[NCM 410] NURSING CARE OF CLIENTS WITH LIFE THREATENING CONDITIONS, ACUTELY ILL OR MULTI ORGAN PROBLEMS, HIGH

ACUITY AND EMERGENCY SITUATIONS, ACUTE AND CHRONIC LECTURE

ALTERED TISSUE PERFUSION

1ST SEMESTER ┃A.Y. 2022-2023┃MIDTERMS┃TRANS 1┃TRANSCRIBED BY APRIL TOM O. CUENCA
NAME OF LECTURER: MR. CHRISTIAN RAY A. PASILIAO, RN, MAN
DATE OF LECTURE: SEPTEMBER 29, 2022

ISCHEMIC HEART DISEASE (IHD) DIAGNOSTIC TESTS FOR CORONARY ARTERY DISEASE
• “No oxygen is no fun.” 1. Echocardiogram: An echocardiogram uses sound waves to
• The term ischemic heart disease (IHD) describes a group of produce images of your heart. This common test allows the doctor
clinical syndromes characterized by myocardial ischemia, an to see your heart beating and pumping blood. The doctor can use
imbalance between myocardial blood supply and demand the images from an echocardiogram to identify heart disease.
(Steenbergen 2012). 2. Cardiac catheterization: It is a procedure in which a thin, flexible
tube (catheter) is guided through a blood vessel to the heart to
MYOCARDIAL ISCHEMIA (MI) diagnose or treat certain heart conditions, such as clogged arteries
or irregular heartbeats. Cardiac catheterization gives doctors
• Myocardial ischemia occurs when blood flow to the heart muscle important information about the heart muscle, heart valves and
(myocardium) is obstructed by a partial or complete blockage of a blood vessels in the heart. Some heart disease treatments — such
coronary artery by a buildup of plaques (atherosclerosis). as coronary angioplasty and coronary stenting — are done
• A condition in which heart muscle cells receive less oxygen than using cardiac catheterization.
needed 3. Coronary angiogram: A coronary angiogram is a procedure that
uses X-ray imaging to see your heart's blood vessels. The test is
CORONARY ARTERY DISEASE (CAD) generally done to see if there's a restriction in blood flow going to
• It is a narrowing or blockage of the heart. Coronary angiograms are part of a general group of
your coronary arteries usually procedures known as heart (cardiac) catheterizations.
caused by the buildup of fatty 4. Chest x-ray: Chest X-rays can detect the presence of calcium in
material called plaque. your heart or blood vessels. Its presence may indicate fats and
Coronary artery disease is also other substances in your vessels, damage to your heart valves,
called coronary heart disease, coronary arteries, heart muscle or the protective sac that surrounds
ischemic heart disease and the heart.
heart disease. 5. IABP (intra-aortic balloon pump) monitoring: It is a technique
• “Quit smoking to avoid CAD.” that involves direct measurement of arterial pressure by inserting
a cannula needle in a suitable artery. An intra-aortic balloon pump
(IABP) is a type of therapeutic device. It helps your heart pump
more blood. The IABP consists of a thin, flexible tube called a
DEVELOPMENT OF CORONARY ARTERY DISEASE (CAD) catheter. Attached to the tip of the catheter is a long balloon. This
is called an intra-aortic balloon, or IAB. The other end of the
catheter attaches to a computer console. This console has a
mechanism for inflating and deflating the balloon at the proper time
when your heart beats.

CLINICAL MANIFESTATIONS OF CORONARY ARTERY DISEASE

1. Chest pain or discomfort (angina)
2. Weakness, light-headedness, nausea (feeling sick to your
stomach), or a cold sweat
3. Shortness of breath
4. Pain or discomfort in the arms or shoulder

TRANSCRIBED BY APRIL TOM O. CUENCA 1

6. CVP (central venous pressure): Often, a central venous
pressure (CVP) line is inserted (typically into the subclavian or • Shock state (inadequate tissue perfusion, creating an imbalance
jugular vein) and is advanced until the tip of the catheter rests near
the junction of the SVC and the right atrium. The CVP is used to
assess preload in the right side of the heart. Central venous
pressure (CVP), an estimate of right atrial pressure, has been used • It occurs when the heart’s ability to contract and pump blood is
to assess cardiac preload and volume status in critically ill patients,
assist in the diagnosis of right-sided heart failure, and guide fluid
resuscitation. It is determined by the interaction between cardiac
function and venous return.
1.
2.
3.
4.
5.
6.
7.
INTERVENTIONS FOR CORONARY ARTERY DISEASE
1. Prevention
2. Nursing interventions
3. Cardiac catheterization
4. Physical activity
5. Medications
a. Aspirin: Aspirin or acetylsalicylic acid is perhaps the most
commonly used analgesic and antipyretic medication
worldwide. Aspirin is known as a salicylate and a
nonsteroidal anti-inflammatory drug (NSAID). It works by
blocking a certain natural substance in your body to reduce
pain and swelling.
b. Nitrates: Nitrates are vasodilators (dilate the blood vessels)
that are used to treat angina (chest pain caused by lack of
oxygen to the heart muscle) and ease the symptoms of
congestive heart failure (a chronic progressive condition
that affects the pumping power of your heart muscle).
Example: Dilatrate-SR, Iso-Bid, Isonate, Isorbid, Isordil,
Isotrate, Sorbitrate (isosorbide dinitrate) Imdur (isosorbide
mononitrate) BiDil (hydralazine with isosorbide dinitrate)
c. Beta-blockers: Also known as beta-adrenergic blocking
agents, are medications that reduce blood pressure. Beta-
blockers work by blocking the effects of the hormone
epinephrine, also known as adrenaline. Beta-blockers cause
1.
the heart to beat more slowly and with less force, which lowers
2.
blood pressure. (-olol)
3.
Examples: atenolol (also called Tenormin), bisoprolol (also
4.
called Cardicor or Emcor), carvedilol, labetalol (also called
5.
Trandate), metoprolol (also called Betaloc or Lopresor),
6.
propranolol (also called Inderal or Angilol) and sotalol.
7.
d. Calcium channel blockers (CCBs): Calcium channel
blockers are medications used to lower blood pressure. They
work by preventing calcium from entering the cells of the heart
and arteries. Calcium causes the heart and arteries to
squeeze (contract) more strongly. By blocking calcium,
calcium channel blockers allow blood vessels to relax and
open.
Examples: Amlodipine (Norvasc), Diltiazem (Cardizem,
Tiazac, others) Felodipine. Isradipine. Nicardipine. Nifedipine
(Procardia) Nisoldipine (Sular), Verapamil (Calan SR,
Verelan)
CARDIOGENIC SHOCK
between the delivery of oxygen and nutrients needed to support
cellular function) resulting from impairment or failure of the
myocardium.
impaired, and the supply of oxygen is inadequate for the heart and
the tissues.
MANAGEMENT OF CARDIOGENIC SHOCK
Oxygenation
Pain management
Hemodynamic monitoring: Hemodynamic monitoring is a
cornerstone in the care of critically ill patients with shock. It allows
physicians to identify the pathophysiologic mechanisms sustaining
shock, to target therapy delivery on the pathogenesis of the
disease, and to evaluate the effects of treatments over time.
Pulmonary artery pressure: Defined as left atrial (LA) pressure +
(pulmonary blood flow x pulmonary vascular resistance). Normal
pulmonary artery pressure is 8-20 mmHg at rest. If the pressure in
the pulmonary artery is greater than 25 mmHg at rest or 30
mmHg during physical activity, it is abnormally high and is called
pulmonary hypertension. It may be measured through either
echocardiogram or cardiac catheterization.
ECG (electrocardiogram): An electrocardiogram (ECG) is a
simple test that can be used to check your heart's rhythm and
electrical activity. Sensors attached to the skin are used to detect
the electrical signals produced by your heart each time it beats.
Fluid therapy
Pharmacologic therapy
a. Epinephrine: (catecholamines and alpha- and beta-
adrenergic agonists or sympathomimetic agents) Epinephrine
decreases the splanchnic blood flow and may increase
oxygen delivery and consumption. Administration of this agent
may be associated with an increase in systemic and regional
lactate concentrations. The use of epinephrine is
recommended only in patients who are unresponsive to
traditional agents.
Examples: Adrenaclick, Adrenalin, Adrenalin Chloride. Auvi-
Q., Epipen, Epipen Jr., and Twinject.
b. Norepinephrine: (catecholamines and alpha- and beta-
adrenergic agonists or sympathomimetic agents)
Norepinephrine is recommended as a first‐line vasopressor
agent in the haemodynamic stabilization of cardiogenic shock.
Examples: Levarterenol (nortriptyline hydrochloride)and
levophed
c. Dopamine: Recent evidence indicates that dopamine inhibits
renal tubular reabsorption of sodium. Thus, dopamine can be
used to increase systemic arterial pressure by stimulating the
myocardium, without compromising renal blood flow and urine
output.
Examples: Bromocriptine (Parlodel), Cabergoline,
Apomorphine (Apokyn, Pramipexole (Mirapex), Ropinirole
(Requip), and Rotigotine (Neupro).
CLINICAL MANIFESTATIONS OF CARDIOGENIC SHOCK
Pain
Dysrhythmias
Fatigue
Feelings of doom
Shortness of breath
Sweating
Pale skin
TRANSCRIBED BY APRIL TOM O. CUENCA 2
 HYPERTENSIVE CRISIS CARDIOMYOPATHY
• A severe, sudden, rapid elevation in BP is considered a • Cardiomyopathy refers to diseases of the heart muscle. This
hypertensive crisis with a blood pressure measurement of more disease of the heart muscle makes it harder for the heart to pump
than 179/109 mmHg blood to the rest of the body. In most cases, cardiomyopathy
• A hypertensive crisis is a sudden, severe increase in blood causes the heart muscle to become enlarged, thick or rigid. In rare
pressure. The blood pressure reading is 180/120 millimeters of instances, diseased heart muscle tissue is replaced with scar
mercury (mm Hg) or greater. A hypertensive crisis is a medical tissue. (AHA 2020)
emergency. It can lead to a heart attack, stroke or other life-
threatening health problems. FOUR (4) TYPES OF CARDIOMYOPATHY
1. Dilated cardiomyopathy (enlarged ventricles): Dilated
TWO (2) TYPES OF HYPERTENSIVE CRISIS cardiomyopathy is a type of heart muscle disease that causes the
1. Hypertensive emergency: The most common symptoms of heart chambers (ventricles) to thin and stretch, growing larger. It
hypertensive emergency were chest pain (92.86%) and shortness typically starts in the heart's main pumping chamber (left ventricle).
of breath (71.43%). A hypertensive emergency is an acute, marked Dilated cardiomyopathy makes it harder for the heart to pump blood
elevation in blood pressure that is associated with signs of target- to the rest of the body.
organ damage. These can include pulmonary edema, cardiac 2. Restrictive cardiomyopathy (stiffness of ventricles): Restrictive
ischemia, neurologic deficits, acute renal failure, aortic dissection, cardiomyopathy (RCM) is a heart condition. Muscle tissue in your
and eclampsia. Hypertensive emergencies encompass a spectrum heart's lower chambers (ventricles) becomes stiff, and the ventricles
of clinical presentations in which uncontrolled blood pressures (BPs) can't fill with blood. This leads to reduced blood flow in your heart.
lead to progressive or impending end-organ dysfunction. In these Another common name for restrictive cardiomyopathy is idiopathic
conditions, the BP should be lowered aggressively over minutes to restrictive cardiomyopathy.
hours. 3. Arrhythmogenic right ventricular cardiomyopathy (mutation):
2. Hypertensive urgency: The most common symptoms of Arrhythmogenic right ventricular dysplasia / cardiomyopathy
hypertensive urgency were headache (78.87%) and chest pain (ARVD/C) is a rare familial disorder that may cause ventricular
(56.34%). Hypertensive urgency is an acute, severe elevation in tachycardia and sudden cardiac death in young, apparently healthy
blood pressure without signs or symptoms of end-organ damage. individuals. The clinical hallmark of the disease is ventricular
Proposed blood pressure levels indicating hypertensive urgency are arrhythmias, arising predominantly from the right ventricle.
arbitrary and not associated with short-term morbidity and mortality. 4. Hypertrophic cardiomyopathy (hypertrophic septum):
Hypertrophic cardiomyopathy (HCM) is a disease in which the heart
DIAGNOSTIC TESTS FOR HYPERTENSIVE CRISIS muscle becomes thickened (hypertrophied). The thickened heart
1. Blood tests: CBC, cardiac markers, blood urea nitrogen, muscle can make it harder for the heart to pump blood. Hypertrophic
creatinine, urinalysis and a urine toxicology screen cardiomyopathy often goes undiagnosed because many people with
2. CT (computerized tomography) scan: CT scans can help the disease have few, if any, symptoms.
personalize treatment in patients whose blood pressure falls in the
gray zone of just above normal or mild high blood pressure. SIGNS AND SYMPTOMS OF CARDIOMYOPATHY
3. MRI (magnetic resonance imaging): MRI could offer novel 1. Murmurs
imaging strategies for risk stratifying patients with HTN via 2. Extra heart sounds
assessment of aortic distensibility, pulse wave velocity and 3. Pulmonary crackles (rales)
cerebral blood flow. 4. Atrial fibrillation: Atrial fibrillation happens when abnormal
4. Echocardiogram electrical impulses suddenly start firing in the atria. These impulses
5. Close hemodynamic monitoring override the heart's natural pacemaker, which can no longer
control the rhythm of the heart. This causes you to have a highly
MEDICATIONS FOR HYPERTENSIVE CRISIS irregular pulse rate.
1. Captopril: Captopril, sold under the brand name Capoten among 5. Ventricular dysrhythmias: Ventricular arrhythmias are abnormal
others, is an angiotensin-converting enzyme inhibitor used for heart rhythms that make the lower chambers of your heart twitch
the treatment of hypertension and some types of congestive heart instead of a pump. This can limit or stop your heart from supplying
failure. Captopril was the first oral ACE inhibitor found for the blood to your body. While some of these arrhythmias are harmless
treatment of hypertension. and don't cause symptoms, some can have serious — or even
2. Clonidine: Clonidine, sold under the brand name Catapres among deadly — effects on your body.
others, is an α₂-adrenergic agonist medication used to treat high
blood pressure, ADHD, drug withdrawal, menopausal flushing, INTERVENTIONS FOR CARDIOMYOPATHY
diarrhea, spasticity, and certain pain conditions. It is used by 1. Identify causes
mouth, by injection, or as a skin patch. 2. Exercise and diet: Choose foods that are low in saturated and
3. Nitroglycerine: Nitroglycerin, a vasodilator, is also known as trans fats. Healthy choices include lean meats, poultry without skin,
trinitroglycerin, nitro, glyceryl trinitrate, Nobel Oil, or 1,2,3- fish, beans as well as fat-free or low-fat milk and milk products.
trinitroxypropane, dense, colorless, oily, explosive liquid most Choose and prepare foods with little salt (sodium). Too much
commonly produced by nitrating glycerol with white fuming nitric sodium can raise your risk of high blood pressure.
acid under conditions appropriate to the formation of the nitric acid 3. Cardiac implants: Cardiac
ester. implantable electronic
4. Nicardipine: Nicardipine is a medication used to treat high blood devices, including
pressure and angina. It belongs to the dihydropyridine class of pacemakers, implantable
calcium channel blockers. It is also used for Raynaud's cardioverter defibrillator
phenomenon. It is available in by mouth and intravenous (ICD), biventricular
formulations. It has been used in percutaneous coronary pacemakers, and cardiac
intervention. loop recorders, are designed
to help control or monitor
irregular heartbeats in
people with certain heart
rhythm disorders and heart
failure.

TRANSCRIBED BY APRIL TOM O. CUENCA 3

Pacemaker therapy: A pacemaker is an causes slow heartbeats, pauses (long periods between
electronic device that provides electrical stimuli heartbeats) or irregular heartbeats (arrhythmias).
to the heart muscle. b. Conduction block: Conduction block can be defined as the
focal failure of a nerve impulse to propagate along a structurally
intact axon. Several possible mechanisms are known to cause
conduction block, of which the most important is demyelination.

ELECTROCARDIOGRAM
INTERVENTIONS • A recording of the heart's electrical activity. It is an electrogram of
1. Dislodgment of the pacing electrode. the heart which is a graph of voltage versus time of the electrical
2. ECG is monitored very carefully to detect pacemaker malfunction. activity of the heart using electrodes placed on the skin.
3. A patient experiencing pacemaker malfunction may develop
bradycardia as well as signs and symptoms of decreased cardiac
output (e.g., diaphoresis, postural hypotension, syncope).
4. Objects that contain magnets (e.g., the earpiece of a phone, large
stereo speakers, jewelry) should not be near the generator for
longer than a few seconds.
5. Patients are advised to place digital cellular phones at least 6 to 12
inches away from (or on the side opposite of) the pacemaker
generator and not to carry them in a shirt pocket.

ARRYTHMIAS
• Heart rhythm problems (heart arrhythmias) occur when the
electrical impulses that coordinate your heartbeats don't work
properly, causing your heart to beat too fast, too slow or irregularly.

Step 1: SA node activity and atrial activation begin [Time=0]

Step 2: Stimulus spreads across the atrial surfaces and reaches the AV
node [Elapsed time=50msec]
Step 3: There is a 100-msec delay at the AV node. Atrial contraction
begins [Elapsed time=150msec]
Step 4: The impulse travels along the interventricular septum within the
AV bundle and the bundle branches to the Purkinje fibers and via the
moderator band, to the capillary muscles of the right ventricle [Elapsed
time=175msec]
Step 5: The impulse is distributed by Purkinje fibers and related
throughout the ventricular myocardium. Atrial contraction is completed
and ventricular contraction begins.

1. SA node depolarized
2. Electrical activity goes rapidly to AV node via internodal pathways
3. Depolarization spreads more slowly across atria. Conduction
slows through AV node
4. Depolarization moves rapidly through ventricular conducting
system to the apex of the heart
5. Depolarization wave spreads upward from the apex

TWO (2) TYPES OF ARRYTHMIAS

1. Tachycardia: Tachycardia is the medical term for a heart rate over
100 beats a minute.
a. Atrium: atrial fibrillation, atrial flutter, and supraventricular
tachycardia
- In atrial fibrillation, the atria beat irregularly. In atrial flutter,
the atria beat regularly, but faster than usual and more
often than the ventricles, so you may have four atrial beats
to every one ventricular beat.
- Supraventricular tachycardia (SVT) is a condition where
your heart suddenly beats much faster than normal.
b. Ventricle: ventricular tachycardia, ventricular fibrillation, long
QT syndrome
2. Bradycardia: Bradycardia is a slow heart rate. The hearts of adults
at rest usually beat between 60 and 100 times a minute. If you have
bradycardia, your heart beats fewer than 60 times a minute.
a. Sick sinus syndrome: Sick sinus syndrome is a type of heart
rhythm disorder. It affects the heart's natural pacemaker (sinus
node), which controls the heartbeat. Sick sinus syndrome

TRANSCRIBED BY APRIL TOM O. CUENCA 4

1. The heart wall is completely relaxed with no change in electrical
activity, so the ECG remains constant
2. P wave occurs when the SA node and atrial walls depolarize
3. Atrial walls are completely depolarized and thus, no change is
recorded in the ECG
4. The QRS complex occurs as the atria repolarize and the ventricular
walls depolarize
5. The atrial walls are now completely repolarized, the ventricular walls
are now completely depolarized and thus no change is seen in the
ECG
6. The T wave appears on the ECG when the ventricular walls
repolarize
7. Once the ventricles are completely repolarized, the voltage returns
to the baseline of the ECG

CARDIOVERSION
• This is a procedure used to return an
abnormal heartbeat to a normal
rhythm. This procedure is used when
the heart is beating very fast or
irregular (arrythmias).
• Electrical cardioversion involves the
delivery of a “timed” electrical current
to terminate a tachydysrhythmia. In
cardioversion, the defibrillator is set
to synchronize with the ECG on a
cardiac monitor so that the electrical
impulse discharges during ventricular
depolarization (QRS complex).

CATHETER ABLATION
• This is a procedure wherein a special catheter is advanced at or
near the origin of the dysrhythmia, where high-frequency, low-
energy sound waves are passed through the catheter, causing
thermal injury, localized cell destruction, and scarring.

HEART FAILURE
• Heart failure is a condition that develops when your heart doesn't
pump enough blood for your body's needs. This can happen if your
heart can't fill up with enough blood. It can also happen when your
heart is too weak to pump properly.

NEW YORK HEART ASSOCIATION (NYHA) HEART FAILURE

CLASSIFICATION
Class 1: No limitation of physical activity; ordinary physical activity does
not cause symptoms
Class 2: Slight limitation of physical activity; comfortable at rest; ordinary
physical activity causes symptoms
Class 3: Marked limitation of physical activity; comfortable at rest, but
less than ordinary activity causes symptoms
Class 4: Severe limitation and discomfort with any physical activity;
symptoms present even at rest

TRANSCRIBED BY APRIL TOM O. CUENCA 5

 SIGNS AND SYMPTOMS OF HEART FAILURE
1. Dizziness
2. Shortness of breath
3. Palpitations
4. Chest pain and discomfort

DIAGNOSTIC TESTS FOR HEART FAILURE

1. Chest x-ray
2. Echocardiogram
3. ECG
4. Blood tests: B-type natriuretic peptide (BNP) blood test and
electrolytes (sodium, potassium), creatinine, albumin, and certain
biomarkers

MANAGEMENT OF HEART FAILURE

1. Coronary artery bypass graft (CABG) surgery: A coronary
artery bypass graft (CABG) is a surgical procedure used to treat
coronary heart disease. It diverts blood around narrowed or
clogged parts of the major arteries to improve blood flow and
oxygen supply to the heart.
2. Pharmacologic management: ACE inhibitors, angiotensin-2
NURSING INTERVENTIONS FOR END-STAGE HEART FAILURE
receptor blockers (ARBs or AIIRAs), beta blockers,
mineralocorticoid receptor antagonists, diuretics, ivabradine, 1. Hemodynamics
sacubitril valsartan, hydralazine with nitrate, digoxin and SGLT2 2. Respiratory care
inhibitors 3. Fluid balance or renal function
3. Heart transplant
4. Valve surgery ALTERNATIVE TREATMENTS
• Fish oil or omega 3 fatty acids: Omega-3 fish oil supplements do
PALLATIVE CARE FOR END-STAGE HEART FAILURE not prevent a second heart attack, but taking about a gram a day
1. Dyspnea could reduce deaths from coronary heart disease and sudden
2. Pain cardiac death by about 10 percent. New to Monday's advisory is
3. Depression that heart failure patients may also benefit from fish oil
4. Fatigue supplements.
• Hawthorn plant: One study found that hawthorn extract (900
CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY mg/day) taken for 2 months was as effective as low doses of
captopril (a prescription heart medication) in improving symptoms
• It is a surgical procedure to restore
of heart failure. A large study found that a standardized hawthorn
normal blood flow to an obstructed
supplement was effective in 952 people with heart failure.
coronary artery.
• Gingko biloba: The impaired glucose regulation is prevalent in
patients with cardiovascular disease. However, there are few
NURSING MANAGEMENT POST-CABG
drugs that interfere early with impaired glucose regulation. Ginkgo
SURGERY
biloba extract not only is a commonly used drug for cardiovascular
1. Maintain patent airway
diseases, but also has a significant effect in reducing blood sugar.
2. Monitor vital signs, including intake and
output • Ginseng: Ginseng helps increase heart rate and blood pressure
3. Neurologic vital signs during exercise and also increases the cardiac output and blood
4. Post-operative wound care circulations and therefore increases oxygen delivery to active
muscles.
• Garlic: Some studies have shown that garlic and garlic
supplements may have positive effects on heart health by
RECANALIZATION
preventing cell damage, regulating cholesterol and lowering blood
• It is the reestablishment of blood flow into a formerly occluded pressure. Other research shows that garlic supplements may also
region (Hall et al., 1989) reduce plaque buildup in the arteries

REFERENCES
1. https://www.mayoclinic.org/diseases-conditions/myocardial-ischemia/symptoms-
causes/syc-20375417
2. https://www.cdc.gov/heartdisease/coronary_ad.htm
3. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-
pharmaceutical-science/hypertensive-crisis
4. Healthline.com
5. Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M, Survival and
Prognosis: Investigation of Crataegus Extract WS 1442 in CHF (SPICE) trial study
group.
6. Eur J Heart Fail. 2008 Dec; 10(12):1255-63.
7. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in
patients with chronic stable New York Heart Association class-III heart failure.
Tauchert M Am Heart J. 2002 May; 143(5):910-5.
8. TheLancet.com
9. htts://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858335/
10. https://www.providence.org/news/uf/414540885#:~:text=However%2C%20resear
HEART TRANSPLANT
chers%20recorded%20the%20results,reduce%20total%20cholesterol%20by%20
• Orthotopic transplantation is the most common surgical procedure 8%25.
for cardiac transplantation. Some surgeons prefer to remove the 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC139960/
recipient’s heart but leave a portion of the recipient’s atria (with the 12. Brunner & Suddarth's Textbook of Medical-Surgical Nursing
vena cava and pulmonary veins) in place, which is known as the
biatrial technique.

TRANSCRIBED BY APRIL TOM O. CUENCA 6