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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) are
currently treated with primary percutaneous intervention (PCI). This
relatively
new procedure has reduced the time patients with the diagnosis of
STEMI spend in
hospital. In this literature review we explore patients' perceptions
of their
experience of receiving primary percutaneous intervention (PCI) as a
treatment
for STEMI. We critiqued and graded for relevance 10 papers that
included original
research and other sources. Key findings indicate that there is
considerable
variability in how patients treated for STEMI perceive the experience
of PCI.
Further, there is a misalignment between some patients' perceptions
and health
professionals' perceptions of this experience related to the event as
well as the
language used to speak of it. Thus, we recommend that nurses assess
patients'
perception of the experience and patients' health literacy level, then
tailor the
content and language of patient and family education to ensure an
effective
educative 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 or
undergoing percutaneous coronary intervention.
Fletcher B, Thalinger KK.
Brooks College of Health, School of Nursing, University of North
Florida,
Jacksonville, Florida 32250, USA. bjflet@att.net
Erratum in
Crit Care Nurse. 2011 Feb;31(1):15.
PMID: 20889512

[PubMed - indexed for MEDLINE]

3. J Ren Care. 2010 May;36 Suppl 1:118-26.
Coronary revascularisation in chronic kidney disease. Part II: acute
coronary
syndromes.
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
patients
with CKD presenting with acute coronary syndromes is more complex than
in the
general 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
patients
potentially have much to gain from conventional revascularisation
strategies used
in the general population. This review summarises the current evidence
regarding
the treatment of patients with CKD presenting with acute coronary
syndromes, in
particular with respect to coronary revascularisation strategies.
PMID: 20586907

[PubMed - indexed for MEDLINE]

4. J Ren Care. 2010 May;36 Suppl 1:106-17.
Coronary revascularisation in chronic kidney disease. Part 1: stable
coronary
artery 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
limitations
of 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
conventional

strategies used in the general population. This review summarises the
current
evidence regarding the treatment of coronary artery disease in
patients with CKD,
with the focus on coronary revascularisation by percutaneous coronary
intervention or coronary artery bypass grafting.
PMID: 20586906

[PubMed - indexed for MEDLINE]

5. Aust Crit Care. 2010 Nov;23(4):177-87. Epub 2010 Apr 21.
Development of clinical practice guidelines for the nursing care of
people
undergoing percutaneous coronary interventions: An Australian & New
Zealand
collaboration.
Rolley JX, Salamonson Y, Dennison CR, Davidson PM.
Centre for Cardiovascular and Chronic Care, Curtin Health Innovation
Research
Institute, Curtin University, Australia. j.rolley@curtin.edu.au
AIM: This paper describes the development of nursing practice
guidelines for
percutaneous coronary intervention (PCI).
BACKGROUND: Clinical practice guidelines (CPGs) supporting PCI nursing
care are
limited.
METHOD: The National Health and Medical Research Council's (NH&MRC)
health and
medical practice development guidelines were used for the guideline
development
process. A panel of experts (clinicians and consumers) attended a
consensus
conference to review existing evidence. Subsequently, nurses' opinions
were
identified via an online survey. This was followed by a modified
Delphi method
was used to refine a draft set of guidelines over two rounds.
RESULTS: The consensus conference was attended by 41 participants (39
cardiovascular nurses and 2 consumer representatives). Eight
additional members
joined the panel for the modified Delphi rounds with 27 participants
completing
the 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 definitive
recommendations. Therefore, consultation and consensus are important
in
developing guidelines to achieve standardised nursing care and
monitoring of
outcomes.
IMPLICATIONS FOR PRACTICE: Nurses play a crucial role in PCI care, yet
currently

Myocardial infarction and subsequent death in a patient undergoing robotic prostatectomy. presents a unique challenge in anesthetic management. The preoperative cardiac evaluation and pharmacological management of patients with drug-eluting coronary stents are reviewed. All attempts to resuscitate were unsuccessful. and several hours later he was pronounced dead. Underlying patient comorbidity and procedural issues contributed to the patient's death. ASA physical status IV.there are limited guidelines to inform practice. Hospital of St Raphael.com A 52-year-old patient. 2009 Oct. This course reviews the current literature on the surgical implications for patients with drug-eluting stents and the physiologic factors related to position and pneumoperitoneum and their associated stressors. undergoing a radical prostatectomy for cancer with a robotic system had a cardiac arrest 3 hours into the case. . School of Nurse Anesthesia.indexed for MEDLINE] 6. PMID: 20413321 [PubMed .indexed for MEDLINE] 7. judy6270@yahoo. The needed positioning. New Haven. Thompson J. Connecticut. combined with the problems associated with insufflation.77(5):365-71. especially in relation to the requirement of low-lithotomy and steep Trendelenburg positions. USA. By using a review of the contemporary literature. There are a number of positional and technical considerations for patients undergoing robotic surgical procedures. The patient had a history of coronary artery disease that required the placement of drug-eluting stents 2 years before this surgical procedure. a bestevidence approach to anesthetic management is reviewed.21(8 Suppl A):11A-17A. PMID: 19911646 [PubMed . 2009 Aug. AANA J. J Invasive Cardiol. This paper describes the method developing clinical practice guideline and deriving consensus. The cardiac and respiratory systems are especially vulnerable to the extreme and lengthy head-down position.

indexed for MEDLINE] 8. increased patient comfort. Angina following percutaneous coronary intervention: in-stent restenosis. kthrondson@mts. and decreased hospital costs. Alfonso C. transradial vascular access for coronary angiography and intervention has flourished in many countries while still accounting for less than 2% of all cases performed in the United States due. FL 33136. Although published data suggest that 100-200 cases are necessary to become proficient.edu Over the past 20 years. To establish a transradial program and offer the benefits of this approach to most patients. and some operators may become proficient sooner. University of Miami.miami. peripheral vascular disease. University of Miami Hospital. a dedicated interventionalist must incorporate peers and hospital staff to create a multidisciplinary team. University of Manitoba. A learning curve to gain the specific set of skills for transradial access has been well described. since the first reports. Sawatzky JA.Starting a transradial vascular access program in the cardiac catheterization laboratory. USA. the learning curve is likely highly individual. it is not without risks both . Can J Cardiovasc Nurs. in part. Faculty of Nursing. Miami. Cardiovascular Division. However. lessened post-procedure nursing workload. mgcohen@med. Cohen MG. and anticoagulation clearly benefit from this approach. Patients with morbid obesity. The equipment to start a transradial program is minimal and includes modified sheaths and catheters. Throndson K.net Percutaneous coronary intervention (PCI) represents a technical advance in the treatment of coronary artery disease. 2009.19(3):16-23. PMID: 19734569 [PubMed . The benefits of transradial access include decreased bleeding risk. to difficulties in introducing change to established practice patterns. Miller School of Medicine.

effective. PMID: 19694113 [PubMed . the authors highlight the unique characteristics of these patients. Advanced practice cardiovascular nurses play . secondary prevention strategies are critical to prevent disease progression.19(2):17-24. Unfortunately. the pathophysiology of angina related to ISR. Individuals with ISR are vulnerable to the consequences of angina. Individuals who experience angina associated with ISR often fail to recognize its seriousness and. In-stent restenosis (ISR) is the most common complication following PCI. In this article.indexed for MEDLINE] 9.net Percutaneous coronary intervention (PCI) is a safe. The demand for PCI has increased exponentially since the 1980s and it has become the treatment of choice for many individuals with CAD. Sawatzky JA. Exercise is a central component of any cardiac prevention strategy. In this article. current strategies ignore the specific needs of the elective PCI population. do not respond appropriately to the situation. and the challenges that face patients who develop recurrent angina post-PCI. including increased morbidity and mortality. 2009. therefore. nonsurgical treatment for coronary artery disease (CAD). Can J Cardiovasc Nurs. which may contribute to their lack of engagement in healthy lifestyles. kthrondson@mts. Since PCI is not a cure. Throndson K. and lack of enrolment in secondary prevention programs. as well as a decreased health-related quality of life. Improving outcomes following elective percutaneous coronary intervention: the key role of exercise and the advanced practice nurse. the authors review the risks for developing ISR. Individualized exercise programs that incorporate physical activity and counselling can potentially improve the clinical outcomes of these patients. Cardiovascular nurses play a critical role in the clinical management and education of patients following PCI. Elective PCI patients are vulnerable due to limited knowledge and follow-up. University of Manitoba.during and after the procedure. and supporting patients with recurrent angina. Faculty of Nursing. managing. The provision of post-PCI followup care is key to identifying.

com BACKGROUND: There is considerable variation in use of pain relief for managing pain or discomfort of femoral sheath removal. Pain relief for the removal of femoral sheath in interventional cardiology adult patients. MEDLINE. Two trials (three treatment arms) involving 399 participants compared intravenous . SEARCH STRATEGY: Databases searched in August 2007: Cochrane Pain. were sought. Price SM. Weighted mean differences (WMD) were calculated where meta-analysis of pain score data was feasible. with no significant difference between pain scores. National Research Centre. School of Nursing.a key role in developing. CINAHL.Determine if pain relief influences rate of complications associated with this procedure.indexed for MEDLINE] 10. Nelson. New Zealand.12 (95% CI -0. Stewart JT. All results were reported using a zero to ten pain scale. Auckland. Adverse effects information was collected. 7061. Wensley CJ. PubMed. PMID: 19517901 [PubMed . OBJECTIVES: Assess efficacy of pain relief used to manage pain of femoral sheath removal in adults after interventional cardiology. Cochrane CENTRAL.46 to 0. 2008 Oct 8. Kent B. SELECTION CRITERIA: Randomised studies comparing opioid.(4):CD006043. Efficacy of pain relief to promote comfort during this procedure or to reduce the incidence of vascular and procedural complications has not been established. implementing. local anaesthetic. EMBASE. McAleer MB. WMD 0. no treatment or placebo administered for alleviation of pain or discomfort of the femoral sheath removal procedure. anxiolytic. Three trials (four treatment arms) involving 498 participants compared subcutaneous lignocaine with control. University of Auckland. Australia's Australasian Medical Index.69). DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality and extracted data. and evaluating exercise programs in this population. Web of Knowledge and Digital Dissertations. cynthia@wensley. Cochrane Heart Group Trials Register. Palliative and Supportive Care Group Trials Register. Cochrane Database Syst Rev. MAIN RESULTS: Four trials involving 971 participants were included.

Shoulders-Odom B. The largest trial. .pain regimens with control. USA. However. Time = MUSCLE the case for STEMI care improvements. quiz 45-6. Rathman L. Crit Care Nurse. Paterson. Nurs Manage. Longer-acting local anaesthetic significantly lowered pain score by -1. quiz 42. Tampa.90 (95% CI -1. USA. There is insufficient evidence to determine if pain relief influences the rate of complications..26 to -0. WMD -0. AUTHORS' CONCLUSIONS: Intravenous pain regimens and levobupivacaine may have greater efficacy when compared to control for the management of pain related to femoral sheath removal.28(5):26-41.94). 2008 Oct.com PMID: 18827085 [PubMed .10 (95% CI -1. A significant reduction in pain score with an intravenous pain regimen (opioid and anxiolytic) was observed when compared with placebo. Management of patients after percutaneous coronary interventions. Crowther M.indexed for MEDLINE] 11.indexed for MEDLINE] 13. J Cardiovasc Nurs. One study involving 60 participants compared levobupivacaine with placebo. Delgado S. Bso1029@aol. a definitive study is still required because the clinical difference is small. PMID: 18843700 [PubMed . Using devices for physiologic monitoring in heart failure. 2008 Mar-Apr.27). There is no evidence to support the use of subcutaneous lignocaine for the relief of femoral sheath removal related pain. Florida. N. Data is insufficient to identify any influence of pain regimens on incidence of vascular and procedural complications. Trupp R. Saint Joseph's Regional Medical Center.54 to -0.indexed for MEDLINE] 12. comprising 661 participants was unblinded with a quality score of two out of five. No trials reported appropriate blinding for treatment arms.23(2):159-68. Tampa VA Hospital. 2008 Apr.J.39(4):41-5. Repoley J. PMID: 18391825 [PubMed .

Future advanced monitoring devices will also be discussed.indexed for MEDLINE] 14. Lancaster. Miller PS. Invasive cardiac strategies. University of California. Pennsylvania 17603. USA. School of Nursing. Racial disparities in access to care within the cardiac revascularization population. 2007 Dec. PMID: 18382259 [PubMed . particularly among vulnerable groups such as African-Americans. The purpose of this article is . pmiller1@ucla. This article will review the evidence for using diagnostic information from cardiac rhythm management devices in the management of HF patients.Heart Failure Program. Early management and preventive therapy has been the cornerstone of cardiovascular medicine for acute coronary syndromes.18(2):63-74. The Heart Group. CA 900951702.edu Health disparities and vulnerability are embedded within the context of historical and contemporary dynamics. Device-based diagnostic monitoring provides clinicians with information that can assist in identifying patients at risk for HF decompensation and subsequent hospitalization. There is a paucity of nursing research in the area of access to care and cardiovascular disease. and are confounded by inequities in access to quality healthcare. Implanted cardiac rhythm management devices are increasingly used in the HF population to provide therapies such as protection from sudden death and cardiac resynchronization therapy. lisakev@ptd. Los Angeles. Several studies have described the obstacles and variance involved in the distribution of access to cardiac catheterization. USA.net Heart failure (HF) is a complex and costly disease process associated with high morbidity and mortality. including revascularization with percutaneous coronary intervention or coronary artery bypass grafting have been instituted as methods to minimize subsequent cardiovascular events and to improve survival benefits. J Natl Black Nurses Assoc.

in cardiology research.indexed for MEDLINE] 15. This inconsistency calls into question whether use of MACE in cardiology research is of value. kkip@health. We subsequently tested 3 different definitions of MACE during 1year of follow-up among 6. Hollabaugh K. Florida 33612. MACE is a composite of clinical events and usually includes end points reflecting safety and effectiveness. This will be followed by an exploration of avenues to which nursing science can make substantial contributions. BACKGROUND: The term MACE is a commonly used end point for cardiovascular research. single-lesion stenting) according to the various definitions of MACE. no MI) and multilesion stenting (vs. . J Am Coll Cardiol. Williams DO.edu OBJECTIVES: Our purpose was to evaluate the heterogeneity and validity of composite end points. The problem with composite end points in cardiovascular studies: the story of major adverse cardiac events and percutaneous coronary intervention. 2008 Feb 19. By definition. RESULTS: The review identified substantial heterogeneity in the studyspecific individual outcomes used to define MACE. and 2) studies published in the Journal in calendar year 2006. major adverse cardiac events (MACE) in particular. METHODS: We conducted a 2-phase literature review on the use of MACE as a composite end point: 1) studies that have compared use of bare-metal versus drug-eluting stents. Marroquin OC.usf. There is no standard definition for MACE. Markedly different results were observed for selected patient subsets of acute myocardial infarction (MI) (vs. College of Nursing. Kip KE.51(7):701-7. as individual outcomes used to make this composite end point vary by study. University of South Florida. USA. Tampa.922 patients in the DEScover registry who received at least 1 drug-eluting stent.to examine the existing nature of disparities in health-care access among ethnic minority cardiac populations who utilize or require invasive cardiac procedures. PMID: 18318333 [PubMed .

Kiemeneij F. and construct separate composite end points to match these different clinical goals. Reynolds S. Review several studies that investigate head elevation. Patient care after percutaneous transluminal coronary angioplasty. 56. County Durham. 2007 May 30-Jun 5. Nurs Manage. Overview of the transradial approach in percutaneous coronary intervention. Waterhouse K. PMID: 18279733 [PubMed . 2001 Sep. J Cardiovasc Med (Hagerstown). Recent advances in angina management: implications for nurses. Conway B. barbara.nhs. USA.CONCLUSIONS: Varying definitions of composite end points. PMID: 17929730 [PubMed . .indexed for MEDLINE] 17.32(9):51-4. early walking.uk This article describes the physiology of the heart and the pathophysiology of angina. and when composite study end points are desired.indexed for MEDLINE] 16. should not be used. can lead to substantially different results and conclusions. The authors also discuss cardiac rehabilitation programmes and the extended role of nurses in managing patients with angina. are outlined. including pharmacological therapies.8(4):230-7. PMID: 17569470 [PubMed . Fuat A.21(38):49-56.indexed for MEDLINE] 18. such as MACE. Nurs Stand. Therefore. Laarman GJ. quiz 58. Diagnosis and treatment options. in particular. 2007 Apr.conway@darlingtonpct. and patient comfort after percutaneous transluminal coronary angioplasty (PTCA). the term MACE. University of Massachusetts/Memorial Health Care. Darlington Primary Care Trust. Worcester. Miller KH. researchers should focus separately on safety and effectiveness outcomes. Amoroso G.

Primary angioplasty for acute ST-elevation myocardial infarction. Leahy M. Pittsburgh. 2007 Jan-Mar. complications. Since then TRA has spread through the interventional community and many centres have now adopted TRA as the arterial access of choice. This review is focused on the hot issues and the latest developments in this field. nurse workload.Amoroso@olvg. Nurs Stand.co. contraindications. PMID: 17413298 [PubMed . as well as less invasive repair of atrial septal abnormalities. Onze Lieve Vrouwe Gasthuis. The following subjects will be addressed and discussed: drawbacks and learning curve. This article will give a brief overview of each intervention and identify important nursing care.Department of Interventional Cardiology. Crit Care Nurs Q. Hammersmith Hospital.edu The catheterization laboratory is no longer limited to coronary arterial interventions. Percutaneous interventions.21(12):48-56. PA 15213. PMID: 17198033 [PubMed . G. renal. 2006 Nov 29-Dec 5. Physicians have been striving to make more interventions less invasive that now can include carotid. and peripheral arterial stenting. Amsterdam. and economics. patient management. Tarolli KA. procedural technique. quiz 58. The Netherlands.30(1):12-9. USA.uk . Even cardiac assist devices can be implanted percutaneously to bridge a critically ill patient to other modes of treatment. London.indexed for MEDLINE] 19. tarollika@upmc. University of Pittsburgh Medical Center. indications (with particular attention to acute coronary patients).indexed for MEDLINE] 20.nl Thirteen years have passed since the first percutaneous coronary intervention was performed at Onze Lieve Vrouwe Gasthuis in Amsterdam using the transradial approach (TRA). missmarieleahy@yahoo.

USA. Thomas' Hospital. treatment. Mich. 2004 Dec. Crit Care Nurse. Nurs Stand. clinical examination. 2006 May 24-30.20(37):49-56. St. Crit Care Nurse. Managing patients with non-ST-segment elevation acute coronary syndrome. quiz 58. Lins S. Guffey D. This article discusses diagnosis. London. quiz 46. elaine.26(6):38-45. ongoing management and discharge practice is discussed. 2006 Dec.indexed for MEDLINE] 21. VanRiper S. electrocardiogram and biochemical markers that help to differentiate between types of non-ST-segment elevation ACSs. ST-segment elevation ACS has been considered to be more serious.uk Acute coronary syndromes (ACSs) can be described as ST-segment elevation or non-ST-segment elevation.This article examines primary percutaneous coronary intervention as a reperfusion treatment for acute ST-segment elevation myocardial infarction. Cardiothoracic Centre.indexed for MEDLINE] 22. Traditionally. sharonv@umich.coady@gstt. PMID: 17195384 [PubMed . It discusses the nursing care of patients undergoing this procedure. Risk stratification and treatment strategies are examined. Coady E. PMID: 16764400 [PubMed . including unstable angina.. but non-STsegment elevation ACS has higher mortality rates in the longer term. Kline-Rogers E. Decreasing vascular complications after percutaneous coronary interventions: partnering to improve outcomes.indexed for MEDLINE] 23. Case studies of ST-segment elevation before and after percutaneous coronary . including history taking.24(6):32-9. Oakwood Hospital and Medical Center in Dearborn.nhs. as well as pharmacological treatments. The nurse's role in assessment.edu PMID: 17123950 [PubMed . Blue Cross/Blue Shield Michigan Cardiovascular Consortium.

intervention in patients with acute myocardial infarction.edu Since its introduction in 1977. Drug-coated stents: preventing restenosis in coronary artery disease. Ontario. Interventional Cardiology.19(6):404-8. wvlasic@sympatico. 79 Glenridge Crescent.to address ongoing questions of interest to continually improve client care.39(4):829-44. Drugeluting stents. are key to providing the highest quality of nursing care for this unique client population. PMID: 15561164 [PubMed .indexed for MEDLINE] 24. Department of Nursing. Vlasic W. Baltimore.indexed for MEDLINE] 25. 2005 Feb. Erratum in Crit Care Nurse. USA. London N6G 4W6. Johns Hopkins University School of Nursing. building on an understanding of the foundations for interventional cardiology practice. Quality Management Department. Washington. London Health Sciences Centre. the success of percutaneous interventional cardiology has been limited by the occurrence of restenosis. Nursing care of the client requiring percutaneous coronary intervention. Johns Hopkins Hospital. Nurs Clin North Am. Pa. Nurses need to be actively engaged in all phases of the research process. PMID: 15646087 [PubMed . jstanik1@jhmi. 2004 Nov-Dec. 2004 Dec.and paclitaxel-coated stents. J Cardiovasc Nurs. particularly sirolimus. have been shown in . New research findings. Washington Hospital.ca The scope of interventions for a wide variety of cardiac conditions and the research basis for practice are continuing to expand at a phenomenal rate. USA.25(1):15. and Inpatient Cardiology Nurse Practitioner Service. Stanik-Hutt JA. Canada. MD 21205. McAvoy J.

J Cardiovasc Nurs.jhmi. stem cell differentiation. use of a wide range of cells such as fetal cardiomyocytes. These outcomes increase the clinical value of this technology to "real world" practice. native coronary arteries. and stem cell therapy and its ability to repair injured or ischemic cardiac tissue. 2004 Nov-Dec. No currently available therapy has the capability to restore cardiomyocytes or to replace myocardial scar tissue with contractile tissue. Although angioplasty and thrombolytic therapy can remove the offending atherosclerotic plaque and thrombi. both therapies are dependent upon timely recognition and initiation of treatment and thus have a limited window of opportunity. In animal models. transplantation of adult stem cells directly into the area of infarction has shown clinical promise. and even after in-stent restenosis.19(6):396-403. The Johns Hopkins University School of Nursing and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. tyeo@son. This article reviews the current state of our knowledge regarding drug-eluting stents and identifies areas for further research. Baltimore.randomized controlled trials to dramatically reduce restenosis in single. skeletal myoblasts. In addition. Yeo TP. PMID: 15529061 [PubMed .edu Acute myocardial infarction results in regional necrotic heart tissue that is considered irreversible. This article explores the current data on extramedullary hematopoiesis. MD 21205. in long atherosclerotic lesions and small arteries. and bone marrow stem cells have been shown to differentiate into functional cardiomyocytes. investigators have reported that these stents can also reduce restenosis in more complex patient situations such as in diabetics.indexed for MEDLINE] 26. de novo. PMID: 15529062 [PubMed . during acute coronary syndromes. Heal thyself: Potential applicability of stem cell therapy in the management of heart disease. Over the last 2 years. USA.indexed for MEDLINE] .

Nursing outcomes: percutaneous coronary interventions. 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 to provide recommendations for future research. functional status.104(1):81-3. Cardiovascular Services.27. Nursing research on indicators related to costs of care. bobbil@baylorhealth.19(5):346-53. Nurs Stand. 2005 Jan 5-11. James Cook University Hospital. symptom management. 2004 Sep-Oct.18(37):45-53. J Cardiovasc Nurs. USA. patient responses. and home/occupational function following PCI are discussed in this review. Dallas. Baylor University Medical Center. . 2004 Jan. PMID: 15495895 [PubMed . The process of caring for this patient population has changed dramatically over the last 10 years. Chest pain is one of the main reasons for emergency admission to hospital in the UK. behavior. Assessment and treatment of chest pain.nhs. 2004 May 26-Jun 1. Am J Nurs.tough@stees. patient/family knowledge. Tough J. Delays in seeking MI treatment. Leeper B. Jackie Tough examines the causes and treatment of chest pain and offers a structured system for taking the patient's history. jackie. PMID: 15198022 [PubMed .edu Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. Middlesbrough.uk Comment in Nurs Stand.indexed for MEDLINE] 28.indexed for MEDLINE] 29. morbidity. TX 75246.19(17):26. quiz 54-5. with many of the changes being driven by an evolution in the knowledge base underlying nursing practice.

Treatment with anti-proliferative agents presents a logical approach to eradicating restenosis. dyspnoea. and is currently the most commonly used percutaneous coronary intervention in the United States.18(1):11-6. School of Nursing.indexed for MEDLINE] 31. Illinois. 1999). Chicago. Goode I. Nurs Times. The National Service Framework for Coronary Heart Disease (Department of Health. University of Salford. Symptoms associated with coronary heart disease include chest pain.99(27):46-7. Drug-eluting stents to prevent reblockage of coronary arteries. Ryan CJ. In . juljohns@uic. 1997). palpitations and collapse (Delahaye. 2003 Jul 8-14. Percutaneous transluminal coronary angioplasty (PTCA) has been found effective for relieving some of these symptoms (RITA-2 trial participants. Schwertz DW. J Cardiovasc Nurs. Coating stents with antiproliferative agents allows local delivery of high doses and avoids systemic side effects.Zerwic JJ. University of Illinois. these drugs are highly toxic. Percutaneous coronary intervention. Chicago. However. 2000) identified a need to double the number of these procedures carried out per year by 2010 to provide a service comparable with the rest of western Europe. Vaitkus P. Department of Medical Surgical Nursing. Restenosis limits the success of percutaneous transluminal coronary interventions. improves outcomes. USA. In-stent restenosis is a neointimal hyperplastic response resulting primarily from vascular smooth muscle cell proliferation. USA. Jones I. Manchester. PMID: 12882057 [PubMed . however.indexed for MEDLINE] 30. University of Illinois. 2003 Jan-Mar.edu PMID: 14707818 [PubMed . Coronary artery stenting decreases restenosis. in-stent restenosis continues to occur at an unacceptable rate. College of Nursing.

indexed for MEDLINE] 34. Vincent RN. Children's Healthcare of Atlanta.indexed for MEDLINE] 33. Georgia. O'Grady E. Sibley Heart Center.17(11):651-4. Atlanta. Cardiac Catheterization Laboratory. In the last two decades we have seen an evolution in cardiac catheterization from a diagnostic (anatomic and physiologic) to a therapeutic modality. Diehl HJ. . PMID: 12537084 [PubMed . USA. Leeds General Infirmary. These dramatic results represent a tremendous advance in the treatment of coronary heart disease. This article highlights some of the more common and newer interventional procedures now performed. J Invasive Cardiol. 2002 Apr. 2002 Jul. best practice. This paper reviews the literature. It is now increasingly common for the removal of the sheath to be a nursing procedure. PMID: 12138580 [PubMed . Crit Care Nurs Q. Since its inception in 1929.2001. Patients with coronary heart disease may require a percutaneous transluminal coronary angioplasty. cardiac catheterization has undergone many changes. potential complications and post-removal nursing care. 2002 Nov. RAVEL and ELUTES. involving the use of a balloon catheter to dilate the arteries introduced via a sheath. Interventional Cardiology Unit. Prof Nurse. Emory University School of Medicine. Removal of a femoral sheath following PTCA in cardiac patients. using sirolimus.14 Suppl B:48B-54B. Leeds. the results of two clinical trials.25(3):37-47. Interventions in pediatric cardiac catheterization.and paclitaxil-coated stents demonstrated nearly complete elimination of in-stent restenosis.indexed for MEDLINE] 32. PMID: 12450158 [PubMed .

Australia. . Adelaide. obtaining serial serum biochemical markers of myocardial necrosis. Prairie Cardiovascular Consultants. because some patients may benefit from incremental pharmacologic or invasive reperfusion strategies. PMID: 11967390 [PubMed . Ltd. 2002 Mar-Apr. BACKGROUND: Failed reperfusion after thrombolysis occurs in as many as 30% of patients with acute myocardial infarction (MI). some patients have incomplete tissue perfusion despite reperfusion of the infarct-related artery. Southern Illinois University School of Medicine. PMID: 11910386 [PubMed . Continuous ST-segment monitoring is a relatively inexpensive. Failed reperfusion after thrombolytic therapy: recognition and management. Zeitz CJ. Illinois.Increasing benefit. particularly with regard to myocardial perfusion status. Aguirre FV. PURPOSE AND METHOD: This article reviews a number of strategies to assess infarct-related artery patency and myocardial tissue perfusion. and assessment of changes in chest pain intensity. and accurate tool for assessing real-time myocardial perfusion. reducing risk: focusing on hemorrhagic complications in percutaneous coronary intervention. Springfield.Suppl:3-14. These include coronary angiography. monitoring for reperfusion arrhythmias.. continuous ST-segment monitoring. serial electrocardiography. University of South Australia School of Nursing and Midwifery. Heart Lung. Crit Care Nurse. Kucia AM. Furthermore. CONCLUSION: The early detection of failed reperfusion is critical if incremental strategies to enhance myocardial salvage are to be considered.indexed for MEDLINE] 35.indexed for MEDLINE] 36. 2000 Apr. quiz 15-6. Close assessment of the efficacy of thrombolytic administration in people with evolving acute MI is necessary. Gill JB. USA.31(2):113-21. reliable.

Acute coronary syndromes: new developments in pharmacological treatment strategies. Restenosis is a common and serious complication following angioplasty and stent implantation in patients with arterial vascular disease. Fink DA. Department of Nursing Research and Education. USA. The treatment of coronary artery disease and. School of Nursing and Health Studies.indexed for MEDLINE] 37. New strategies in the prevention of restenosis. 2000 Oct. Washington. Angerio AD. An understanding of their mechanism of action may lead to more effective methods for preventing restenosis. in particular. USA. Ohio. University of California-Los Angeles School of Nursing. Georgetown University.24(1):62-8. Crit Care Nurs Q. Surgical management of unstable angina and symptomatic coronary artery disease. Restenosis is a form of intimal hyperplasia. Department of Physiology and Biophysics. The Cleveland Clinic Foundation. USA. DC. ET-1 receptor antagonists may play a prominent role in prophylaxis. ET-1 and VEGF may act in concert in promoting restenosis following mechanical injury to the vessel wall in angioplasty and stent implantation.15(1):27-42. Weber MM. acute coronary syndromes has evolved from watchful waiting to an early aggressive intervention strategy. PMID: 11868697 [PubMed . Gold M. J Cardiovasc Nurs. Patients are currently receiving either percutaneous or surgical . Comment in Crit Care Nurse. Endothelin-1 (ET-1) and vascular endothelial growth factor (VEGF) stimulate intimal hyperplasia and may play a role in restenosis. Gylys K. 2000 Oct.20(5):16. 2001 May.indexed for MEDLINE] 38. PMID: 11876169 [PubMed .

New York.indexed for MEDLINE] 40. Parson C.11(2):143-57.indexed for MEDLINE] 39. Heart Lung. the author's institution has been able to offer quality patient care at a reasonable cost. As a result of these studies. Based on this evidence. . and other clinical risk factors. and (3) the ability to judge through continued variance analysis whether the actions taken made a difference or whether more changes are necessary. The author's institution now has a process that enables it to accomplish three objectives: (1) the ability to track outcomes. PMID: 11061219 [PubMed . Several major clinical trials have identified those patients mostly likely to benefit from surgical intervention. unique needs and outcomes of special populations have been identified. evidence-based clinical outcome management has occurred.29(3):161-72. Perceived learning needs of the patient undergoing coronary angioplasty: an integrative review of the literature. older persons. and innovations in surgical techniques that may improve patient outcomes. triple vessel disease with decreased left ventricular function. This article will present an overview of surgical treatment of coronary artery disease with emphasis on patient selection with particular attention to women. 2000 May-Jun. Gentz CA. Crit Care Nurs Clin North Am. through the use of pathways and case management. ViaHealth. supported by the literature. PMID: 10838979 [PubMed . USA. These patients typically include those with left-main coronary artery disease.revascularization. In conclusion. (2) the ability to obtain information about opportunities for improvement and develop action plans for this. Rochester General Hospital. diabetic patients. Evidence-based clinical outcome management in interventional cardiology. 1999 Jun.

Aust Nurs J. through an integrative review. USA. IMPLICATIONS: Health professionals must emphasize the seriousness and long-term outcomes of untreated heart disease. such as risk factor education and survival management. 1999 Aug. Continuing education and resources need to be available for patients who are recovering from percutaneous transluminal coronary angioplasty and their families. Northern Illinois University. Education programs should be individualized and streamlined. OBJECTIVE: This study presents. Rockford.7(2):suppl 1-4. Learning needs in the acute care setting differ from those in the outpatient setting. routine procedure. These studies were examined to compare samples. Self-efficacy expectations and levels of anxiety were predictors of behavior changes and knowledge retention in the early recovery period after the coronary angioplasty procedure. Current statistics reflect that cardiovascular disease (CVD) continues to be the . SCOPE: Nineteen studies involving the patient who has undergone coronary angioplasty were identified using CINAHL and MEDLINE.Graduate School of Nursing. Illinois. were considered of high importance. and the most common modification was in diet. a comprehensive account of the perceived concerns and learning needs of patients in the early recovery period after a coronary angioplasty. McVeigh JP. PMID: 10819798 [PubMed . and they viewed it as a minimally invasive. Acute myocardial infarction. NSW College of Nursing. Both learned knowledge and lifestyle changes decreased over time. The majority of subjects modified their behavior. methods. findings. Musto J. FINDINGS: Overall the subjects believed that undergoing coronary angioplasty was positive and beneficial.indexed for MEDLINE] 41. Spouses and significant others have informational needs and should be included in education programs. Informational knowledge. and suggestions for future research. and should build upon knowledge obtained during hospitalization. implications.

35. The quest to identify the acute interventional approach that will achieve the lowest mortality rate with the fewest adverse events has led to a continued controversy surrounding the relative merits of thrombolytic therapy compared with primary angioplasty in the setting of acute myocardial infarction. GA 30322.greatest health problem affecting the Australian population.6(8):28-32. 1998 Sep-Oct. McErlean ES. . Stony Brook. Early management of acute myocardial infarction. Atlanta. This article summarizes the benefits and limitations of each reperfusion strategy and highlights adjunctive therapies that will enhance either treatment strategy. Adv Nurse Pract. Quick thinking needed.27(5):308-14. PMID: 10745736 [PubMed .indexed for MEDLINE] 43.indexed for MEDLINE] 42. ischaemic heart disease is associated with highest mortality rates.13(3):46-59. Cleveland Clinic Foundation. Of all cardiovascular disorders. J Cardiovasc Nurs. 1998 Aug. USA. Kimble LP. Nell Hodgson Woodruff School of Nursing. Acute Coronary Syndromes. School of Nursing. Emory University. USA. Thrombolytic therapy versus primary angioplasty in the treatment of acute myocardial infarction. Perceived side effects and benefits of coronary angioplasty in the early recovery period. accounting for approximately 42% of all deaths recorded. State University of New York. 1999 Apr. King KB.indexed for MEDLINE] 44. Heart Lung. PMID: 10098005 [PubMed . PMID: 9814141 [PubMed . Ohio. Buhse M. USA.

77% of whom were men. Seventy-nine percent of subjects reported PTCA made things better. Abciximab. Montana State University-Bozeman. Crit Care Nurse. SAMPLE: Convenience sample of 62 subjects. . The most frequently reported side effect (22. sex. The most commonly reported benefit of PTCA was relief of chest pain. PMID: 9708118 [PubMed . Missoula. elective PTCA. and 5% reported that PTCA made things worse. Mayer DM. College of Nursing. Subjects who experienced chest pain since the time of hospital discharge were less likely to report that PTCA was beneficial. DESIGN: Descriptive.indexed for MEDLINE] 46. was discomfort in the groin site. RESULTS: Fifty-two percent of subjects reported side effects 2 weeks after PTCA.5%). a novel platelet-blocking drug: pharmacology and nursing implications. 1997 Dec. with a mean age of 62 years (SD 11 years).indexed for MEDLINE] 45. Age. Docktor WJ. Crit Care Nurs Clin North Am. USA. Further research is needed to examine the impact of patients' uncertainty concerning treatment benefit or perceptions of no treatment benefit in the early recovery period on intermediate and long-term PTCA recovery outcomes. who had undergone successful. 1998 Apr. and to determine whether selected demographic and clinical variables were associated with perceptions of side effects and treatment benefit.9(4):497-509. PMID: 9777376 [PubMed . correlational study. CONCLUSION: More emphasis should be placed on helping patients who are candidates for a PTCA to predict and to manage treatment side effects and to have realistic expectations concerning the trajectory of recovery from PTCA.18(3):27.18(2):29-37.OBJECTIVE: To examine patients' perceptions of the side effects and the treatment benefit of percutaneous transluminal coronary angioplasty (PTCA) in the early postdischarge recovery period. and a history of previous PTCA were not related to reported side effects or reported benefits. Erratum in Crit Care Nurse 1998 Jun.

Women who undergo revascularization with CABG or PTCA may experience more negative acute outcomes compared with men. . the various types of stents available. 1997 Apr. Pennsylvania. This article presents an overview of the rationale for the implantation of stents. USA. Maryland.93(3):32-4. only one in three patients benefits from comprehensive risk factor intervention. After these interventions. once women have survived the revascularization procedure. PMID: 9444173 [PubMed . quiz 254-5. Stenting is a new method for treating coronary artery stenosis.indexed for MEDLINE] 48.indexed for MEDLINE] 47. Xu X. long-term outcomes are generally similar to those of men. Allen JK. Home Healthc Nurse. USA. Baltimore. Intracoronary stents: expanding options for patients with angina. These gender differences in acute outcome are partly explained by the size of coronary arteries. PMID: 9146159 [PubMed . 1997 Mar. Risk factor identification and modification is an important approach to enhance our ability to reduce long-term restenosis and progression of atherosclerosis following revascularization in women as well as men. and roles the home care nurse assumes in caring for these patients. baseline differences in clinical risk factors.Coronary revascularization in women. Scaffolding the coronary arteries: intracoronary stenting. School of Nursing. Pittsburg. South Hills Health System Home Health Agency. Nurses are in key positions to approach patients and their families at the time of these major interventions when they are likely to be more receptive to the idea of risk factor modification. Can Nurse. Johns Hopkins University. Forsha B.15(4):247-53. However. and the unfavorable cardiovascular profiles seen in women.

Moscucci M.indexed for MEDLINE] 50. and prevent long-term disability. Interventional Cardiology. J Cardiovasc Nurs. PMID: 9090516 [PubMed . and complex interventions such as stent deployment or atherectomy. Heart Lung. often negatively affecting quality of life and ability to work. 1995 Oct. use of femoral sheaths for extended lengths of time. many of these complications result in considerable increases in hospital stays and in the costs associated with the procedures. 1997 Mar-Apr. . multiple interventions during the same hospitalization. Longstreet J. Vascular complications of coronary interventions. improve early detection and prompt treatment of the vascular injury. symptoms of coronary disease have a significant impact on the health status of individuals and families. Specific interventions have been identified that help to decrease procedural risk. VanRiper S. catheter insertion in the superficial or deep femoral artery larger catheter size. Cardiovascular disease remains the leading cause of death in canada. USA.10(1):8-29.indexed for MEDLINE] 49. London Health Sciences Centre. A number of risk factors for vascular complications after coronary interventions have been identified. They include excessive anticoagulation. Franklin BA. and arteriovenous fistula that occur after intracoronary or intracardiac procedures are responsible for considerable morbidity and some mortality. In addition. In addition. It is responsible for 40 per cent of all deaths and is the leading cause of premature death in people aged 35 to 64.26(2):118-27. University of Michigan Hospitals. Cardiac Step-down Unit. Vascular complications such as hematoma. pseudoaneurysm. PMID: 9110636 [PubMed . Davis C. Ann Arbor. Diagnostic and functional exercise testing: test selection and interpretation.Vlasic W.

detailed history. Research review: use of activated clotting time to monitor heparin therapy in coronary patients. Michigan. and basic laboratory analyses) and serve as a diagnostic. or exercise training. Management of patients experiencing an acute myocardial infarction has evolved dramatically during the past 2 decades. diagnose relative myocardial ischemia. University of California at Los Angeles. prognostic. In recent studies. and investigate physiologic mechanisms of cardiac symptoms. chest radiograph. Noureddine SN. quiz 278-9. and therapeutic guide. and economical method of reperfusion. Primary angioplasty in the acute myocardial infarction setting. medications. thorough physical examination. The results extend the clinical significance of information obtained from other sources (ie. effective. PMID: 7627783 [PubMed . percutaneous transluminal coronary angioplasty.indexed for MEDLINE] 51. Coombs VJ. Exercise stress tests are useful in many areas of medical practice and research. The responses may also be used to determine the effects of interventions such as coronary artery bypass surgery. The role and timing of percutaneous transluminal coronary angioplasty in patients experiencing a myocardial infarction has remained controversial and under investigation.4(4):272-7. PMID: 8537834 [PubMed . Am J Crit Care. School of Nursing. resting electrocardiogram. USA. AACN Clin Issues.Cardiac Rehabilitation and Exercise Laboratories. Leg or arm ergometry is commonly used to assess a patient's functional status. USA. William Beaumont Hospital. it was revealed that direct use of percutaneous transluminal coronary angioplasty in the presence of an acute myocardial infarction appears to be a safe. Brinker JA. 1995 Jul. . Detroit.indexed for MEDLINE] 52. 1995 Aug.6(3):387-97.

25(1):1-8. 1995 Feb. Traditionally.Comment in Am J Crit Care. and for the expanding boundaries of rehabilitation to include patients who undergo coronary angioplasty.indexed for MEDLINE] 53. Patient Educ Couns. there has been a call for rehabilitation to be uniformly offered to partners and families of cardiac patients. 1995 Sep. Tooth L. PMID: 7663590 [PubMed . Although the literature supports the use of activated clotting time in angioplasty. Recently. however. This paper aims to highlight patient education strategies for cardiac patients and partners with a focus on assessment of their educational needs. Education is accepted as a key component of cardiac rehabilitation for patients following myocardial infarction and bypass graft surgery. Successful management of patients after coronary angioplasty requires careful monitoring of the coagulation status in order to titrate heparin therapy and prevent thrombosis or bleeding. McKenna K. The unique needs of patients undergoing coronary angioplasty and their partners will then be discussed with existing cardiac educational strategies expanded to encompass this group of patients. the activated partial thromboplastin time was used to monitor heparin therapy. limitations of the studies and the different methodologies used preclude generalization of results. More research is needed to confirm the efficiency and effectiveness of the activated clotting time in monitoring heparin therapy. Cardiac patient teaching: application to patients undergoing coronary angioplasty and their partners. This article reviews the research on the use of activated clotting time in titrating heparin therapy in angioplasty patients. Recently.4(5):414-5. PMID: 7603928 [PubMed .indexed for MEDLINE] . use of activated clotting time is gaining more support because it can be performed at the bedside and is cost-effective.

indexed for MEDLINE] 55. Abrupt closure requiring intervention occurs in approximately 3. Because of recent improvements in pharmacologic therapy and medical interventions. prolong survival. the average restenosis rate reported in the literature is 30%. Intracoronary stents: a new approach to coronary artery dilatation. The primary goals of coronary artery bypass graft (CABG) surgery are to relieve symptoms. Surgical myocardial revascularization in the 1990s.7(1):34-49. These difficulties can produce profound hemodynamic compromise requiring additional intervention.4(2):219-27.54. This article describes the purpose and design of intracoronary stents and reviews clinical trial results and nursing management of patients with such stents. Rosborough D. One new approach to this goal is the use of intracoronary stents after balloon angioplasty to maintain the luminal diameter of the coronary artery. McLimore E. The effectiveness of intracoronary stents is currently being evaluated. PMID: 1447583 [PubMed . AACN Clin Issues Crit Care Nurs. Substantial changes in the practice of cardiology ultimately produce a change in the types of patients who become candidates for surgery. the criteria used to select patients for CABG surgery has changed secondary to the clinical characteristics of the patient population. PTCA research focuses on methods to treat or prevent abrupt closure and restenosis of the stenotic segment.indexed for MEDLINE] . J Cardiovasc Nurs. Two major complications associated with angioplasty are abrupt closure and restenosis of the treated vessel.6% of patients. 1993 May. This has been especially true for patients with coronary artery disease. 1992 Oct. Bevans M. and improve the quality of life. Percutaneous transluminal coronary angioplasty (PTCA) is a low-risk treatment for proximal and localized coronary artery disease. PMID: 7683895 [PubMed .

Heart Lung. PMID: 1545990 [PubMed . bundle branch blocks. Drew BJ. Further research is needed to evaluate the future of PTCA. The procedure has developed into a technique heavily relied on for the management of coronary artery disease. stents. given the relatively high degree of restenosis. Management of the patient undergoing myocardial revascularization: percutaneous transluminal coronary angioplasty. In addition. The present article addresses the problem by reviewing electrocardiographic criteria for diagnosing the arrhythmias and ischemic conditions of major importance in the critically ill patient including wide QRS complex tachycardias. however. Johns Hopkins Hospital.27(1):231-42.indexed for MEDLINE] 57. in conjunction with the use of newer therapeutic measures. Department of Physiological Nursing.000 PTCAs were done in the United States. it should not be viewed as a panacea.20(6):610-23. In 1990 approximately 250. the advantages and disadvantages of various monitoring leads are discussed with recommendations regarding the most ideal leads for detecting these . Nurs Clin North Am. and ST segment monitoring after thrombolytic therapy and balloon angioplasty. Baltimore. University of California. Maryland. Cardiovascular Diagnostic Laboratory. PTCA has a high primary success rate. San Francisco 94143-0610.56. Recent evidence indicates that misdiagnosis of cardiac arrhythmias is a common occurrence in critical care and telemetry units. Bedside electrocardiographic monitoring: state of the art for the 1990s. and laser-assisted balloon dilatation. McKenna M. Nurses will continue to play an important role in the education and care given to patients undergoing these procedures. 1992 Mar. including atherectomy. 1991 Nov.

Aaberg RA. practical suggestions are offered for improving the quality of bedside electrocardiographic monitoring. Although lasers have been used in other health disciplines. Smith RB.indexed for MEDLINE] 60. . PMID: 1883592 [PubMed . and atherectomy devices.arrhythmias of interest. Coburn C. 1991 Sep. Percutaneous transluminal angioplasty or surgical revascularization will be necessary in some patients to control blood pressure or improve renal function.1(1):87-109. 1990 May. Renal artery occlusive disease. There are several ways to evaluate this system as well as several pharmacologic agents that will intervene and modulate the hypertension that results. Renal artery occlusive disease. Successful evaluation and treatment of these patients are based on clinical experience. It is important for the critical care nurse to be knowledgeable concerning these techniques in order to provide optimal patient care. Finally. PMID: 1960065 [PubMed . PMID: 2192759 [PubMed . AACN Clin Issues Crit Care Nurs. and a comprehensive team approach. Crit Care Nurs Clin North Am. Techniques in cardiac care: lasers.1(2):339-57. Various new technologies are currently being investigated to treat cardiovascular disease less invasively than with conventional open heart surgery. stents.indexed for MEDLINE] 59.3(3):507-14. from either atherosclerosis or fibrous dysplasia. Hypertension results from increased activity of the renin-angiotensin-aldosterone system. Halfman-Franey M.indexed for MEDLINE] 58. their use in the cardiovascular field is relatively new. Crit Care Nurs Clin North Am. may cause hypertension or renal insufficiency. an understanding of the natural history of the various disease processes involved. Flaherty R. 1989 Jun. Even newer is the use of atherectomy devices and endovascular stents.

aortic BV also provides improvement over the natural course of the disease. The procedure is still investigational and performed following approved research protocols. however results obtained with mitral BV are similar to those obtained using surgical commissurotomy. in the very elderly patient who is a nonsurgical candidate. Although technically more difficult and at times impossible to perform. The procedure appears to be only palliative and is associated with high rates of restenosis occurring fairly soon after the procedure. results of aortic BV in the elderly population are less impressive. Thus far. Because of the relative infancy of the procedure. However. long-term data are available for only 1 to 2 years following BV. aortic BV can provide improvement in aortic valve orifice size and in relief of debilitating symptoms associated with severe aortic stenosis.Percutaneous balloon valvuloplasty in adult patients with valvular heart disease. percutaneous BV of the 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 severe rheumatic mitral stenosis. More data are needed to aid in better definition and selection of patients who are suitable candidates for this procedure. As with surgical aortic valve replacement. Percutaneous balloon valvuloplasty is a new. nonsurgical technique for treatment of acquired mitral or aortic valvular stenosis. PMID: 2684233 [PubMed .indexed for MEDLINE] . From a long-term perspective. Daily EK.