February is American Heart Month!

February is a time to rejoice many wonderful traditions – Black History Month, Valentine’s Day, and our ancestors’ birthdays, to call a couple of. February can also be American Heart Month, which was first proclaimed by President Lyndon B. Johnson in 1964.¹ Since then, February has been a month dedicated to promoting cardiovascular health by many organizations, equivalent to the American Heart Association¹Heart disease is the leading reason behind mortality for each men and girls in America.² It is a disease that will be largely prevented by changing your lifestyle.¹Thanks to advances in medical therapies and higher education about heart disease, the variety of deaths related to heart problems has steadily declined over the past three many years.¹.

This month brings back many memories. My first job out of faculty within the mid-90s was within the Intensive Care Unit (ICU) at a big medical center in midtown Manhattan. It was a singular ICU setting, where the staff rotated between medical, coronary, surgical, and cardiovascular (post-op) ICUs every few months. It was during these early years that I gained an appreciation for heart problems and the way it may very well be treated medically and surgically. In the medical ICU and the cardiac ICU, I cared for patients who had been transferred from the emergency room with acute coronary syndrome (ACS) and were awaiting cardiac catheterization for diagnosis and possible angioplasty. Each patient’s presentation was very different. A stable ICU patient with mild symptoms, equivalent to dyspepsia, could rapidly deteriorate to acute exhaustion and severe chest pain, and even full-blown coda. Stabilizing these patients with aspirin, supplemental oxygen, and sublingual nitroglycerin was critical, and monitoring the electrocardiogram (ECG) was paramount. I do not think any nurse forgot that this was the primary time they’d witnessed ST-segment elevation.

In the surgical and cardiovascular intensive care unit, patients returned from the operating room with a tangle of lines, arterial lines, central lines, pulmonary artery catheters, in addition to chest tubes, drains, and complex surgical wounds. Monitoring vital signs, titrating intravenous drips, managing oxygenation and potential bleeding were all a part of the postoperative course. Patients undergoing open-heart surgery needed to be often assessed for elevated jugular venous pressure and a paradoxical pulse (a systemic drop in blood pressure during inspiration).³), each signs of impending cardiac tamponade, or the buildup of fluid within the pericardial space. It didn’t occur fairly often, but when it did, it resulted in urgent percutaneous subappendicular drainage—one in every of the more stressful moments for a newly minted nursing graduate.

After a couple of years in New York, I felt a calling back to Philadelphia. During my postgraduate studies, I worked nights within the cardiac intensive care unit (CT-SICU) of a giant academic hospital, caring for patients recovering from open-heart surgery. I believed I had seen all of it in New York and quickly realized I had only scratched the surface when it got here to caring for cardiac patients. Academic facilities often admit patients in very acute conditions due to their ability to supply a number of the most advanced treatment options, equivalent to intra-aortic pumps (IABP), left ventricular and biventricular assist devices (LVAD and BiVAD), extracorporeal membrane oxygenation (ECMO), ventilators, and continuous hemofiltration and dialysis. There were times after I felt more like a mechanic than a nurse, working on the various machines surrounding the delicate life at its center.

Patients typically experience short stays and rapid turnover within the surgical intensive care unit, but we’ve got had numerous patients who’ve spent many weeks and months on our unit. Mr. B.* was one such patient. Mr. B. was transferred from a local people hospital to our facility with severe heart failure. Mr. B, who had reached the limit of his medical therapies, had been hospitalized multiple times for acute exacerbations of heart failure over the past yr. Each hospitalization worsened, requiring increased doses of intravenous (IV) dobutamine and milrinone to enhance his heart’s pumping capability. On arrival, Mr. B., who was classified as having grade 4 (severe) heart failure, was assessed by the team for heart transplantation. At 64 years of age, he was beyond the upper age limit of exclusion, but had no evidence of lung, liver or renal disease. He was immediately placed on the transplant list and, given his critical condition, the choice was made to implant a left ventricular assist device (LVAD) to support his heart. Mr. B. had a sophisticated postoperative course. He had difficulty weaning off the ventilator and developed pneumonia because of this. Anticoagulation was fastidiously titrated to forestall clotting within the LVAD, but this led to bleeding within the gastrointestinal tract. His blood glucose levels rose rapidly, requiring intravenous insulin. He struggled through these challenges and after stabilizing, Mr. B. was capable of walk with the brand new device and start rehabilitation in preparation for transplant. He was extremely positive, cracking jokes with the nurses, and all the time smiling. I could tell he was truly grateful for day-after-day he was alive. Today, LVAD patients will be discharged home and live comfortably with the device, some as a bridge to transplant and a few as a destination therapy if transplant just isn’t an option. Mr. B. was with us for a couple of weeks as a consequence of complications but was eventually discharged home.

On a chilly November morning, Mr. B. and his family were notified that a heart was available for transplant and that it was a match. He was admitted back to our unit that afternoon and later that evening received the gift of a brand new heart and a second likelihood at life. The operation was extremely successful. Mr. B. spent 4 days recovering within the CT Intensive Care Unit, where we fastidiously monitored him for rejection. He was then transferred to the General Surgery Unit for cardiac rehabilitation and discharged from the hospital on the fifteenth day after surgery.

The most rewarding a part of being an ICU nurse is watching patients get better. Mr. B. often got here back to say “hi” and thanks, which all the time warmed our hearts. He is one in every of many heart patients I’ll always remember. Although Mr. B.’s story ends well, many other heart patients aren’t so fortunate. We, as healthcare providers, should proceed to emphasise the importance of heart health education and lifestyle changes to forestall the progression of heart disease. Happy Heart Month to all!

Bibliography

1. American Heart Association (2016) American Heart Month. Retrieved from http://newsroom.heart.org/events/american-heart-month-events-and-info-3136417

2. Center for Disease Control and Prevention (2016) Heart Disease Facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm

3. UpToDate (2016) Pulsus Paradoxus in Pericardial Disease. Retrieved from http://www.uptodate.com/contents/pulsus-paradoxus-in-pericardial-disease