Chapter 14: Invasive Management of Cardiac and Vascular Disease

Invasive cardiovascular interventions form a critical continuum of care for patients with coronary artery disease, valvular dysfunction, arrhythmias, and peripheral vascular obstruction. Percutaneous coronary intervention employs balloon angioplasty and stent deployment to restore myocardial perfusion, while coronary atherectomy uses specialized catheters to remove atherosclerotic material from vessel walls. Peripheral arterial disease, carotid stenosis, renal artery narrowing, and valvular stenosis can be treated with percutaneous transluminal angioplasty or percutaneous balloon valvuloplasty, offering less invasive alternatives to surgery. Rhythm management devices including temporary and permanent pacemakers address bradycardia and conduction abnormalities, while implantable cardioverter defibrillators detect and terminate life-threatening dysrhythmias through pacing, cardioversion, or defibrillation. Major surgical interventions include coronary artery bypass grafting using internal mammary or saphenous vein conduits, which may be performed on or off cardiopulmonary bypass. Valvular surgery involves repair or replacement with either mechanical prostheses requiring lifelong anticoagulation or biological tissue valves with shorter durability. Vascular surgeries encompass aortic and peripheral bypass grafting, endovascular or open aneurysm repair, carotid endarterectomy for stroke prevention, and thromboembolectomy for acute arterial occlusion. Cardiac transplantation represents the definitive treatment for end-stage heart disease but demands complex postoperative management including immunosuppressive therapy and vigilant monitoring for rejection. Nursing care across this spectrum requires preoperative assessment of renal function and bleeding risk, postoperative hemodynamic and neurological monitoring, vigilant surveillance for complications such as bleeding, tamponade, and compartment syndrome, and comprehensive patient education addressing medication adherence, lifestyle modification, and participation in cardiac rehabilitation programs.