Kvantifisering av hjertets muskelfunksjon med tøyning og tøyningshastighet målt med ultralyd for vurdering av koronar sykdom. Automatisert metode versus manuell ved akutt hjerteinfarkt og ultralyd stress test. Vanligvis måles hjertets muskelfunksjon med ultralyd, en mye brukt metode for å diagnostisere hjertesykdommer. Vurderingen av muskelfunksjonen baserer seg i dag på en subjektiv visuell gradering av bevegelsen av hjertemuskelen, og dette krever erfaring. En ny automatisert diagnostisk ultralydsmetode basert på måling av hastigheten i hjertemuskelen gir et kvantitativt mål på muskelens tøyning og sammentrekning. Den nye metoden gir ny og mer detaljert informasjon om hjertets funksjon og om pasientens prognose enn vanlig ultralydsvurdering. Den nye metoden er mer presis ved oppfølgning etter hjerteinfarkt. Et hjerteinfarkt gir nedsatt bevegelse av muskelen og måles med den nye metoden som nedsatt hastighet som muskelen forkortes med. Små forandringer i den skadde hjertemuskelen, ikke alltid synlige for øyet, kan mer nøyaktig følges over tid med den nye metoden. Utbredelsen av hjerteinfarktet kan også vurderes mer nøyaktig. Det samme gjelder når angina vurderes under belastning. Når en pasient ikke kan sykle eller gå på tredemølle brukes en medisinsk belastningstest. Ved å belaste hjertet med et medikament som øker hjertemuskelens arbeid samtidig med en ultralydundersøkelse, kan vi oppdage redusert blodforsyningsreserve i hjertet. Stresstesten hjelper til med å vurdere om en trang blodåre bør åpnes etter et hjerteinfarkt, og til å vurdere pasienters risiko for hjertekomplikasjoner før en større operasjon. Den nye metoden gir i tillegg mer informasjon om den langsiktige prognosen sammenlignet med den gamle metoden. Vi har funnet at den nye ultralydsmetoden er mer presis (gir større diagnostisk treffsikkerhet i diagnostikk av koronarsykdom) sammenlignet med den gamle. Måling av sammentrekningshastigheter i hjertemuskelen ble utviklet og testet på Institutt for sirkulasjon og bildediagnostikk ved NTNU av Andreas Heimdal og Asbjørn Støylen i 1998. Metoden trengte teknisk videreutvikling og testing i et større pasientmateriale. Metoden har ikke fått stor utbredelse på sykehusene pga støyfylte kurver og tidskrevende analyser, men med denne automatiserte metoden blir brukervennligheten større som muliggjør klinisk bruk. / Paper I and II preprinted with kind permission of Elsevier, sciencedirect.com

Uppsatsens syfte är att undersöka vilka ekonomiska effekter införandet av distansuppföljning för ICD-patienter har ur ett samhällsperspektiv. Delsyftet är att identifiera ekonomiska argument och kvalitativa aspekter för och emot införandet av tjänsten distansuppföljning. Författarna har kommit fram till ett antal slutsatser. Att införa distansuppföljning som uppföljningsmetod för ICD-patienter istället för konventionella återbesök på sjukhus innebär stora kostnadsbesparingar. Nettonuvärdet uppgår till drygt 268 miljoner kronor efter femton år. Vid tidsperiodens slut erhålls en kostnadsbesparing på cirka 35,6 procent. De ekonomiska fördelarna överstiger kostnaderna redan efter ett år, och hela investeringskostnaden återfås efter sju år. Kvalitativa argument som talar för distansuppföljning är tidsbesparingar, förenklad uppföljning, bättre övervakning och att patienterna upplever en större trygghet.

Includes vita. / Title from PDF of title page. / Document formatted into pages; contains 103 pages. / Thesis (Ph.D.)--University of South Florida, 2003. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: The goal of this study was to examine differences in the psychological characteristics of patients admitted to the hospital for acute or chronic Myocardial Infarction (MI) or Unstable Angina (UA). Depression, anger, anxiety, curiosity, defensiveness, social support, and coping were evaluated for 165 patients (86 MI and 79 UA), who were tested on the Cardiology Stepdown Ward of Tampa General Hospital. The following psychological measures were administered to these patients: the Beck Depression Inventory (BDI), the State-Trait Anger Expression Inventory (STAXI-2), the Rationality/Emotional Defensiveness (R/ED) Scale, the Adult Form of the Coping Responses Inventory (CRI-Adult), the Interpersonal Support Evaluation List (ISEL), the Illness Perception Questionnaire (IPQ), the State-Trait Personality Inventory (STPI), and the Structured Clinical Interview (SCID-I) for the DSM - IV. Significantly more chronic patients than acute patients met criteria for depression as measured by the SCID following admission to the hospital, and more UA than MI patients also met these criteria. However, no differences were found between the acute and chronic MI and UA patients two weeks prior to admission. Results of this study also indicated that chronic patients and UA patients reported a greater frequency of illness symptoms and tended to cope with their heart disease through avoidant strategies. Chronic patients endorsed higher levels of state and trait anger compared with acute patients, and UA patients were less likely to believe that their illness could be cured or controlled (Control of Cure) than MI patients. Based on the results of this study, it appears that avoidance coping may be an insufficient strategy for addressing negative emotions of chronic patients and UA patients. In addition, perceived lack of control over the success of treatment may be related to depression for UA patients. These findings have important implications for the development and implementation of interventions designed to address perceived control over treatment effectiveness and coping skills for negative emotions in the treatment and rehabilitation of cardiac patients. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

Thesis (M.S.)--Florida State University, 2004. / Advisor: Dr. Yousef Haik, Florida State University, College of Engineering, Dept. of Mechanical Engineering. Title and description from dissertation home page (viewed June 16, 2004). Includes bibliographical references.

The goal of this study was to examine differences in the psychological characteristics of patients admitted to the hospital for acute or chronic Myocardial Infarction (MI) or Unstable Angina (UA). Depression, anger, anxiety, curiosity, defensiveness, social support, and coping were evaluated for 165 patients (86 MI and 79 UA), who were tested on the Cardiology Stepdown Ward of Tampa General Hospital. The following psychological measures were administered to these patients: the Beck Depression Inventory (BDI), the State-Trait Anger Expression Inventory (STAXI-2), the Rationality/Emotional Defensiveness (R/ED) Scale, the Adult Form of the Coping Responses Inventory (CRI-Adult), the Interpersonal Support Evaluation List (ISEL), the Illness Perception Questionnaire (IPQ), the State-Trait Personality Inventory (STPI), and the Structured Clinical Interview (SCID-I) for the DSM - IV. Significantly more chronic patients than acute patients met criteria for depression as measured by the SCID following admission to the hospital, and more UA than MI patients also met these criteria. However, no differences were found between the acute and chronic MI and UA patients two weeks prior to admission. Results of this study also indicated that chronic patients and UA patients reported a greater frequency of illness symptoms and tended to cope with their heart disease through avoidant strategies. Chronic patients endorsed higher levels of state and trait anger compared with acute patients, and UA patients were less likely to believe that their illness could be cured or controlled (Control of Cure) than MI patients. Based on the results of this study, it appears that avoidance coping may be an insufficient strategy for addressing negative emotions of chronic patients and UA patients. In addition, perceived lack of control over the success of treatment may be related to depression for UA patients. These findings have important implications for the development and implementation of interventions designed to address perceived control over treatment effectiveness and coping skills for negative emotions in the treatment and rehabilitation of cardiac patients.

Magistro darbe yra analizuojamas sergamumas širdies ir kraujagyslių ligomis, ligonių, sergančių nestabilia krūtinės angina ir ūmiu miokardo infarktu, srautai į Šiaulių apskrities gydymo įstaigas, įvertintos Šiaulių teritorinės ligonių kasos lėšos, skirtos šių įstaigų stacionarinių ir ambulatorinių kardiologinių paslaugų apmokėjimui, numatytas lėšų poreikis 2010 m. Išsamiai pateikti finansinio sveikatos priežiūros strateginio valdymao principai, Lietuvos nacionalinė sveikatos politika širdies ir kraujagyslių ligų atžvilgiu bei širdies ir kraujagyslių sistemos ligų paplitimo ir jų pasekmių mažinimo strateginės nuostatos Šiaulių apskrityje. Kardiologinės pagalbos situacija Šiaulių apskrityje apibūdinama teiginiais: Šiaulių apskrities ligoninėse stacionarinis sergamumas nestabilia krūtinės angina ir ūmiu miokardo infarktu bei ligonių srautai į šias ligonines turi tendenciją didėti; intervencinės kardiologinės pagalbos apimtis Šiaulių apskrities ligoninėje didėja ir turi poreikį didėti; visose Šiaulių apskrities ligoninėse lėšos, skirtos vienam NKA ir ŪMI atvejui gydyti, didėjo, tačiau neproporcingai atskiroms ligoninėms. Kardiologinę pagalbą Šiaulių apskrityje galima tobulinti šiomis priemonėmis: Šiaulių apskrities gydytojo tarnyba turi parengti apskrities sveikatos programą su prioritetine širdies ir kraujagyslių ligų sritimi, kurioje būtų numatyti veiksmai ir priemonės sergamumo ir mirtingumo mažinimui, kardiologinės pagalbos struktūros ir organizavimo tobulinimui; didesnį... [toliau žr. visą tekstą] / In the present work different characteristics of patients with instable ischemic hearth disease and acute myocardial infarction in Hospitals of Siauliai County are analyzed. Additionally, the financial resources expenses for inpatient and outpatient and the predicted asset allocation (up to year 2010) for healthcare services devoted for cardiovascular patient are calculated. In addition, the present work deals with principles of financial healthcare management, the national Lithuanian healthcare politics and strategic directions for cardiovascular disease epidemiology and consequences in Šiauliai County. Not only the number of patients with cardiovascular complaints associated to ischemic hearth disease but also necessity for interventional cardiology procedures exhibits a clear tendency to increase. Consecutively, the money spend on a single case of acute ischemic hearth disease per patient has also increased. However, there were differences of expenses per patient among single hospitals within the County. Here presented data points to several opportunities for optimization of the treatment of cardiovascular patients in Šiauliai County. First, the committee of physicians of Šiauliai County should prepare a healthcare program that treats the cardiology aid as a first priority field and defines specific actions to reduce the morbidity and mortality of cardiovascular disease. In addition, the structure and organization of cardiology aid should be improved by redirecting most... [to full text]

This thesis presents the first work, to our knowledge, to evaluate the potential of Optical Coherence Tomography (OCT) as an intravascular imaging modality to characterize and guide interventions on chronic total occlusions (CTOs) in arteries. An ex vivo imaging study using OCT is presented that characterizes various pathologies associated with peripheral CTOs and illustrates the ability to differentiate between the vessel wall and the occluded lumen. We also found that, while OCT could image approximately 1mm through tissue, it was effective for imaging deeper through clarified microchannels seen within the occluded lumen. While others had reported observing such microchannels within the lumen before, little was known about the global architecture of these channels. This motivated a study of the global morphology of microchannels in occlusions using micro computed tomography (microCT). In this microCT study, we found that microchannels within the occluded lumen of the artery appeared to be continuous over several millimeters. However, these channels also exited the artery frequently, suggesting the need for some form of imaging guidance. As a potential intravascular imaging set-up, a forward-viewing OCT catheter was built. This catheter uses a novel scanning mechanism that combines high voltage and a dissipative polymer to achieve fast compact actuation. Doppler OCT results are presented using this catheter to image flow in the forward direction. Doppler OCT imaging of microchannels in vivo is also shown in a surgically exposed occluded artery in situ.

This thesis presents the first work, to our knowledge, to evaluate the potential of Optical Coherence Tomography (OCT) as an intravascular imaging modality to characterize and guide interventions on chronic total occlusions (CTOs) in arteries. An ex vivo imaging study using OCT is presented that characterizes various pathologies associated with peripheral CTOs and illustrates the ability to differentiate between the vessel wall and the occluded lumen. We also found that, while OCT could image approximately 1mm through tissue, it was effective for imaging deeper through clarified microchannels seen within the occluded lumen. While others had reported observing such microchannels within the lumen before, little was known about the global architecture of these channels. This motivated a study of the global morphology of microchannels in occlusions using micro computed tomography (microCT). In this microCT study, we found that microchannels within the occluded lumen of the artery appeared to be continuous over several millimeters. However, these channels also exited the artery frequently, suggesting the need for some form of imaging guidance. As a potential intravascular imaging set-up, a forward-viewing OCT catheter was built. This catheter uses a novel scanning mechanism that combines high voltage and a dissipative polymer to achieve fast compact actuation. Doppler OCT results are presented using this catheter to image flow in the forward direction. Doppler OCT imaging of microchannels in vivo is also shown in a surgically exposed occluded artery in situ.

Objective: To determine the role of candidate gene polymorphisms in patients who sustained myocardial infarction at a young age and examine their relationship, if any, to risk factors. Since angiotensin II is known to play a pathophysiological role at the myocardial and vascular level, the genes to be studied are those regulating the renin angiotensin system and tissue metabolism. Design: The risk factors and genetic profile is described in 117 young Indians with myocardial infarction recruited over a period of thirty months (Dec 1997 - Jun 1999). Controls comprised 80 normal subjects with no clinical evidence of coronary heart disease (CHD) and with a normal effort response. The key features of this study are the selection of young subjects with myocardial infarction, (mean age 43 ± 6.8 years) in whom the possibility of a genetic basis for the disease was felt to be more likely since the confounding effect of age as a risk factor was reduced. Setting: Patients recruited 3 -12 months after myocardial infarction from Addington Hospital, Durban. This hospital subserves the Indian community in the north of Durban. The majority of patients were from the Phoenix settlement area. Results: 1. The clinical profile of the young Indian with myocardial infarction is a young man, slightly overweight with a high prevalence of risk factors, particularly smoking and diabetes, coupled with sedentary behaviour and risk-prone dietary patterns characterised by high red meat intake and low fruit and vegetable consumption, resulting in increased BMI and W/H ratios. 2. There were no differences in the patterns of gene polymorphism in the reninangiotensin system between the study and control groups. This finding extended across all candidate gene loci studied i.e. those involving aldosterone, G-protein, TGF-B and homocysteine metabolism. Serum triglycerides, haemoglobin AlC and urine microalbumin levels were elevated in the probands together with low HDL-C levels (p = 0.001). 3. A striking finding of this study was the substantial proportion of patients found to have diabetes mellitus, totalling 47% of the proband group. Of the 53 diabetic patients, (45 males and 8 females) four (3 males, 1 female) had impaired glucose tolerance. Cigarette smoking, a positive family history of hypertension/diabetes and a family history for premature CHD emerged as important risk predictors for MI. Conclusion: This study, the first to report candidate gene polymorphisms in young Indians with coronary heart disease, has shown no obvious association between the genetic loci studied and acute myocardial infarction. Instead a high prevalence of risk factors, particularly smoking and diabetes mellitus, coupled with coronary-prone behavioural patterns was observed. In the light of these findings, genome-wide screening of unaffected siblings of subjects with early onset CHD cannot be recommended in this population until common polymorphisms can be clearly identified as risk factors. Indeed this study again supports the dire need for early, school level, education in behavioural lifestyle patterns and disease predisposition. The Indian community is a very high-risk group who should be targeted, not for secondary, but for primordial disease prevention measures. The study does not rule out the role of other candidate gene polymorphisms in the pathogenesis of CHD in these subjects. The high prevalence of diabetes and insulin resistance suggests that studies of genes regulating glucose and lipid metabolism should be pursued. Such candidate genes should include genes for lipoprotein lipase and paraoxonase polymorphisms which may explain the dyslipidaemia patterns in this group. / Thesis (Ph.D.)-University of Natal, Durban, 2000.

Pulmonary dysfunction following cardiopulmonary bypass surgery is a widely explored complication and a multitude of factors have been implicated, including but not limited to: operative trauma; the cardiopulmonary bypass circuit; cardioplegia; the type of donor grafts utilised; anaesthesia and fluid administered. There is a paucity of information regarding the effect of cardioplegia on the lungs. No studies have previously investigated whether allowing cold-blood cardioplegic solution to enter the lung parenchyma, during the period of cardioplegia delivery, has an effect on the clinical outcome of lung function following cardiopulmonary bypass surgery. For this reason an original study was done to determine the effect of preventing cardioplegia from entering the lungs, by evacuating overflow of cardioplegia not drained via the atriocaval cannula, by using a pulmonary artery vent. A total of 403 patients admitted to undergo full cardiopulmonary bypass were screened and 142 patients who fitted the criteria for inclusion and provided informed consent took part in this prospective double blind randomised clinical trial. The control group underwent routine cardiopulmonary bypass grafting. The study group had the intervention of a pulmonary artery vent sutured in position at the time the heart was cannulated for bypass. During cardioplegia delivery the cardioplegia was removed via the atriocaval cannula in the control group (A) and via the atriocaval cannula and the pulmonary artery vent in the study group (B). Aside from this difference, the two groups were managed identically intra- and post-operatively. Outcomes which were compared included eight time measures of arterial blood gases; electrolytes and shunt fraction; bedside lung spirometry measures over five time periods; radiographic measures of atelectasis and effusion over three time points; as well as physiotherapy and hospitalisation requirements. Numerous other potentially extraneous variables were measured and compared in order to monitor homogeneity of the study samples. The consistency of the results within each group throughout the study provides strong evidence that the measurements taken were accurate. The use of standardised equipment and vigilant adherence to the protocol ensured no extraneous deviation. The internal validity of this study was therefore good and accurate. The findings of the study however brought into question a previously accepted belief that the pulmonary artery vent prevents the overflow of cardioplegia, not drained from the right atrium, from entering the lungs. There was no literature or previous studies to confirm or dispute this accepted ‘observation’ by cardiac surgeons that the cardioplegia does enter the lung parenchyma. To therefore validate the findings of the study a further four original studies were designed and initiated. The objective of these studies was to establish the efficacy of the pulmonary artery vent and to determine whether cardioplegia indeed circulates through the lung parenchyma or merely accumulates and ‘pools’. Technetium (Tc-99m), a radio labelled isotope was added to the cold blood cardioplegia solution prior to delivery in order to determine this. In the four sub-studies it was confirmed that the pulmonary artery vent is 90-100% effective in retrieving any cardioplegic solution not drained by the atriocaval cannulae, thus confirming the effectiveness of the pulmonary artery vent in preventing cold blood cardioplegic solution from entering the lungs. The findings of the main study confirmed that respiratory impairment after uncomplicated cardiopulmonary bypass, even in low risk patients, is relatively common, as within each group there was a significant change in outcome measures over time. Inter-group comparisons however showed these changes were not significant, with both groups deteriorating by the same degree post-operatively, therefore establishing that these changes were independent of the intervention of the pulmonary artery vent. In the control group, the cold blood cardioplegia solution that did not drain from the atriocaval cannula entered the lungs and circulated the lung parenchyma during cardiopulmonary bypass. The study group made certain that none, or very little, of the cold blood cardioplegia solution entered the lungs. The main findings of this study are therefore that pulmonary function and gas exchange, although markedly reduced following cardiac surgery, are not affected by placement and suctioning via a pulmonary artery vent during the time of cardioplegia delivery intraoperatively. Furthermore, these studies strongly suggest that cold blood cardioplegia solution is innocuous to the lungs / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2006.