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Cardiovascular Manual fortheAdvanced Practice Provider
Mastering theBasics
RichardMusialowski KristaAllshouse
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Cardiovascular Manual for the Advanced Practice Provider
Richard Musialowski • Krista Allshouse
Editors
Cardiovascular Manual for the Advanced Practice Provider
Mastering theBasics
Editors
Richard Musialowski Sanger Heart and Vascular Institute Atrium Health Charlotte, NC, USA
Krista Allshouse Atrium Health Levine Childrens’ Congenital Heart Center Charlotte, NC, USA
ISBN 978-3-031-35818-0 ISBN 978-3-031-35819-7 (eBook)
https://doi.org/10.1007/978-3-031-35819-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword
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It is with honor that I write this foreword to the rst Cardiovascular Manual for the Advanced Practice Provider. In my over thirty-year cardiovascular
career, I have witnessed the inception, acceptance, growth, indispensability, and leadership of advanced practice providers (APPs) to the cardiovascular care (CV) team. This is corroborated now by nearly 7000 CV team members in the American College of Cardiology (ACC) worldwide. Recent innovative new pathways to both associate (AACC) and fellow (FACC) status ensure this continued growth and leadership. These designations are awarded each year at ACC’s annual scientic sessions convocation and emphasize the importance of APPs to the College’s mission to “transform cardiovascular care and improve heart health for all.” Furthermore, the APP numbers continuing global growth will promote the College’s vision of “a world where science, knowl­edge, and innovation optimize cardiovascular care.” In short, APPs are now essential to the CV team, and this manual will aid in the best care of complex cardiovascular patients as well as lling a previously unmet clinical need.
Much appreciation goes to Richard Musialowski, MD, FACC, Director of CV Education at Sanger Heart and Vascular Institute/Atrium Health, and Krista Allshouse, PA-C, who conceived and kick-started this manual. Much credit goes to Amy Winiger, DNP, FACC, who has shown the far-reaching possibilities that APPs can achieve in cardiology today, as well as Kathy Venable, PA-C, who trailblazed and has led our own APP program at Sanger Heart and Vascular Institute/Atrium Health for over 30years. This program now employs over 120 APPs. Nationally, George Rodgers, MD, MACC, Eileen Handberg, Ph.D., FACC, and Janet Wyman, DNP, FACC, have led the ACC CV Team section to become one of the strongest forces for advocacy and advancement of the ACC in the past decade.
I close with admiration and awe for all those who have contributed not only to the writing of this manual but to the acceleration of APP leadership within the CV team. This manual will become an invaluable resource in the optimal care of all our cardiovascular patients.
Sanger Heart & Vascular Institute/Atrium Health B.HadleyWilson Charlotte, NC, USA Clinical Professor of Medicine, Wake Forest University-Atrium Health, Charlotte, NC, USA President, American College of Cardiology, Washington, DC, USA May 1, 2022
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Letter from Editor
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Dear Readers,
Why was this manual created? It was the brainchild of the editors after many long discussions about how advanced practice providers (APPs) are currently used in the healthcare setting, the future of our work, and APP education. How can we best prepare a new graduate from PA/NP school, a resident, or an APP changing specialties to practice in cardiology? In today’s environ­ment of ultra-specialized APPs, how can we best give them a broad knowl­edge base in cardiology? Then it hit us! Write a Cardiovascular Manual BY APPs working in cardiology FOR these new APPs. What would these sea­soned providers want their new colleagues to know in each of their areas of expertise? And the book was born: Cardiovascular Manual for the Advanced Practice Provider.
There were many discussions regarding other learning, outside of books. It is critical for new providers to learn from the entire healthcare team. Each aspect of patient care is important and a provider can learn from each of these specialties, especially nursing. Nurses provide patient care for hours on end, whether that is an 8, 10, or 12h shift and gain an exorbitant amount of infor­mation about the patient during this time. Listen to them! They will always know the patient better than you. Respect everyone in the care team; they all have different jobs to do, but are equally important. The more you talk to and ask questions to the care team, the more likely they will come to you with concerns or questions, which will improve patient care and communication. You do not want to be unapproachable.
You also should become a leader in your eld and to the entire care team. Everyone is busy but as a provider, you should be the guide for care and take responsibility of the patient. Lead by doing. Be a leader in the way you direct care, create a team-based care team, and educate. Accept education gladly from other care providers. It is all a learning experience. Don’t be afraid to be vulnerable and admit you don’t know something. It is the only way to learn. Put the effort in to educate yourself outside of the job—go to conferences, read and LISTEN!
We hope this publication serves you well in your journey to becoming a well-rounded and spectacular Cardiovascular APP!
Thank you to Dr. Ronald Sing for jump starting our idea by allowing us to help with his book Interventional Critical Care. We appreciate the opportu­nity to be involved.
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We also want to thank the following people for their help obtaining images
for this work:
Tom Johnson, M.D.F.A.C.C., F.A.S.E. Markus Scherer, M.D.F.A.C.C., F.A.S.E. Kristi Johnson, RDCS, F.A.S.E. Cody Frye, RDCS, F.A.S.E. Amar Parikh, M.D. Joshua Lisenby Shannon Culver Nainesh Patel, M.D., F.A.C.C., F.S.C.A.I.
Sincerely,
Richard Musialowski and Krista Allshouse
Letter from Editor
Contents
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Part I Introduction
1 Cardiac Anatomy, Physiology, and Exam . . . . . . . . . . . . . . . . . . . 3
Richard Musialowski and Krista Allshouse
2 Basic Hemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Courtney Bennett and Amanda Solberg
Part II Coronary Artery Disease
3 Acute Coronary Syndrome (ACS) ST Segment Elevation
Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Amy Winiger and George P. Rodgers
4 ACS Non-ST Elevation Myocardial Infarction (NSTEMI) . . . . . 31
Michelle Ross and John Cedarholm
5 Outpatient Management of Coronary Artery Disease. . . . . . . . . 43
Michelle Ross and John Cedarholm
6 Surgical Management of Coronary Artery Disease . . . . . . . . . . . 53
Elisabeth A. Powell and Larry Watts
Part III Cardiac Electrophysiology
7 Antiarrhythmic and Anticoagulant Agents . . . . . . . . . . . . . . . . . 63
Craig J. Beavers
8 Bradycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Hannah Kibler and Sharon Vannoy
9 Atrial Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Lora Raines
10 Ventricular Tachycardia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Robert Hipp
11 Cardiac Channelopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Krista Allshouse
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12 Introduction to Cardiac Ablation . . . . . . . . . . . . . . . . . . . . . . . . . 127
Krista Allshouse
13 Introduction to Electrophysiology Devices . . . . . . . . . . . . . . . . . . 131
Jamie A. Dietrich
14 Cardioversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Lora Raines
15 Cardiac Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Krista Allshouse and Richard Musialowski
Part IV Structural/Valvular Heart Disease
16 Aortic Valve Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Anne Booke, Michael Rinaldi, Elisabeth A. Powell, Larry Watts, and Richard Musialowski
17 Mitral Valve Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Anne Booke, Michael Rinaldi, Elisabeth A. Powell, Larry Watts, and Richard Musialowski
18 Tricuspid Valve Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Anne Booke, Michael Rinaldi, Elisabeth A. Powell, Larry Watts, and Richard Musialowski
Contents
19 Infective Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Allen Stephens, Todd McVeigh, Cary Ward, Elisabeth A. Powell, and Larry Watts
Part V Cardiomyopathies/Congestive Heart Failure
20 Heart Failure with Reduced Ejection Fraction (HFrEF) . . . . . . 197
Lauren Eyadiel and Bridget Rasmussen
21 Heart Failure with Preserved Ejection Fraction (HFpEF) . . . . . 221
Carolina D. Tennyson
22 Pulmonary Vascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Lyn Shelton and Joe Mishkin
23 Pericardial Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Ashley McDaniel and Richard Musialowski
Part VI Shock
24 Cardiogenic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Courtney Bennett and Amanda Solberg
25 Introduction to Mechanical Support . . . . . . . . . . . . . . . . . . . . . . . 265
Courtney Bennett and Amanda Solberg
Contents
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Part VII Peripheral Vascular Disease
26 Carotid Artery Stenosis (CAS). . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Trent Gabriel and Frank R. Arko III
27 Peripheral Arterial Disease (PAD) . . . . . . . . . . . . . . . . . . . . . . . . . 279
Trent Gabriel, Amber Amick, and Frank R. Arko III
28 Diseases of the Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Tracy Totten and Frank R. Arko III
Part VIII Adult Congenital Heart Disease (ACHD)
29 ACHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Amanda Green and Jorge Alegria
Part IX Ambulatory/Preventative Cardiology
30 Prevention of Cardiometabolic Disease . . . . . . . . . . . . . . . . . . . . 331
Allison W. Dimsdale and Christopher Kelly
Part X Emergency Department Evaluation of Chest Pain
31 Acute Evaluation of Chest Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Devin Stives and Richard Musialowski
Part XI Cardiovascular Disease in Pregnancy
32 Cardiovascular Disease in Pregnancy . . . . . . . . . . . . . . . . . . . . . . 359
Cindy Sing and Malissa J. Wood
Index 373