Sjukdomar i hjärtats kranskärl och dess komplikationer förorsakar 23% av alla dödsfall hos kvinnor i Sverige där akut hjärtinfarkt ensam står för 6% av fallen. Atypiska och diffusa symtom är en av orsakerna till att kvinnor med hjärtinfarkt inte alltid kommer till sjukhus i tid. Syftet med denna litteraturstudie är att belysa kvinnors upplevelser av hjärtinfarkt i det akuta skedet. Vi vill även få klarhet i varför kvinnor ofta väntar med att söka vård och dessutom riskerar att inte bli tagna på allvar. Vi har valt metod i form av en litteraturstudie där vi analyserar kvalitativ forskning som bygger på nio vårdvetenskapliga artiklar. I vårt resultat kom vi fram till följande teman och subteman: Kvinnor söker inte vård i tid, Tar inte signalerna på allvar, Relaterar symtomen till andra orsaker, Vill inte var till besvär för andra och hjärtinfarkt drabbar inte mig, Något är fel i min kropp, Sökande av råd och stöd och Upplevelser av symtomen i det akuta skedet, samt Kvinnor blir inte alltid tagna på allvar, Risk för felaktig diagnos – felaktig behandling och Blir inte tagna på allvar. Vi ser det som ett stort problem att många kvinnor underskattar risken att drabbas av akut hjärtkärlsjukdom. Likaså att de vid det akuta insjuknandet relaterar sina hjärtinfarktsymtom till något annat och därför väntar med att söka medicinsk hjälp. Vår förhoppning är att kvinnor blir mer uppmärksamma på kroppens signaler och inte tvekar att söka vård om de känner sig osäkra eller oroliga. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

O presente estudo procurou avaliar, prospectivamente, a segurança do sistema de tele-eletrocardiografia para a liberação de pacientes que se apresentem a postos de saúde com queixa de dor torácica. Avaliamos a incidência de infarto do miocárdio dessa população ao longo de seis meses. Como objetivo secundário, correlacionamos, retrospectivamente, a razão das probabilidades entre diferentes indicadores clínicos e eletrocardiográficos e a ocorrência do infarto do miocárdio. Entre junho e dezembro de 2006, 32444 pacientes foram atendidos em postos de saúde pública, carentes de cardiologistas e tiveram o seu tele-eletrocardiograma transmitido até uma central de telemedicina, através de linha telefônica fixa. Selecionaram-se 1535 pacientes atendidos devido a dor torácica, que tinham mais de 50 anos e apresentavam exame clínico, laboratorial (troponina I ou creatino fosfoquinase fração MB-CKMB) e tele-eletrocardiográfico normais além de consentirem em repetir o tele-eletrocardiograma após um e seis meses. Todos os pacientes foram seguidos durante seis meses. Não houve eventos durante o primeiro mês. No segundo mês houve 12(0,8%) infartos; no terceiro mês, 18(1,2%); no quarto mês, 38(2,4%) e no sexto, 18(1,2%). Ao longo dos seis meses houve 15(1%) óbitos, sendo 9(0,6%) de origem cardíaca; 9 (0,6%)acidentes vasculares encefálicos e 86(5,6%) infartos agudos do miocárdio. Entre as variáveis que se correlacionaram, independentemente, com maior chance de infarto agudo do miocárdio, encontrou-se a obesidade grau I [p=0,009 RC 4,5 IC 95%(1,5-13,8)], a dislipidemia [p< 0,0001 RC 3,4 IC 95%(2,0-5,8)], a baixa amplitude da onda T em V2 [p<0,001 RC 2,9 IC 95%(2,4-3,5)] e o sobrepeso [p=0,019 RC 2,6 IC 95%(1,2-5,7)]. Cada 0,5mm de redução na amplitude da onda T aumentou em quase três vezes a chance de ocorrência do infarto agudo do miocárdio durante seis meses. O tabagismo apresentou forte tendência [p=0,057 RC 1,7 IC 95%(1,0-2,8)] à regressão logística binária e foi significante após análise por árvore de decisão. Estes resultados permitiram as seguintes conclusões: o sistema de tele-eletrocardiografia oferece alta segurança ao estratificar o risco de pacientes com exame clínico, laboratorial e tele-eletrocardiográfico normais, queixando-se de dor torácica. Identificou-se, ao longo dos seis meses, a população de maior chance de apresentar o evento através de variáveis clínicas (obesidade, dislipidemia, tabagismo e sobrepeso) e tele-eletrocardiográficas (amplitude da onda T em V2), que determinaram, independentemente, a ocorrência de infarto agudo do miocárdio / The present study aimed at prospectively evaluating the reliability of teleeletrocardiography for the discharge of chest pain patients who present themselves at remote medical centers. The incidence of acute myocardial infarction among this population was evaluated during a period of six months. As a secondary objective, the correlation between different clinical and electrocardiographic features and the occurrence of myocardial infarction was retrospectively checked. Between June and December of 2006, 32.444 patients were treated in public medical centers which lacked the assistance of cardiologists. Those patients had their electrocardiogram transmitted to a telemedicine center over a fixed-wired telephone line. Among them 1535 patients who had been assisted due to chest pain were selected. Those patients were all older than 50 years and showed normal clinical and laboratorial (troponine I or creatine phosphokinase MB-CKMB fraction) exams, as well as normal tele-electrocardiograms. They also agreed to repeat the teleelectrocardiogram in a six-month period. All patients were followed up to the sixth-month. In the second month, there were 12 (0,8%) infarctions; in the third month there were 18 (1,2%) infarctions; in the fourth month there were 38 (2,4%) infarctions, and in the sixth month there were 18 (1,2%) infarctions. Over that six month period, there were 15 (1%) deaths, 9 (0,6%) of which were related to cardiac causes; 9 (0,6%) strokes, and 86 (5,6%) acute myocardial infarctions. Among the variables which independently correlated with greater risk of acute myocardial infarction, we found grade I obesity [p=0,009 RC 4,5 IC95%(1,5-13,8)]; dyslipidemia [p<0,0001 RC 3,4 IC 95%(2,0-5,8)]; low T-wave amplitude in V2 [p<0,001 RC 2,9 IC 95%(2,4-3,5)], and overweight [p=0,019 RC 2,6 IC 95%(1,2-5,7)]. Each 0,5mm reduction in the T-wave raised almost three times the chance for the occurrence of acute myocardial infarction in a sixmonth period. Smoking showed a strong tendency [p=0,057 RC 1,7 IC 95%(1,0-2,8)] to binary logistic regression and was significant after decision tree analysis. These results lead to the following conclusions: the teleelectrocardiographic system offers high level of safety and reliability due to its capacity to stratify chest pain patient risk. Over these six months the study identified the population who showed greater chances of presenting the event through clinical (obesity, dyslipidemia, smoking and overweight) and teleelectrocardiography (amplitude of T-wave in V2) variables, which independently, determined the occurrence of acute myocardial infarction

The aim of this project was to investigate the transcriptome of human haematopoietic stem cells (HSCs), megakaryocytes and platelets to gain insights into steady state and accelerated thrombopoiesis that occurs in states of haemostatic demand and in thrombosis by applying these findings to the pathological setting of acute coronary thrombosis. To investigate transcriptional heterogeneity within the human HSC population, single cell RNA sequencing was performed in human bone marrow HSCs. Transcriptionally distinct subpopulations were identified including two megakaryocyte biased subsets with potentially differing functional relevance. Both populations expressed megakaryocyte specific transcripts, one of which also co-expressed common myeloid and megakaryocyte-erythroid progenitor transcripts while the other did not. This study represents the first interrogation of the human bone marrow megakaryocyte transcriptome. Cells were collected from healthy human bone marrow and analysed by low input and single cell RNA sequencing. To identify novel drivers of megakaryocyte maturation, the human bone marrow megakaryocyte transcriptome was compared to that of megakaryocytes cultured from human CD34+ cells, a process known to generate immature megakaryocytes. Transcriptional signatures associated with increasing megakaryocyte ploidy were then investigated. Increasing megakaryocyte ploidy level was found to be associated with an upregulation of transcripts involved in translation and protein processing as well as expression of a number of transmembrane receptors which might have functional relevance. Finally, the pathological setting of acute coronary thrombosis was used as a model for accelerated thrombopoiesis. Megakaryocyte and platelet transcriptomes were compared between patients with acute myocardial infarction (AMI) as well as severe coronary disease and a control group. The transcriptional signature relating to disease compared to control in megakaryocytes included upregulation of platelet activation related transcripts in megakaryocytes isolated from patients with AMI and severe coronary artery disease.

Introdução- A hiperglicemia (HG), durante o infarto agudo do miocárdio (IAM), está associada com aumento de mortalidade hospitalar em pacientes diabéticos e não diabéticos. Entretanto, não é conhecido o mecanismo responsável por esta associação. Assim estudou-se, simultaneamente, a correlação entre a glicemia e marcadores bioquímicos relacionados ao sistema neuro-humoral de estresse, metabolismo glicídico e lipídico, sistema de coagulação e inflamatório. Métodos- 80 pacientes foram incluídos consecutiva e prospectivamente. Foram realizadas duas coletas de sangue, a primeira com 24h a 48h do início dos sintomas do IAM (fase aguda) e a segunda após 3 meses do IAM (fase crônica), sempre com 12h de jejum. Foram analisados os seguintes parâmetros: glicose, cortisol, noradrenalina, hemoglobina glicada (HbA1c), insulina, LDL minimamente modificada eletronegativa, ácidos graxos livres (AGL), adiponectina, factor VII da coagulação, fibrinogênio, inibidor do ativação do plasminogênio tipo 1, proteína C reativa ultra-sensível (PCRus), colesterol total (c) e frações e triglicérides. Nas correlações univariadas entre glicemia e as variáveis contínuas empregou-se o teste de correlação de Pearson. As análises multivariadas foram feitas através de regressão logística (variáveis qualitativas) e modelo linear generalizado (quando as variáveis independentes incluídas foram quantitativas e nominais). Resultados- Na fase aguda, a glicemia correlacionou-se significativamente com HbA1c (r=0,75, p<0,001), insulina (r=0,25, p<0,001), AGL (r=0,3, p=0,01), adiponectina (r=-0,22, p=0,05), LDL-c (r=-0,25, p=0,03), VLDL-c (r=0,24, p=0,03) e triglicérides (r=0,27, p=0,01). No modelo multivariado, as variáveis correlacionadas de forma independente com a glicemia, na fase aguda, foram: HbA1c (p<0,001), insulina (p<0,001), e AGL (p=0,013). Para analisar uma variável de confusão, a história de diabetes mellitus (DM), incluiu-se esta variável num modelo, juntamente com as variáveis acima e todas mostraram associação significativas com glicose: HbA1c (p<0,001), insulina (p=0,001), AGL (p=0,013) e história de DM (p=0,027). Na fase crônica, glicose correlacionou-se com: cortisol (r=0,31, p=0,01), noradrenalina (r=0,54, p<0,001), HbA1c (r=0,78, p<0,001) e PCRus (r=0,46, p<0,001). Na análise multivariada, somente HbA1c (p<0,001) e noradrenalina (p<0,001) mantiveram correlação independente. Conclusão- A HbA1c foi a única variável que correlacionou-se de forma significativa e independente com a glicemia, tanto na fase aguda, quanto na crônica, mostrando que a hiperglicemia, durante o IAM, pode representar uma alteração crônica, sub-diagnosticada, do metabolismo glicídico. / Introduction- Hyperglycemia (HG) is an important prognostic factor in acute myocardial infarction (AMI). However, the pathophysiology is poorly understood. So we proposed a simultaneous correlation between glycemia and biochemical markers of stress, glucose and lipid metabolism, coagulation and inflammation system. Methods- Eighty AMI patients were included prospectively. Blood were collected between 24h and 48h from the pain (acute phase), and 3 months post AMI (chronic phase), with 12-h fasting. These parameters were analyzed: glucose, cortisol, norepinephrine, hemoglobin glycated (HbA1c), insulin, minimally modified electronegative LDL, free fatty acids (FFA), adiponectin, factor VII coagulant, fibrinogen, plasminogen activator inhibitor-1, high sensitive C reaction protein (hsCRP), total cholesterol (c) and fractions and triglyceride. The relationships between glucose and continuous variables were assessed by Pearsons correlation coefficient (r) and multivariate analysis with linear regression. Results- At acute phase, glucose correlated significantly with HbA1c (r=0.75, p<0.001), insulin (r=0.25, p<0.001), FFA (r=0.3, p=0.01), adiponectin (r=-0.22, p=0.05), LDL-c (r=-0.25, p=0.03), VLDL-c (r=0.24, p=0.03) and triglyceride (r=0.27, p=0.01). In a multivariate model, variables correlated were: HbA1c (p<0.001), insulin (p<0.001), and FFA (p=0.013). At the chronic phase, glucose correlated significantly with cortisol (r=0.31, p=0.01), norepinephrine (r=0.54, p<0.001), HbA1c (r=0.78, p<0.001) and hsCRP (r=0.46, p<0,001). By multivariable analysis, only HbA1c (p<0.001) and norepinephrine (p<0.001) remained correlated. Conclusion- HbA1c was the main variable that correlated significantly and independently with glycemia at acute and chronic phases, suggesting that HG during AMI can represent an exacerbation of abnormal glucose metabolism previously not diagnosed.

Angiotensin Converting Enzyme (ACE) inhibitors are one of the recommended prevention therapy for patients with acute myocardial infarction (AMI) in the clinical guidelines. Two types (tissue and non-tissue) of ACE inhibitors are available with huge cost difference but the comparative treatment benefit and risk between them are unclear. The objective of this study was to investigate the comparative treatment effectiveness and safety between tissue and non-tissue ACE inhibitors among elderly patients after AMI. This is a retrospective cohort study with intention to treatment design using Medicare service claims files from 2007 to 2009 with Medicare beneficiaries 65 years or older after the index AMI hospitalization and who survived to discharge between January 1 2008 to December 31 2008 and received ACE inhibitors (N=34,679). Risk adjustment and instrumental variable (IV) analyses were used to investigate comparative treatment effectiveness including AMI, stroke, heart failure requiring hospitalization, all-cause mortality and a composite of the endpoints during the follow-up and the comparative treatment safety - a composite of hyperkalemia and acute renal failure requiring hospitalization during the follow-up. Both the risk adjustment and IV analyses showed no significant differences between tissue and non-tissue ACE inhibitors for the investigated outcomes of the comparative treatment effectiveness and safety in the study cohort. However, subgroup analyses from the IV models showed that tissue ACE inhibitors as compared to non-tissue ACE inhibitors increased the hazard risk by approximately 30% to 60% (p < 0.05) for heart failure requiring hospitalization among the patients with heart failure and reduced hazard risk by approximately 30% to 40% (p <0.05) for AMI among patients without heart failure. In conclusion, though this study did not find significant difference between tissue and non-tissue ACE inhibitors for the comparative treatment effectiveness and safety in the study cohort, considerable comparative treatment effectiveness may exist in the subgroup of patients with and without heart failure in the elderly patients after AMI.

The adoption of health behaviours is essential if coronary heart disease patients are to optimise their chance of survival and reduce the likelihood of recurrent coronary events. However, this behavioural change may not ensue following an acute myocardial infarction(AMI). This study on first AMI subjects sought firstly to examine the psychometric properties of five scaled instruments used for assessing health behaviours. Secondly, the study assessed the prevalence of health-enhancing behaviours at the time of the first AMI and 6 months after this event.Thirdly, the magnitude of health behavioural change was then examined. Fourthly, sociodemographic, clinical and psychosocial predictors of health-enhancing behaviours were explored.These health-enhancing behaviours included non-smoking behaviours, normal body mass index (BMI), adequate physical activity, medication adherence and low dietary fat intake. Finally, the study examined relationships between sociodemographic , psychosocial and modifiable lifestyle factors, based on Antonovsky's hypothesis on sense of coherence(SOC), stress and adaptive coping. The study highlights that some modifiable risk factors, for example, being overweight or obese and physical inactivity were more resistant to change following an AMI.This finding, and the relationship between stress and increased dietary fat suggest a need for individualised programs to support the specific needs of AMI patients to change their modifiable cardiac risk factors. / Doctor of Philosophy (PhD)(Health)

The overall aim of this thesis was to investigate recovery in the relationshipbetween couples following an acute myocardial infarction [AMI]. An additionalaim was to compare differences over time regarding hope and health‐relatedquality of life [HRQoL] for both patient and partner. The thesis is based on fourempirical studies (I‐IV), and has a longitudinal design employing both qualitativeand quantitative methods. A purposive sample was recruited comprising 15couples in which one partner had been diagnosed with an AMI. Study I wascarried out as individual tape‐recorded interviews aimed at describing thepatient´s and their partner´s experiences after hospital discharge. Study II alsoused individual tape‐recorded interviews, this time with the aim of describing andinterpreting the couple´s thoughts and expectations about their future life after thepatients’ discharge. Study III used the HHI‐S and SF‐36 measures to comparechanges over time in self‐rated hope and health‐related quality of life, anddifferences between patients’ ratings and their partner´s. Study IV used repeatedindividual tape‐recorded interviews with the aim of interpreting the couples´narratives about their relationship and daily life. The data were analysed andinterpreted using a number of qualitative content analysis methods (I, II, IV) anddescriptive and comparative statistics (III).Overall, the couples´ recovery from an AMI in the two years after an AMI consisted of a striving to reach some kind of balance and stability in their currentlife situation. The period after discharge from the hospital involved understandingthe importance of the home as a place in which one feels at home and which bringsa feeling of safety, experiencing the phenomenon of security and being at homewithin oneself, and seeking normalisation in returning to an ordinary life (I). Thecouples´ thoughts about their future lives were either optimistic, taking an activeapproach, or pessimistic, taking a wait‐and‐see approach. The couples could bedivided into four positions in terms of their visions of the future: life companions,who were in concordance regarding their future; tightrope walkers, who had incommon a need to reprioritise what they considered important in their future;pathfinders, who had in common an undefined vision of their future and observers, who saw their future including both physical as well as sociallimitations (II). Self‐rated hope and HRQoL both improved over time, but few ofthese improvements were statistically significant, and I found no statistically groupeffects. Estimation of the MDC index revealed that neither HHI‐S nor SF‐36measures stable traits (III). Finally, the repeated interviews revealed how thecouples viewed their daily life, mutual relationships and roles in their relationshipVIIover time. There was an abundant variation in a number of the couples´ storiesabout their relationship and daily life during the recovery period (IV).In conclusion, it is clear that what happen to one party in a relationship influencesthe other party. The couples in the studies showed improvements in both hope andhealth‐related quality of life over time. The HHI‐S and SF‐36 measures seemed tobe sensitive to and affected by the current situation. Going through an AMI is alife‐changing event that makes it necessary for the couple to make adjustments andadapt to their new situation. Different couples have different approaches tohandling this situation; no two couples are the same, and every couple willperceive and deal with the AMI differently. An AMI starts a process of transition,and over time a couple affected by AMI will undergo external as well as internal changes. / Avhandlingens övergripande syfte var att undersöka återhämtning i parrelation efter hjärtinfarkt. Ett ytterligare syfte var att jämföra skillnader avseende hopp och hälsorelaterad livskvalitet över tid men också emellan patienter och deras partners.Avhandlingen baseras på fyra delstudier (I‐IV), och har en longitudinal designmed både kvalitativa och kvantitativa metoder. Ett ändamålsenligt urval av 15 par rekryterades där en i parrelationen diagnostiserats med akut hjärtinfarkt. DelstudieI genomfördes med individuella bandinspelade intervjuer med syfte att beskrivapatienter och deras partners erfarenheter efter utskrivning från sjukhus eftergenomgången hjärtinfarkt. Delstudie II använde också individuella bandinspelade intervjuer, den här gången med syfte att beskriva och tolka parens tankar ochförväntningar kring deras framtid efter att patienten skrivits ut från sjukhus.Delstudie III använde instrumenten HHI‐S och SF‐36 för att jämföra skillnader av självskattat hopp och hälsorelaterad livskvalitet över tid och emellan patienter och deras partners. Delstudie IV använde upprepade bandinspelade intervjuer medsyfte att tolka parens berättelser kring deras relation och det dagliga livet. Data haranalyserats och tolkats med kvalitativ innehållsanalys på olika sätt (I,II,IV) ochmed såväl deskriptiv som jämförande statistik (III).Avhandlingen visar att parens återhämtning efter hjärtinfarkt under en period avtvå år omfattar en strävan efter att uppnå någon form av balans och stabilitet i denrådande livssituationen. Perioden efter utskrivning från sjukhus innebar enförståelse för hur viktigt hemmet är som plats för att känna sig hemma eller för att skapa en känsla av trygghet samt erfarenheter av fenomenet trygghet och attkänna sig hemma i sig själv. Slutligen sökte paren efter normalisering för att återkomma till det vanliga livet (I). Parens tankar kring deras framtid var antingenoptimistisk, en aktiv inställning, eller pessimistisk, en vänta ‐ och ‐ se inställning.Paren kunde också grupperas i fyra positioner som beskrev deras visioner omframtiden. De som kallades livskamrater syntes vara i samklang vad gällde återhämtning, balanskonstnärerna hade gemensamt ett behov av att omprioriter a vad som var viktigt för framtiden, de som var gemensamt för de som kallades stigfinnare var deras odefinierade/oklara bild av framtiden och slutligenobservatörerna såg sin framtid omfatta såväl fysiska som sociala begränsningar(II). Både självrapporterat hopp och hälsorelaterad livskvalitet förbättrades övertid, men få av dem var statistiskt signifikanta och inga statistiska gruppeffekterhittades. Beräkning av MDC index visade att varken HHI‐S eller SF‐36 mäterstabila dimensioner (III). Slutligen visade de upprepade intervjuerna hur paren sågpå dagligt liv, den inbördes relationen och roller i relationen över tid. Det fanns enIXrikedom av variationer i parens berättelser om deras relation och det dagliga livetunder återhämtningsprocessen (IV).Till sist framträder det klart att det som händer den ene i relationen fårkonsekvenser för den andre. Paren i studierna visade på att det skeddeförbättringar vad gäller både hopp och hälsorelaterad livskvalitet över tid. BådeHHI‐S och SF‐36 är instrument som synes vara känsliga för och påverkade av denrådande situationen. Att gå igenom en hjärtinfarkt är en livsavgörande händelsesom fodrar att paren ställer in sig på och gör anpassningar till en ny situation.Paren har dock olika sätt att handskas med den nya situationen och det finns intetvå par som är lika, och inte heller uppfattar och hanterar de hjärtinfarkten i vardagen och i relationen på samma sätt. En hjärtinfarkt startar en transitionsprocess och över tid genomgår paren såväl yttre som inre förändringar.

Die koronare Herzkrankheit ist trotz wachsendem Lebensstandard und aller präventiven medizinischen Maßnahmen nach wie vor von hoher medizinischer und ökonomischer Bedeutung. Die Akutform stellt das akute Koronarsyndrom dar. Komplizierend kann sich im Rahmen eines akuten Koronarsyndroms ein kardiogener Schock manifestieren, welcher die häufigste Todesursache für Patienten mit akutem Myokardinfarkt nach Aufnahme ins Krankenhaus darstellt. Ziel dieser Arbeit war die Identifizierung von Risikofaktoren für die Krankenhaus- sowie Langzeitmortalität bei der chirurgischen Revaskularisation von Patienten mit akutem Koronarsyndrom und komplizierendem kardiogenen Schock. Wir führten hierfür eine retrospektive Datenanalyse an 302 konsekutiven Patienten durch, welche im akuten Koronarsyndrom und kardiogenen Schock mittels aortokoronarer Bypassoperation therapiert wurden. Insgesamt wurden 44 präoperative, 18 intraoperative und 28 postoperative binäre Items analysiert. Wir konnten zeigen, dass bei den Höchstrisiko-Patienten die Letalität stark vom präoperativen Risikoprofil und dem Ausmaß des kardiogenen Schocks abhängt. Insbesondere der präoperative Einsatz einer IABP sowie die Verwendung der linken Arteria mammaria als Bypassgefäß wirkten sich positiv aus. Das gute Langzeit-Ergebnis demonstriert den Benefit einer chirurgischen Revaskularisation bei den Patienten mit akutem Koronarsyndrom und kardiogenen Schock mit anderenfalls schlechter Prognose.

ABSTRACT THE EXAMINATION OF FACTORS THAT INFLUENCE TREATMENT SEEKING DELAY AMONG OLDER ADULTS DIAGNOSED WITH ACUTE MYOCARDIAL INFARCTION By Deonna S. Tanner Early diagnosis and treatment of acute myocardial infarction (AMI) can greatly reduce the morbidity and mortality associated with this condition. However, individuals, particularly older adults, delay seeking treatment for AMI symptoms. The purpose of this study was to examine the relationship of factors that influence pre-hospital delay in seeking treatment among older adults diagnosed with AMI. A descriptive, cross-sectional, comparative study design with a correlational component was used. Data were collected from 82 hospitalized older adults (60-80 years of age). For statistical analyses, older adults were divided into two groups. The shorter delay group delayed ≤ 120 minutes from the onset of symptoms (OS) and the longer delay group delayed > 120 minutes. Using the Common Sense Model as a guide, groups were compared on the following variables: internal influences (age, gender, race, history of AMI) and external influences (personal and professional support), cognitive representations of symptoms (symptom interpretation, perceived level of control, seriousness), and emotional representations of symptoms (anxiety and uncertainty). The majority of participants were retired/unemployed (64.6%) White men (82.9%) who were married (73.2%) with a mean age of 69.04 (± 5.82) years. The median delay time was 2.6 hours (range 0.5 - 432 hours). Participants experienced on average eight (± 3.86) symptoms (typical and atypical) with high levels of pain (M= 7.1 ± 3.4) and high state anxiety (M = 56.47 ± 10.37) at the time of the AMI. Findings show the only significant independent predictor of delay time was personal support. Being more certain that symptoms were heart related or having a previous AMI resulted in significantly shorter delay time (p <.05). Contacting a healthcare provider was not helpful for these older adults. Findings show factors influencing delay are challenging and complex, yet laypersons play an important role in the decision to seek treatment. Future research should include community-based educational programs focusing on atypical AMI symptoms and ways to increase the activation of emergency medical services soon after the OS.

Detection of coronary calcification from computed tomography scans is a noninvasive examination and has great potential for heart disease diagnosis. This study proposes new features to characterize calcium lesions. Different from the traditional calcium score features, these features are generated from the texture, shape, and gray level statistics of the calcium lesions. We study the correlation between these features and acute myocardial infarction and then compare the results with traditional calcium score features. According to the location of the lesions, patients are first divided into two groups. In one group, the myocardial infarction is located in segment of culprit lesion. For the second group, myocardial infarction is located in segment of non-culprit lesion. In comparing their means, the corresponding p-value of gray level statistics feature ¡§histogram relative smoothness¡¨ could reach 4.47E-07, which has fairly high significance. Furthermore, in studying the differences among patients, experiment on Hypercholesterolemia provide a good result. By comparing the means of patients which are classified into Hypercholesterolemia and non-Hypercholesterolemia groups, the corresponding p-value of texture feature ¡§inverse difference moment¡¨ could reach 3.74E-04. Initially, acute myocardial infarction do not have statistically significant result However, after adding the location weighting factor for the lesions, the corresponding p-value of texture feature ¡§average of information measures of correlation¡¨ could be reduced to 8.8921E-03, and p-value of gray level statistics feature ¡§Histogram relative Smoothness¡¨ could be improved to 2.4019E-02.