Ventricular dysrhythmias in heart failure.
Left-ventricular systolic dysfunction, or heart failure (HF), is a chronic, progressive condition with a poor prognosis. Approximately 50% of deaths, especially in mild to moderate cases, are sudden. Most sudden deaths are thought to be due to ventricular tachycardia; however, premature ventricular contractions and couplets parallel severity of HF and have been associated with increased mortality risk as opposed to dysrhythmic death. Ventricular arrhythmogenesis results from many mechanisms (afterdepolarizations, reentry, and enhanced automaticity) and preconditions (electrophysiologic abnormalities, neuroendocrine activation, electrolyte imbalances, scar from an ischemic event in ischemic cardiomyopathy, fibrosis in dilated cardiomyopathy, hemodynamic abnormalities, and HF medical management). Nurses are key caregivers in optimally managing HF, either by direct actions or by using advocacy, communication, and collaboration skills to promote positive outcomes. Ventricular dysrhythmia management consists of facilitating core HF pharmacologic and nonpharmacologic medical therapies, using amiodarone to improve symptoms, as needed, and utilizing implantable cardioverter-defibrillator therapy to reduce the risk of sudden cardiac death.
Albert
Nancy M
NM
Division of Nursing and CNS, George M. and Linda H. Kaufman Center for Heart Failure, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. albertn@ccf.org
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015984:Causality; D002423:Cause of Death; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D018450:Disease Progression; D006293:Health Promotion; D006333:Heart Failure / Q000150:complications* / Q000628:therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D024802:Nurse's Role; D010344:Patient Advocacy; D011379:Prognosis; D012720:Severity of Illness Index; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000150:complications; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000517:prevention & control; D018879:Ventricular Premature Complexes / Q000209:etiology* / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D000451:Mineralocorticoid Receptor Antagonists; D014665:Vasodilator Agents