Cardiovascular alterations and management

This chapter reviews the support of cardiovascular function in the face of
many compromises to the system. It focuses on two of the most prevalent and fatal diseases affecting the heart: coronary heart disease and heart failure. These diseases are also a common comorbidity in elderly patients admitted to critical care units. The first section on coronary heart disease reviews the pathophysiological concepts of myocardial ischaemia and associated complications, with detailed consideration of the clinical implications, assessment and associated management. Heart failure is discussed in terms of the body’s compensatory mechanisms and the clinical sequelae and associated clinical features of heart failure. Nursing and medical management is outlined including the management of acute exacerbations of heart failure. Finally, other cardiovascular disorders commonly managed in critical care units are reviewed, ranging from other forms of heart failure to hypertensive emergencies and aortic aneurysms. The case study presented at the end of the chapter highlights the key aspects of the management of coronary heart disease and heart failure in patients admitted to critical care units.

Cardiovascular disease in Europe - epidemiological update 2015

This article provides an update for 2015 on the burden of cardiovascular disease (CVD), with a particular focus on coronary heart disease (CHD) and stroke, across the countries of Europe. Cardiovascular disease is still the most common cause of death within Europe, causing almost two times as many deaths as cancer across the continent. Although there is clear evidence, where data are available, that mortality from CHD and stroke has decreased substantially over the last 5-10 years, there are still large inequalities found between European countries, in both current rates of death and the rate at which these decreases have occurred. Similarly, rates of treatment, particularly surgical intervention, differ widely between those countries for which data are available, indicating a range of inequalities between them. This is also the first time in the series that we use the 2013 European Standard Population (ESP) to calculate age-standardized death rates (ASDRs). This new standard results in ASDRs around two times as large as the 1976 ESP for CVD conditions such as CHD but changes little the relative rankings of countries according to ASDR.

Cardiovascular risk screening of volunteer firefighters

Background: The work demands involved in firefighting place significant stress on the cardiovascular system. This study investigated the application of the AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire in volunteer Country Fire Brigade (CFA) firefighters. Methods: Cardiovascular disease (CVD) risk factors were measured in 3777 CFA firefighters and entered into a modified version of the American Heart Association (AHA)/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire to stratify individuals as low, moderate or high risk. Results: Just over half (50.8%) of female and more than two thirds (68.2%) of male CFA firefighters were classified as moderate risk. The questionnaire further stratified 2.6% of female and 5.2% of male CFA firefighters as high risk while the remaining 46.6% and 26.6% of female and male firefighters, respectively, were classified as low risk. Conclusion: The majority of firefighters screened were at moderate risk and therefore, would be advised by AHA/ACSM guidelines to undertake and pass a detailed medical examination and a medically supervised exercise test prior to initiating vigorous intensity physical activity. However, considering the financial and practical implications (e.g., reduced emergency response capacity) the introduction of mandatory screening may cause, fire agencies should focus screening for high risk personnel only, while promoting agency wide CVD health education.