters, provides a waveform representation of pulsatile peripheral blood flow, from which can be drawn assessments of both the peripheral and central circulation. Implementation and maintenance of plethysmography monitoring is straightforward and uncomplicated by virtue of its non-invasiveness. Yet despite its capabilities, ease of use and widespread availability it remains an underutilised data source. Diagnostic and monitoring capabilities of the device include heart rate and rhythm monitoring, detection of myocardial and valvular dysfunction, assessment of intra-aortic balloon pump performance when pressure waveforms are unobtainable, detection and measurement of pulsus paradoxus, improved performance of the Allen's test and detection of peripheral vascular diseases, peripheral vasoconstriction and developing shock. This paper describes the range of established applications of plethysmography, reviews pertinent literature and describes the directions in which, in the absence of supportive literature, clinical practice is finding applications.

Carers' opinions and emotional responses following cardiac surgery: cardiac rehabilitation implications for critical care nurses.

The recent joint position statement made by the RCN Critical Care and Rehabilitation Nursing Forums highlights the need for rehabilitation to commence early. This paper reports the findings of a descriptive survey of 59 carers of cardiac surgery patients and presents implications for cardiac rehabilitation. Data were obtained by postal questionnaire during early recovery (one week following discharge) and six weeks later. The questionnaire explored carers' perceptions about the timing of discharge from hospital; opinions of the information provided by hospital staff; and anxiety and depression measured on the Hospital Anxiety and Depression Scale. The results indicated that carers assumed a heavy burden once the patient had left the specialist cardiac centre. Carers responding at one week were less satisfied with the timing of discharge than those questioned at six weeks. Information provided by nurses was rated more highly than that provided by doctors or physiotherapists. However, there was scope for increasing input. The findings suggest that cardiac rehabilitation needs to be aimed at carers as well as patients. Investment in targeted carer support could facilitate patient recovery and rehabilitation. Strategies aimed at the carer need to begin early and commence during the acute stage of the patients' recovery.

Valvular heart disease: a review for nurse anesthetists.

Those who do not regularly participate in cardiac surgery are often anxious when faced with the patient with valvular dysfunction. The need for periodic review by anesthetists is critical for quality patient care. A review of the physiology and anesthetic management of aortic stenosis, mitral stenosis, aortic insufficiency, mitral regurgitation, and mitral valve prolapse is presented.

Valve disorder: theoretical and practical nursing perspectives.

Little nursing research has been done towards reaching a better understanding of the experience of living with valve disorder. Most available resources to nurses caring for patients with valve disorder focus on pathophysiology of the disorder. The purpose of this article is to explore from both theoretical and practical perspectives, nursing issues related to caring for patients and their families while they live with a valve disorder. A chronic illness framework provides a basis to explore theoretical perspectives. Practical perspectives are explored using theoretical and pathophysiological aspects of nursing care. It is hoped that when nurses incorporate the aspects of care highlighted in this article into their practice, the patient's and family's experience of living with a valve disorder will be enhanced.

AANA Journal course: update for nurse anesthetists--anesthetic techniques for patients with valvular heart disease presenting for noncardiac procedures.

Providing anesthesia for patients with valvular heart disease undergoing noncardiac surgery can be extraordinarily challenging. Not only must the principles of normal cardiac physiology be mastered, but also those of the pathophysiology associated with the various valvular lesions. This course will provide a review of the pathophysiology and specific compensatory mechanisms for aortic stenosis, aortic insufficiency, mitral stenosis, and mitral regurgitation. Characteristic findings in the patient interview, physical examination, and diagnostic studies will be discussed. Anesthetic and monitoring considerations pertinent to each valvular lesion will be offered.

Current perspectives on prosthetic heart valves and valve repair.

The quest for the ideal cardiac valve substitute represents a highly categorized goal for the cardiac surgical community. Ongoing research has resulted in the development and creation of multiple newer heart valves and techniques for valve repair. Each of the many valves commercially available possesses a wide array of features. With the expansion of research investigations, improvement in long-term management can be translated and incorporated directly into patient care. As valvular replacement and repair/reconstruction surgery become more commonplace, it is paramount for nurses to be knowledgeable regarding the critical components of care.