You cannot separate the heart and lungs-they are one working unit.
How many times as a clinical practitioner have you heard this statement? When a patient has severe lung disease, the heart may be compromised and may have functional abnormalities. When the heart becomes diseased and functions poorly, oxygenation and ventilation will be altered and effect pulmonary hemodynamics. Treatment protocols for lung disease may impact cardiac function or cause side effects that increase cardiac work. A cycle of interrelated malfunction then continues to increase patient complexity. The focus of this issue is to present lung disease pathophysiology with relevance to heart structure and function.
Lung disease is a major health problem and a leading cause of morbidity and mortality in the work today. It is often underdiagnosed and undertreated. Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States, affecting more than 16 million people. The incidence, morbidity rate, and mortality rate for COPD vary widely among countries and are rising. This variation is possibly related to differences in exposure to risk factors as well as to differences in individual susceptibility. Because lung disease prevalence is so high in patients with underlying heart disease, the practitioner must recognize common pathways of diagnosis, interventions, and novel approaches to care.
The articles included in this issue provide practitioners with the tools to care for patients with interrelated cardiac and lung disease. The issue concentrates primarily on primary and secondary pulmonary hypertension. Dr Cheever's article, "An Overview of Pulmonary Arterial Hypertension: Risks, Pathogenesis, Clinical Manifestations, and Management," leads off with an outstanding review of physiology and pathophysiology of pulmonary hypertension. Dr Klodell then continues with "Secondary Pulmonary Hypertension: A Review of the Cardiac Causes." These articles emphasize the role of pulmonary pressures and right-sided heart function. The concept of preserving right-sided heart function has never been more apparent, especially with the use of destination therapy interventions for heart failure. Treatment methods, both pharmacologic and surgical, are discussed. Dr Curran et al continue with an overview of present-day lung transplantation for category 1 pulmonary artery hypertension. A final clinical article by Ms Carmen Lopez et al identifies the difficulty in the clinical approach to the patient with atrial fibrillation and underlying lung disease. These articles answer questions and, more important, ask questions concerning evidence-based practice principles in the treatment of both cardiovascular and pulmonary patients.
An additional article by Ms Suzanne Rich, "Providing Quality End-of-Life Care," completes this issue. This very timely article brings to light the dilemma of many healthcare professionals regarding the patient's death process. The caregiver as well as the professional practitioner must cope with grief, loss, and the stress that death brings to all involved.
The primary focus of this Journal is to foster expert clinical practice for cardiovascular nurses. As cardiovascular practitioners, we have become more and more aware that our patient population is older, has more comorbid conditions, is being treated by multiple specialists, and is treated with complex treatment plans. Identifying areas of the greatest need for research and developing protocols to guide clinical practice has become our focus. To provide a treatment plan, the practitioner today must have research-based protocols and measurable outcomes to track the outcomes of patient care. It is hoped that this issue will help practitioners identify clearly areas in which to focus future research efforts to improve outcomes in those complex patients with heart and lung disease.