Effect of activity on supraventricular tachyarrhythmias after coronary artery bypass surgery

Article Abstract:

Supraventricular tachyarrhythmias (SVT, including atrial fibrillation, atrial flutter, and paroxysmal atrial tachycardia) are bouts of rapid heartbeats that can lead to low blood pressure, breathing difficulty, weakness, lightheadedness, and fainting. SVT is a frequent and serious complication of coronary artery bypass graft surgery (CABG - pronounced "cabbage"), occurring in 20 to 40 percent of patients. Antiarrhythmic drugs, electrical stimulation of the heartbeat, or both may be necessary. Among the likely causes of SVT are surgical trauma, imbalances of electrolytes (elements in body fluids that conduct electricity), inflammation of the sac surrounding the heart (pericarditis), and the effects of stopping beta-blocker therapy. SVT often seemed to occur at the time of transfer out of intensive care, or during certain nursing care activities, raising the possibility that strict limitation of activity might be beneficial. This study was undertaken to test that premise. Among 173 patients studied after CABG, 49 suffered SVT. Age had a pronounced effect, with older patients more likely to suffer the arrhythmias, a finding also reported earlier from the Coronary Artery Surgery Study (CASS). Smoking, sex, time of day, activity, high blood pressure, and diabetes had no effect. Characteristics of the operation and postoperative measurements provided did not predict the occurrence of SVTs. Few SVTs occurred in the first 24 hours after surgery, but they peaked 24 to 36 hours later. The association with transfer from intensive care would seem to be coincidental. Beta-blocker withdrawal may be a factor, and the use of a beta blocker did reduce the occurrence of SVT in one study, but this does not explain a comparable incidence of SVT in patients who were not receiving beta blockers before surgery. Nursing intervention, patient activity, and backrest position did not cause SVT or make it worse. This suggests that confining a patient to bed or restricting activity may not only be unnecessary, but may even be detrimental. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Atrial fibrillation, Arrhythmia, Coronary artery bypass, Atrial flutter, Paroxysmal tachycardia

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Family needs of patients having coronary artery bypass graft surgery during the intraoperative period

Article Abstract:

A heart attack is a potentially fatal event in which the blood flow to the heart is decreased often resulting in death of heart tissue. Coronary artery bypass graft (CABG) surgery is a procedure in which a portion of a healthy vein is sown (grafted) onto a portion of a clogged coronary artery, thus restoring blood flow to the heart. CABG is performed on patients who have a history of recurrent heart attack in an effort to prevent further heart attacks. CABG surgery is an anxiety provoking event not only for the patient, but also for the patient's family. Family members report their most anxiety provoking event in the hospital was waiting for the results of their loved one's surgery; they had very little if any contact with hospital personnel at this time. A recent study of 23 spouses and 45 adult relatives of 30 patients undergoing CABG surgery for the first time assessed the needs of the family members during the intraoperative period. Families of CABG surgery patients used the Critical Care Family Needs Inventory to rank the importance of 45 needs. Fourteen of the top 24 needs of the family concerned the desire for obtaining more information about the patient, and the highest-ranking need was for their questions to be answered honestly. Isolation and being encouraged to cry were the two lowest needs family members reported. Family members identified nurses as their greatest resource in meeting their needs. In conclusion, the families of patients undergoing CABG surgery wish to be told in a truthful manner the disposition of the patient and nurses are viewed as the group most helpful in doing this. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Surgery, Myocardial revascularization, Heart, Family, Heart surgery

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Expanding role of coronary angioplasty: current implications, limitations, and nursing considerations

Article Abstract:

Atherosclerosis, the build-up of plaque deposits inside arteries, can narrow the blood vessels of the heart. Percutaneous transluminal angioplasty (PCTA) is a surgical procedure that eliminates blood vessel narrowing by inflating a balloon that is inserted in the vessel to widen the passage and reestablish blood flow. Technical improvements have decreased complications of this procedure, increased the primary success rate to 91 percent, and broadened the category of eligible patients. PTCA can now be performed on patients with multiple blood vessel involvement, more severe blockages, and patients who have had previous bypass surgery. Although PTCA was previously reserved for patients with stable angina (the pain associated with narrowed blood vessels) patients with unstable angina, who were thought to be at a higher risk for a potential heart attack, are now acceptable candidates also. In addition, patients who have had a recent myocardial infarction with blood vessel blockage may have blood vessels reopened with PTCA and clot dissolving drugs. Although PTCA has been successful, blood vessels frequently close up again after the procedure. Nurses should be watchful for potential abnormal heart rhythms, symptoms of myocardial infarction, bleeding from PTCA sites, and patient anxiety. In addition, nurses need to instruct patients about heart disease, the proper use of medication, and signs and symptoms of angina. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Coronary heart disease, Transluminal angioplasty, Balloon angioplasty

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