Chapter 32: Concepts of Care for Patients With Cardiac Problems

The content addresses the pathophysiology of heart failure across multiple presentations, distinguishing between left-sided failure with reduced ejection fraction and preserved ejection fraction variants, as well as right-sided failure mechanisms. The chapter explains how underlying conditions such as hypertension and valvular disorders compromise cardiac output and trigger compensatory responses including sympathetic activation and renin-angiotensin system engagement. While these mechanisms initially maintain adequate perfusion, they ultimately increase myocardial workload and contribute to structural remodeling and disease progression. Assessment strategies focus on identifying signs of pulmonary and systemic congestion, evaluating hemodynamic stability through vital signs, and interpreting diagnostic markers such as B-type natriuretic peptide. Nursing interventions prioritize gas exchange improvement and tissue perfusion restoration through medications that reduce cardiac workload, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and neprilysin inhibitors for afterload reduction, diuretics and dietary sodium restriction for preload management, and agents that enhance contractile function. Advanced therapeutic options presented include cardiac resynchronization therapy, mechanical circulatory support devices, and transplantation. The chapter also addresses acute decompensation, particularly pulmonary edema as a medical emergency requiring rapid intervention. Additional content covers valvular pathology including stenotic and regurgitant lesions, their surgical and transcatheter management options, and anticoagulation requirements. Inflammatory and infectious cardiac conditions receive detailed attention, including infective endocarditis with its systemic complications and pericarditis with risk of tamponade requiring emergency drainage. The chapter concludes by categorizing cardiomyopathies by structural pattern and outlines differentiated management approaches while emphasizing patient education and adherence strategies to reduce hospitalizations.