Heart & Lung: The Journal of Acute and Critical Care

Information for Authors

2012-05-01

Redefining the role of telehealth for cardiovascular disease management

Ruth M. Kleinpell — 2012-01-27

Despite diagnostic and treatment advances, coronary heart disease (CHD) remains the leading cause of death in Americans aged more than 65 years. It is well recognized that CHD, including chronic heart failure (HF), often results in repeated hospitalizations, and represents a considerable economic burden to society.

The quest to identify the ideal patient for early left ventricular assist device implantation as destination therapy

Marie Galvao, Cynthia J. Bither — 2012-05-01

Heart failure (HF) with a reduced left ventricular ejection fraction (HFrEF) remains prevalent in the United States, likely representing approximately half of the estimated 5 million individuals suffering from the syndrome. Those in a more advanced stage of HF experience reduced quality of life, frequent hospitalizations, and early mortality. Although evidence-based pharmacologic and cardiac resynchronization therapies have significantly improved outcomes in this population, the mortality rate is still high, and options are limited.

Practice patterns of heart failure nurses

2012-03-19

Abstract: Objective: Little is known about the practice patterns of nurses who work in the specialty of heart failure (HF). This specialty includes inpatient and outpatient sites for practice that incorporate intensive care to rehabilitation. The purpose of this study was to describe the current practice of nurses who are members of the American Association of Heart Failure Nurses (AAHFN).Methods: A convenience sample of nurses attending the 2010 Annual Meeting of AAHFN was surveyed to determine current practice patterns.Results: The mean age of the nurses completing the survey was 48 years (standard deviation [SD] +10), and the majority were white (85%) and female (98%). Approximately half (48%) completed a Master’s degree. The mean time worked as a nurse was 23 years (SD +10), with a mean of 11 years (SD +8.2) caring for patients with HF. Both HF education and physical assessment were reported to be provided frequently.Conclusion: This survey provides insight into the practice patterns of HF nurses. Continued monitoring of this role is warranted and can serve to assist the AAHFN in advancing HF knowledge and skills.

Symptoms and functional performance in Korean immigrants with asthma or chronic obstructive pulmonary disease

2011-11-04

Abstract: Objectives: People with chronic obstructive lung diseases often experience a variety of symptoms. Few studies, however, have described these symptoms in detail. This study sought to examine concurrent symptoms, symptom clusters, and the effects of symptoms on functioning in Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD).Methods: Outpatients with asthma or COPD participated in this cross-sectional, correlational study. Symptoms, dyspnea, mood, and functional performance were assessed with questionnaires. Descriptive and inferential statistics were used to analyze the data.Results: The most frequently reported symptom was shortness of breath. Three factors emerged from 16 symptoms. Age, mean severity score of 7 symptoms, working status, level of acculturation, and level of education explained significant variance in functional performance.Conclusion: The symptom cluster, consisting of 7 symptoms, showed the greatest effect on levels of functioning, which emphasizes the importance of assessment for coexisting symptoms in populations with these diseases.

Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease

2011-10-13

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients’ survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD.Methods: Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years’ history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography.Results: Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean ± SD, 16.1 ± 2.5; range, 12.3 to 23.3; control subjects, mean ± SD, 13.6 ± 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7.Conclusion: Red cell distribution width may be used to identify COPD patients with RV failure.

Factors associated with delayed care-seeking in hospitalized patients with heart failure

Nancy F. Altice, Elizabeth A. Madigan — 2011-11-04

Abstract: Objective: This study sought to evaluate the contributions of symptom recognition and clinical factors to delays in care-seeking.Methods: A descriptive correlational study design was used to study 75 patients (mean age, 74.7 years; SD, 10.86 years; range, 40 to 96 years) admitted to a tertiary-care medical center with recurrent symptoms (New York Heart Association classes 2 to 4). The sample was 52% male and 85.3% white. The Heart Failure Somatic Perception Scale (HFSPS) was used to examine symptoms, and additional data were collected on physiologic, social, and demographic factors.Results: The mean HFSPS score was 37.52 (range, 2 to 74; possible range, 0 to 90). Subjects reported 2 to 16 out of 18 possible symptoms. Durations of individual symptoms ranged from 5 minutes to 8 years, with individual patients describing a variety of symptom combinations and multiple time frames, depending on the specific symptom. Most subjects (80%) reported a mixture of acute and chronic symptoms. A pattern of chronic vs. acute symptoms was associated with proactive vs. emergent care-seeking, respectively. The HFSPS scores did not correlate with care-seeking behavior.Conclusion: Symptom recognition is a complex phenomenon, and few factors differentiate emergent from proactive care-seeking.

Mediastinitis and blood transfusion in cardiac surgery: A systematic review

Lee Boon Ang, Evangeline N. Veloria, Eileen Y. Evanina, Arlene Smaldone — 2011-10-03

Abstract: Background: Mediastinitis, a serious complication after cardiac surgery, increases morbidity, mortality, and cost of care. Accumulating evidence implicates blood transfusions in the development of mediastinitis.Objectives: We conducted a systematic review to evaluate the association between allogeneic blood transfusion and mediastinitis in adult cardiac surgery patients.Results: After a search of Medline, PubMed, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the Institute for Scientific Information's Web of Knowledge (1990-2010) for relevant studies, 7 (3 prospective cohort and 4 retrospective reviews) met our inclusion/exclusion criteria. Between 20% and 80.2% of patients received blood transfusions, with an incidence of mediastinitis ranging from 0.1% to 2.3%. Five studies demonstrated an independent association between red blood cell transfusion and mediastinitis. Two studies identified a dose-response relationship.Conclusion: The findings of this systematic review suggest that allogeneic red blood cell transfusions are associated with an increased risk of mediastinitis in patients undergoing cardiac surgery. Individual risks and benefits should be assessed in each patient before a red blood cell transfusion.

Patients' descriptions of dysphoria associated with cardiac tamponade

Yuko Ikematsu, Janet A. Kloos — 2011-10-13

Abstract: Background: Cardiac tamponade is difficult to diagnose. Patients often experience sustained distress. Mood changes in the early stages of cardiac tamponade were previously described. However, precise descriptions of these moods have not been reported.Objective: We sought to describe the mood changes specifically referred to as dysphoria in the patients' own words.Methods: Structured and semistructured interviews were performed with 29 patients who had survived cardiac tamponade.Results: Twenty-six patients (89.6%) affirmed some dysphoric mood. “A bad thing is happening” was most frequently affirmed. “Felt anxious,” “could not stay still,” and “difficult to settle down” followed. Answers to open-ended questions and free comments were categorized into “fear,” “anxiety,” “impending doom,” “ill feeling,” “unusual,” “uncertain,” “depressed,” and “discouraged.”Conclusion: The majority of patients surviving cardiac tamponade experienced a dysphoric mood. Mood changes may provide a reliable indicator for those at risk for cardiac tamponade.

Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010

Laurie J. Conway, Elaine L. Larson — 2011-09-20

Abstract: Objectives: We set out to review and compare guidelines to prevent catheter-associated urinary tract infection (CAUTI), examine the association between recent federal initiatives and CAUTI guidelines, and recommend practices for preventing CAUTI that are associated with strong evidence and are consistent across guidelines.Background: Catheter-associated urinary tract infections are the most common healthcare-associated infection, and a cause of significant morbidity and mortality in critically ill patients.Methods: A search of the English-language literature for guidelines in the prevention of adult CAUTI, published between 1980 and 2010, was conducted in Medline and the National Guideline Clearinghouse.Results: Many recommendations were consistent across 8 guidelines, including limited use of urinary catheters, the insertion of catheters aseptically, and the maintenance of a closed drainage system. The weight of evidence for some endorsed practices was limited, and different grading systems made comparisons across recommendations difficult. Federal initiatives are closely aligned with the 4 most recent guidelines.Conclusion: Additional research into the prevention of CAUTI is needed, as is a harmonization of guideline grading systems for recommendations.

Detecting myocardial ischemia with continuous ST-segment monitoring: Two case studies

Prasama Sangkachand, Monica Cluff, Marjorie Funk — 2011-12-19

Abstract: Continuous ST-segment ischemia monitoring is recommended for patients at significant risk for myocardial ischemia that, if sustained, may result in acute myocardial infarction or extension of a myocardial infarction. It is especially useful for patients who do not perceive or cannot communicate symptoms of ischemia. We report 2 case studies of young women with acute coronary syndrome who benefited from continuous ST-segment monitoring. One patient was critically ill and unresponsive, and one patient had atypical symptoms and some difficulty communicating clearly.

Pulmonary hemorrhage induced by epileptic seizure

Masanori Azuma, Isao Ito, Riki Matsumoto, Toyohiro Hirai, Michiaki Mishima — 2011-10-24

Abstract: We report a 35-year-old man who presented with pulmonary hemorrhage induced by an epileptic seizure. He had experienced recurrent episodes of massive hemoptysis after epileptic seizures since the age of 28 years. He was admitted to Kyoto University Hospital with massive hemoptysis and hypoxia after an epileptic seizure of a few minutes’ duration. Radiographic signs of infiltrations and hemorrhagic bronchoalveolar lavage fluid were observed. He was intubated and successfully treated with anti-epilepsy drugs and corticosteroids. Epileptic seizures may have induced increased pulmonary vascular permeability and structural damage to the blood–gas barrier, which may have caused pulmonary hemorrhage. Pulmonary hemorrhage could be in the list of differential diagnoses of hemoptysis in patients with epilepsy.

The natural course of traumatic myocardial infarction in a young patient with angiographically normal coronary arteries

Shi-Wei Yang, Yu-Jie Zhou, Zhen-Feng Guo, Da-Yi Hu — 2011-10-19

Abstract: A 23-year-old man with no history of heart disease was admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University for an abnormal electrocardiogram of ST-T changes mimicking myocardial infarction. Catheterization revealed normal coronary and peripheral arteries. The echocardiogram and delayed enhancement cardiovascular magnetic resonance imaging indicated a markedly reduced left ventricular function and enlarged left ventricular cavity with evidence of fibrous tissue. Given the patient’s history of multiple blunt trauma 7 years previously and acute myocardial infarction diagnosis at that time, he was diagnosed with traumatic myocardial infarction (TMI). We describe the natural course of such a patient with TMI. There is a possibility of spontaneous healing of coronary artery dissection induced by trauma. Although early revascularization may be helpful for preventing cardiac remodeling after TMI in some cases, more data are needed to compare the long-term outcome among different interventions in large sample cases.

Superior vena cava and right atrium wall infective endocarditis in patients receiving hemodialysis

2011-09-07

Abstract: Infective endocarditis is significantly more common and causes greater morbidity and mortality in patients receiving hemodialysis than in the general population. Episodes of bacteremia during hemodialysis are primarily the result of frequent vascular access through an arteriovenous fistula, a vascular graft, or an indwelling vascular catheter. This leads to dialysis access infection and secondary bacteremia. We describe 4 cases of patients receiving hemodialysis, with an indwelling intravascular dialysis catheter, who developed right-sided endocarditis with vegetations located exclusively on the superior vena cava and right atrium wall. All patients had persistent bacteremia with Staphylococcus, secondary to an indwelling intravascular hemodialysis catheter, which led to seeding of the right-sided cardiac wall, causing infective endocarditis. The rates of acceptance for hemodialysis are increasing, along with improved survival in this group of patients. This will probably lead to an increase in the incidence of infective endocarditis, with atypical presentations such as superior vena cava and right-sided cardiac wall endocarditis.

Influenza A presenting as viral encephalitis in an adult

Burke A. Cunha, Michael Corbett, Nardeen Mickail — 2011-08-11

Abstract: In adults, influenza A may be accompanied by a variety of neurological findings. Influenza-associated encephalitis (IAE) is rare in adults, and usually follows influenza A after 2 days. In patients with influenza who later develop encephalitis, the diagnosis of IAE is relatively straightforward. We present a rare case of IAE in an adult who presented with viral encephalitis that was later attributed to antecedent influenza A.

Renal transplant with bronchiolitis obliterans organizing pneumonia (BOOP) attributable to tacrolimus and herpes simplex virus (HSV) pneumonia

Burke A. Cunha, Uzma Syed, Nardeen Mickail — 2011-10-13

Abstract: Background: Solid organ transplants (SOTs) may be complicated by a wide variety of infectious and noninfectious pulmonary disorders. Transplant patients receive immunosuppressive drugs to prevent rejection, but these drugs also predispose them to infection. Because immunosuppressive therapy impairs T-lymphocyte function, ie, cell-mediated immunity, such therapy, not surprisingly, predisposes patients to intracellular pulmonary pathogens. Community-acquired pneumonia (CAP) in patients with SOT usually involves one of the common typical or atypical bacterial CAP pathogens infecting immunocompetent hosts. The most frequent intracellular CAP pathogens in SOTs during immunosuppressive therapy are viral, eg, cytomegalovirus (CMV), respiratory syncytial virus (RSV), and herpes simplex virus (HSV). In addition, intracellular fungal pathogens are also common in patients with SOTs during immunosuppressive therapy, eg, Pneumocystis (carinii) jiroveci pneumonia (PCP). In addition, a variety of noninfectious disorders are not uncommon in patients with SOTs, including bronchiolitis obliterans organizing pneumonia (BOOP). Bronchiolitis obliterans organizing pneumonia may be associated with a variety of infectious agents, or may be attributable to drugs, including some immunosuppressive agents.Methods: The clinical approach to CAP in patients with SOTs may be based on the appearance of the chest x-ray (CXR) or chest computed tomography scan, combined with the degree of hypoxemia (ie, the A-a gradient). Patients with SOTs and with a normal or nearly normal CXR and a high degree of hypoxemia (A-a gradient, >35) most often have an early viral pneumonia, eg, CMV or early PCP. If the CXR reveals bilateral patchy interstitial infiltrates and severe hypoxemia, the differential diagnosis is limited to moderate or severe viral pneumonia or PCP. Patients with SOTs and presenting with diffuse infiltrates and mild to moderate hypoxemia (A-a gradient, <35) are usually prone to noninfectious disorders, eg, congestive heart failure, pulmonary embolism, or drug-induced pneumonias. In patients with SOTs and CAP with focal or lobar infiltrates, the distribution of pathogens is the same as in immunocompetent hosts, ie, either a bacterial or atypical CAP pathogen.Case Report and Conclusion: A renal transplant patient developed bilateral patchy interstitial infiltrates with severe hypoxemia during hospitalization. The most likely differential diagnostic possibilities included PCP and BOOP. Bronchoalveolar lavage was performed to rule out PCP, and indicated cytopathic effects diagnostic of HSV pneumonia. Lung biopsy pathology confirmed the diagnosis of BOOP. In reviewing the patient’s medications, we surmised that tacrolimus may have caused BOOP. The tacrolimus was discontinued, and the patient received acyclovir for HSV pneumonia.

Comment on “The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease”

Hamidah Hassan, Srijit Das — 2012-02-20

We enjoyed reading “The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease” by Dickson et al. We wish to share our scientific views on that article.

Reply to Das and Hassan regarding “The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease”

Victoria Vaughan Dickson — 2012-03-02

On behalf of my coauthors, I thank Drs. Das and Hassan for their interest in our study, “The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease.” We wholeheartedly concur that the working population with hypertension and prehypertension constitute important targets of worksite wellness programs. In fact, according to estimates on working adults in the United States, 35% of those with hypertension and 41% with hyperlipidemia are undiagnosed.

2012-05-01

Board of Directors

2012-05-01

Information for Readers

2012-05-01

Heart & Lung: The Journal of Acute and Critical Care

Information for Authors

Redefining the role of telehealth for cardiovascular disease management

The quest to identify the ideal patient for early left ventricular assist device implantation as destination therapy

Practice patterns of heart failure nurses

Symptoms and functional performance in Korean immigrants with asthma or chronic obstructive pulmonary disease

Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease

Factors associated with delayed care-seeking in hospitalized patients with heart failure

Mediastinitis and blood transfusion in cardiac surgery: A systematic review

Patients' descriptions of dysphoria associated with cardiac tamponade

Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010

Detecting myocardial ischemia with continuous ST-segment monitoring: Two case studies

Pulmonary hemorrhage induced by epileptic seizure

The natural course of traumatic myocardial infarction in a young patient with angiographically normal coronary arteries

Superior vena cava and right atrium wall infective endocarditis in patients receiving hemodialysis

Influenza A presenting as viral encephalitis in an adult

Renal transplant with bronchiolitis obliterans organizing pneumonia (BOOP) attributable to tacrolimus and herpes simplex virus (HSV) pneumonia

Comment on “The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease”

Reply to Das and Hassan regarding “The relationship of work, self-care, and quality of life in a sample of older working adults with cardiovascular disease”

Table of Contents

Board of Directors

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