The thesis is focused on the intra-aortic balloon counterpulsation (IABP) from the perspective of nurses in the cardiac intensive care. It consists of two parts. Theoretical and empirical. The theoretical part will deal with the intra-aortic balloon counterpulsation, including basic anatomy of the heart and blood vessels, the principle of IABC, its indications, contraindications, technology IABC and specific nursing care of patients with established IABC. The empirical part is treated as quantitative research, which is used for the data collection method anonymous questionnaire. The aim of the thesis is to determine nurses' knowledge of IABC in the cardiac intensive care and subsequent drafting of guidance for postoperative cardiac surgery department KARIM University, Prague. In this section are also included important questions and answers from the perspective of the specified variables obtained from the questionnaire and subsequent actions arising in practice. Key words Counterpulsation, Cardiac cycle, Aorta, Heart, Nursing care

Every day there are somatosensory stimuli on our skin that we perceive one moment and the next not, despite their unchanged physical presence (e.g., insects, wind, clothing). Yet, which are the physiological determinants and neural correlates that accompany external stimuli to enter consciousness or not? To address this question and inform theories of consciousness, this dissertation presents three empirical studies that used weak electrical finger-nerve stimulation which led - despite being physically identical - to subjective experiences of stimulus presence and absence. The first two studies investigated the interaction of tactile conscious perception with two dominant body rhythms: the cardiac and respiratory cycle. The third study investigated the configuration of neural networks being involved in this near-threshold phenomenon. Tactile conscious perception changed over the course of the cardiac cycle (increased detection during diastole) and respiration was tuned such that stimuli occurred more likely during late inspiration / early expiration, resulting in increased detection during early expiration. On the neural level, conscious perception was accompanied by global broadcasting of sensory content across the brain without substantial reconfiguration of the whole-brain functional network in terms of graph metrics. The cardiac cycle effect on conscious tactile perception is a result of cognitive processes which model and predict our body’s internal state to inform perception and guide behavior (e.g., tuning respiration). This perceptual integration of interoceptive and exteroceptive 'beliefs' is also an explanation for widely distributed brain activity differences without whole-brain functional network changes when a tactile stimulus is perceived.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2010 / This main aim of this study was to assess patients in a general cardiology practice in order to determine the systolic and diastolic profiles of these patients. The aim was also to determine what effect life style and risk factors may have on the echocardiographic variables measured during such an examination. The specific aim of this study was the importance of not only examining the systolic function but the necessity to also examine the diastolic profile of patients. Life-style plays an important role, with the main culprit being obesity. Obesity was the single most important factor that affected the diastolic profile of patients seen in this study. With obesity a combination of other risk factors related to obesity was observed. Most abnormalities found due to these risk factors were associated with diastolic changes in the left ventricle. Echocardiography is routinely used in daily practice, but the diagnostic value of this tool can be enhanced if proper analyses of the systolic as well as the diastolic profiles are determined. Many cardiologists only measure the systolic function of the heart as an indication of the well- being of the left ventricle, although in this study it was proven that systolic function did not alter with ageing or with changes in the risk profile. Hundred-and-twelve patients, divided into three age groups, were evaluated in this study. Both systolic and diastolic variables were measured and analysed for abnormalities. None of these patients had systolic function abnormalities, although they had detectable anatomic changes due to ageing, obesity and hypertension. Several abnormalities were found on the diastolic profile of these patients. Muscle thickness increased due to obesity and hypertension and even with ageing, but with no significant abnormalities in the systolic function of the heart. There was a slight increase in the circumferential shortening of the left ventricle and that both the septal and longitudinal functions decreased with ageing. It is noteworthy that even where the systolic function remained normal in ageing subjects, their diastolic profiles changed significantly. Assessment of left ventricular function required a meticulous and systematic approach. In this study forty- one percent of patients visiting this general practice had abnormalities of their diastolic function although their systolic function was normal. It was found that with ageing, especially in the older age group, important abnormalities occur in their diastolic profile. The most common changes were that the E- peak velocity decreased and that the Apeak velocity of the trans-mitral flow increased. It seemed that passive filling decreased with ageing but that active filling increased simultaneously, causing the cardiac output to remain constant in older subjects. This is important to know because diseases affecting the atrium may have a profound effect on the cardiac output of older patients, even if they have normal systolic function, (due to the decreased passive filling they need their active filling or atrial contraction to support a normal cardiac output). An important marker will be to look at the ratio of the E/A- velocities in older patients to determine the ratio of active against passive filling. Other than that, a relatively new tool in echocardiography called tissue Doppler was used to determine what happened to the muscle with ageing. Here it was demonstrated that the different layers of the left ventricle acted differently with ageing. Results showed that the longitudinal fibres weakened with ageing although the circumferential fibres remained unchanged or even strengthened with ageing. It was apparent in this study that the traditional use of only systolic function may not be adequate when evaluating relative asymptomatic patients presenting at a general cardiology practice. It is important to also evaluate the diastolic profiles of these patients in order to scientifically quantify their heart health, even in asymptomatic patients. It is important to routinely evaluate the diastolic profile of patients so that early detection of these diastolic variables can be detected and timely consideration for its treatment can be given by their cardiologist. It is also important to take note of the significance of the obesity problem and the effect it has on the heart’s health. In conclusion, this study emphasizes the importance of the echocardiographic evaluation of diastolic cardiac function in addition to routine systolic evaluation in asymptomatic patients. This will enable the clinician to detect abnormalities early and tailor therapy accordingly. Lifestyle related risk factors, especially obesity, also have significant effects on diastolic cardiac function.

[pt] Doenças cardiovasculares são responsáveis por um elevado número de óbitos em seres humanos. Muitas dessas patologias são dependentes do ciclo cardíaco e estão localizadas na aorta, a maior e principal artéria do nosso corpo. O conhecimento dos padrões de escoamento e distribuições de tensões nas paredes da aorta podem auxiliar no diagnóstico e prevenção de algumas dessas doenças. Dessa forma, estudou-se numericamente o escoamento do sangue, durante o ciclo cardíaco, em um modelo 3D da aorta de um paciente específico, após a implantação de TAVI (Transcatheter Aortic Valve Implantation). O ciclo cardíaco é formado por dois períodos chamados de sístole e diástole. Durante a sístole, sangue é bombeado do coração para a aorta, apresentado altos valores de vazão, resultando em escoamento turbulento. Por outro lado, na diástole, com o fechamento da válvula aórtica, o sangue escoa com baixas velocidades em regime laminar. Até hoje, cientistas enfrentam um desafio na modelagem da turbulência, pois não existe uma única modelagem que forneça previsibilidade para todas as situações envolvendo o regime turbulento, com esforço computacional razoável. Para seleção do modelo de turbulência mais adequado para análise do escoamento no interior da aorta, na presença da transição de regimes de escoamento durante o ciclo cardíaco, com um custo razoável, selecionou-se a metodologia baseada na Média de Reynolds. Diferentes modelos foram comparados com dados experimentais extraídos do mesmo modelo aórtico em escala real, porém em regime permanente, com vazão correspondente ao pico da sístole. Por fim, avaliou-se o impacto das condições de contorno e dos modelos de turbulência durante o ciclo cardíaco na distribuição e valores de tensões e grandezas turbulentas no endotélio vascular. Mostrou-se que a distribuição espacial das médias temporais de tensão foram qualitativamente e quantitativamente similares, para os dois ciclos cardíacos representativos de diferentes pacientes, porém com pequenas mudanças locais para cada caso. Em termos dos modelos de turbulência, observou-se que o modelo SAS (Scale Adaptive Simulation) foi capaz de representar a relaminarização do escoamento sanguíneo no período diastólico. / [en] Cardiovascular diseases are responsible for a high number of deaths in humans. Many of these pathologies are dependent on the cardiac cycle and are located in the aorta, the largest and main artery in our body. Knowledge of flow patterns and stress distributions in the walls of the aorta can help in the diagnosis and prevention of some of these diseases. Thus, the flow of blood during the cardiac cycle was numerically studied in a 3D model of the aorta of a specific patient, after TAVI (Transcatheter Aortic Valve Implantation) implantation. The cardiac cycle consists of two periods called systole and diastole. During the systole, blood is pumped from the heart to the aorta, presenting high flow rates, resulting in a turbulent flow. On the other hand, in diastole, with the closure of the aortic valve, the blood flows with low velocities in laminar regime. Until today, scientists face a challenge in turbulence modeling, as there is no single model that provides predictability for all situations involving the turbulent regime, with reasonable computational effort. In order to select the most suitable turbulence model for the analysis of the flow inside the aorta, in the presence of the transition of flow regimes during the cardiac cycle, with a reasonable cost, the methodology based on the Reynolds Average was selected. Different models were compared with experimental data extracted from the same real-scale aortic model, but a in steady state, with flow corresponding to the systolic peak. Finally, the impact of boundary conditions and turbulence models during the cardiac cycle on the distribution and values of stresses and turbulent quantities in the vascular endothelium were evaluated. It was shown that the spatial distribution of the temporal averages of tension was qualitatively and quantitatively similar, for the two cardiac cycles representative of different patients, but with small local changes for each case. In terms of turbulence models, it was observed that the SAS (Scale Adaptive Simulation) model was able to represent the relaminarization of blood flow in the diastolic period.

Synchronous contraction and relaxation of the myocardium is required to optimize cardiac function. Regional timing of contraction and relaxation is dyssynchronous in many patients with heart failure. Cardiac resynchronization therapy (CRT) is a highly successful treatment for dyssynchronous heart failure. Patients are currently selected for CRT using surface electrocardiogram QRS duration as a measure of dyssynchrony. However, up to 30% of patients selected for CRT show no improvement. This poor response rate may in part be explained by the poor correlation between mechanical dyssynchrony and QRS duration. Thus, better methods to quantify mechanical dyssynchrony in the heart may improve the poor CRT response rate. The overall goal of this project was to develop better methods to diagnose dyssynchrony in the left ventricle (LV). We developed two new methods with different approaches. The first method improved upon existing tissue-Doppler based echocardiographic diagnosis of dyssynchrony by utilizing a cross-correlation (XC) function to quantify dyssynchrony during post-processing as opposed to the quantitatively simplistic time-to-peak analysis that is currently utilized. The second method utilized standard cine cardiac magnetic resonance (CMR) images to quantify the dyssynchrony in the flow of blood within the LV, which may represent a more direct, physiologically relevant measure of dyssynchrony. Specific aim 1 demonstrated that the new XC delay parameters can be quantified accurately with a stationary region of interest and therefore require significantly less post-processing time to calculate compared to the time-to-peak dyssynchrony parameters. Specific aim 2 showed that XC delays are superior to existing time-to-peak dyssynchrony parameters at discriminating patients with LV dyssynchrony from those with normal function. The time-to-peak parameters showed dyssynchrony in approximately half of the normal, healthy volunteers while the XC delay parameters had nearly perfect diagnostic accuracy. The results of specific aim 3 showed that XC delays could diagnose acute, pacing-induced dyssynchrony in young, healthy children with 79% accuracy while the time-to-peak parameters showed accuracies of 71%, 57% and 57%. Specific aim 4 showed that CMR-based quantification of LV internal flow can be used to discriminate patients with dyssynchronous heart failure from normal controls with 95% accuracy.

The diploma thesis deals with the issue of artificial hearts and ventricular assist devices. The theoretical part describes the heart and its function. Blood is characterized in terms of rheological behavior and the possible criteria for hemolysis are discussed. The following section describes the most commonly used ventricular assist devices, with emphasis on the use of the regenerative pump, including its components. In the practical part, an experimental analysis of two pumps (COV 43 and COV 23) is performed. Furthermore, non-dimensional characteristics of the pumps are constructed using the laws of similarity. In the computational part, the CFD analysis of the regenerative pump is performed by means of stationary and transient calculation. The results are compared with the experimental findings and based on the results, the impeller of regenerative pump was modified.

[pt] As patologias na valva aórtica representam umas das principais causas de óbito no mundo. Nos casos de estenose aórtica grave, a substituição da valva nativa é necessária. Existem dois mecanismos de substituição de valva aórtica: cirurgia convencional, através da toracotomia, ou o implante valvar aórtico percutâneo (TAVI, Transcatheter Aortic Valve Implantation). O posicionamento coaxial da prótese valvar em relação ao ânulo aórtico influência o fluxo sanguíneo transvalvar, podendo contribuir para o remodelamento aórtico, culminando em dilatações aneurismáticas, dissecção aórtica e processo aterosclerótico. O presente estudo avalia numericamente a influência do posicionamento coaxial da prótese valvar nas estruturas hemodinâmicas na região de aorta ascendente e início do arco aórtico, durante um ciclo cardíaco. A geometria anatômica avaliada corresponde a um modelo aórtico de um paciente que foi submetido ao implante valvar percutâneo. O escoamento foi obtido com o modelo de turbulência (K - W), utilizando o software ANSYS-Fluent. A interação entre a complacência aórtica e o fluxo sanguíneo durante o ciclo cardíaco foi obtida empregando simulações do tipo FSI (Fluid Structure Interaction). A metodologia numérica foi validada através de comparações com dados experimentais nobres do tipo PIV estereoscópico, com excelente concordância do campo de velocidade e tensões de Reynolds. Observou-se a importância do posicionamento coaxial da prótese valvar aórtica com relação ao direcionamento do jato e área de impacto na parede da aorta; influenciando na formação de regiões de recirculação na raiz da aorta e aorta ascendente; com diferentes estruturas coerentes (vórtices). Identificou-se as regiões de alta pressão e tensão de cisalhamento na parede da aorta, assim como de alta intensidade das grandezas turbulentas no volume interno da aorta. A partir da análise dos resultados foi possível sugerir que a posição coaxial ideal da prótese pode ser obtida quando é direcionada à parede esquerda da aorta com uma inclinação de 4 graus. / [en] Aortic valve pathologies are one of the leading causes of death in the world. In cases of severe aortic stenosis, replacement of the native valve is necessary. There are two mechanisms of aortic valve replacement: conventional surgery through thoracotomy or Transcatheter Aortic Valve Implantation (TAVI). Coaxial positioning of the valve prosthesis in relation to the aortic annulus influences on the transvalvar blood flow, which may contribute to aortic remodeling, culminating in aneurysmal dilations, aortic dissection and atherosclerotic process. The present thesis evaluates the influence of the coaxial positioning of the valve prosthesis on hemodynamic structures in the ascending aorta and the beginning of the aortic arch, during a cardiac cycle. The anatomical geometry evaluated was the aortic model of a specific patient after being submitted to percutaneous valve implantation procedure. The flow was obtained with the (K - W) turbulence model, using ANSYS-Fluent software. Interaction between aortic compliance and blood flow during the cardiac cycle was obtained using simulations FSI (Fluid Structure Interaction). The numerical methodology was validated through comparisons with noble experimental data obtained from stereoscopic PIV method, with excellent agreement of the velocity field and Reynolds stress. It was observed the importance of the coaxial positioning of the aortic valve prosthesis in relation to the jet direction and the impact area in the aortic wall, influencing the formation of recirculation regions in the aortic root and ascending aorta; with different coherent structures (vortices). The regions of high pressure and shear stress were identified in the aortic wall, as well as high intensity turbulent quantities in the internal aortic volume. From the results analysis it was possible to suggest that the ideal coaxial position of the prosthesis can be obtained when it is directed to the left wall of the aorta with an inclination of 4 degrees.