Bakgrund: Hjärtsvikt har dålig prognos och drabbar ett stort antal människor i Sverige. De som drabbas upplever många problematiska symtom och medicineringen har många biverkningar som kan vara svåra att leva med. Obehagliga känslor kan förvärra symtom hos personer med hjärtsvikt. Sjuksköteskan bör kunna identifiera känslor och förstå varför dessa uppstår hos personer med hjärtsvikt för att bättre kunna vårda dessa. Syfte: Syftet är att beskriva hur personer som lever med hjärtsvikt beskriver sina känslor. Metod: Elva vårdvetenskapliga artiklar analyserades med inspiration från Evans metod för systematiska litteraturstudier. Nyckelfynd sammanfördes och bildade två huvudteman och nio subteman. Resultat: Resultatet indikerade att de finns många känslor associerade med hjärtsvikt. De delades in i positiva och negativa känslor. Känslor som riktar sig utåt, känslor som framkallas av hot, känslor av skuld, känslor av saknad, känslor inför det okända, känslor kring beroende, känslor kring uppskattning av livet, känslor kring säkerhet och positiva känslor om framtiden framkom som subteman. Slutsats: Denna uppsats berikar bilden av känslorna hos personer med hjärtsvikt. Sjuksköterskor bör använda denna kunskap för att på ett bättre sätt främja hälsa. Det framkom slutligen att det behövs mer forskning kring genus och känslor. Nyckelord: Hjärtsvikt, kvalitativ litteraturstudie, känslor, negativa, positiva / Background: A major number of people in Sweden suffer from heart failure and often succumb to the poor prognosis associated with the disease. Experiences among the affected include the various negative symptoms that heart failure generates as well as side effects from medical treatment. Such side effects may be difficult to deal with. Unpleasant emotions can worsen symptoms in people that have heart failure. Nurses should be able to identify these emotions and understand why they emerge in people that have heart failure as a means to better care for them. Aim: The aim is to describe how people living with heart failure describe their emotions. Method: Eleven scientific nursing articles were analyzed using Evans systematic method for reviewing literature as inspiration. Key findings were brought together and formed two major themes and nine sub-themes. Result: The result indicated numerous emotions associated with heart failure. They were divided into positive and negative emotions. Emotions that are extrovert, emotions caused by threat, emotions of guilt, emotions of loss, emotions facing the unknown, emotions encompassing dependency, emotions encompassing appreciation of life, emotions encompassing security and positive emotions concerning ones future appeared as sub-themes. Conclusion: This body of work provides a better picture of the emotional outcomes associated with heart failure. Nurses should use this knowledge to better promote health. Finally it emerged that more research concerning gender and emotion are needed. Keywords: Emotions, heart failure, negative, positive, qualitative literature review

The progress of chronic disorders such as heart failure and chronic obstructive pulmonary disease affects various aspects of life. They have an deep impact on patients´experience of health and wellbeing and their functional qualities and quality of life. Several studies have in an extensive way described heart failure and chronic obstructive pulmonary disease in its own domain but few qualitative studies consider coexistence of the disorders from a caring science perspective. The aim was to describe the meaning of living with heart failure and chronic obstructive pulmonary disease from a lifeworld perspective. With a phenomenological and reflecting lifeworld approach it´s possible to describe eight patients daily experiences of living with severe and chronic disorders from their own narratives. A general structure describing the phenomenon emerges from the analysis as an acceptance of an unpredictable and changed situation in life. When bodily strengths are balanced and adjusted due to the condition of the disorders harmony will appear in life. The phenomenon´s general structure is illustrated through five constituents; the failing body, make sacrifice, living the life that exist, placing one´s life in the hands of others and to lose one´s identity.

Purpose: Patients living with advanced heart failure experience dyspnea, fatigue, poor quality of life, depression and cognitive impairment which may threaten their ability to provide informed consent to undergo heart transplant (HTx) or mechanical support (LVAD). Using qualitative and quantitative methods, we asked how patients with advanced heart failure make decisions regarding HTx and LVAD. The variables chosen to reflect the elements of consent included quality of life and symptom severity (voluntariness), depression and cognitive impairment (capacity) and treatment preferences (decision-making). Methods: 76 patients enrolled in the quantitative arm completed the Minnesota Living with Heart Failure Questionnaire; Visual Analog scales for dyspnea, fatigue and overall health; Beck Depression Inventory; Montreal Cognitive Assessment; Standard Gamble and Time Tradeoff. Qualitative methods were used to discover concepts, relationships and decision-making processes described by 17 of the 76 patients considering HTx and LVAD. Results: Patients reported poor quality of life and high symptom severity scores which compelled them to consider surgery as a way to relieve unpleasant symptoms and improve quality of life. Although 30% of patients had evidence of depression and/or cognitive impairment, no patient was deemed incapable of decision-making. Patients were willing to take considerable risk (35%) and trade considerable time (4months) to improve their health. While heart failure-related concepts were important to the decision, entrustment emerged as the meaningful process for decision-making. Conclusions: Patients who participated in this study were capable of decision-making and understood the risks associated with the surgery. Voluntariness was diminished by disease but not absent, and decisions were free of coercion. These results suggest the entrustment model of decision-making is the dominant process for patients considering high-risk surgical procedures and meets criteria for informed consent. Understanding the process of decision-making will help clinicians support and enable treatment decisions made by patients living with advanced heart failure.

The overall aim of this thesis was to describe the prevalence of depressive symptoms, sleep disordered breathing (SDB) and sleep complaints, as well as to investigate the prognostic value of health-related quality of life (Hr-QoL) and depressive symptoms on mortality in an elderly community living population with a focus on those with impaired systolic function/heart failure (HF). Descriptive, prognostic and explorative study designs were used to examine if a single question about global perceived health (GPH) is associated with the domains of Hr-QoL as assessed by the SF-36 (I), as well as to evaluate whether GPH provided prognostic information concerning cardiovascular mortality (II). The aim was also to evaluate if depressive symptoms are associated with mortality (III), and to describe the prevalence of SDB and its relationship to impaired systolic function, different insomnia symptoms, as well as excessive daytime sleepiness (IV). In primary care elderly patients with HF, GPH correlated to the physical and mental aspects of Hr-QoL. Patients who rated poor GPH also scored worse physical and mental Hr-QoL compared to patients with good GPH, but the mental aspect of Hr-QoL was however not significant (p<0.07) (I). Moreover, GPH also had an independent association with cardiovascular mortality during a ten-year follow-up. Compared to patients with good GPH, those who scored poor GPH had a four times increased risk for cardiovascular mortality (II). A total of 24% of the patients with HF suffered from depressive symptoms, not significantly different compared to 19% among those without HF. Depressive symptoms were a poor prognostic sign during the six-year follow-up and HF patients with depressive symptoms had the highest risk for cardiovascular mortality compared to HF patients without depressive symptoms (III). SDB is common among elderly people living in the community, almost one quarter (23%) had moderate or severe SDB. However, people with moderate impaired systolic function had a median apnea hypopnea index that was more than twice as high compared to those with normal systolic function (10.9 vs. 5.0, p<0.001). No obvious associations between SDB and excessive daytime sleepiness or the insomnia symptoms; difficulties maintaining sleep; non-restorative sleep; or early morning awakenings were detected. Difficulties initiating sleep were however more common in those with moderate or severe SDB (IV). GPH can be used as a simple tool in clinical routine practice as an aid in identifying patients in need of additional management. SDB is a common phenomenon among elderly people and associated with impaired systolic function, but with a limited impact on subjective sleep complaints. Depressive symptoms were shown to be a poor prognostic sign and may amplify the patient’s experience of suffering. Screening for depressive symptoms could therefore be an important action in the management of patients with HF.

No description available.

Bakgrund: Majoriteten av de epidemiologiska studierna visar på en ökning av hjärtsvikt över hela västvärlden. I takt med att antalet patienter med hjärtsvikt ökar kommer också vårdpersonalens behov av att förstå hur hjärtsviktspatienter lever med sjukdomen att öka, vilket är en förutsättning i processen för patienten att anpassa sig till sjukdomen och dess påverkan på det dagliga livet.Syfte: Syftet med denna studie är att beskriva hur patienter med hjärtsvikt upplever att sjukdomen påverkar det dagliga livet.Metod: Litteraturbaserad studie med grund i kvalitativ forskning som följer Friberg (2006) metod för analys där 14 artiklar granskades.Resultat: Fem teman identifierades: (1) en ny och osäker situation, (2) förändringar i patientens psykiska och fysiska förmågor, (3) förändringar i det sociala livet, (4) anpassning och acceptans i situationen med ny mening och identitet, (5) ångest kring döden och sjukdomens oförutsägbara natur. Att leva med hjärtsvikt karakteriserades av påfrestande symtom, begränsningar av de dagliga aktiviteterna, förändringar i sin identitet och det sociala livet samt ångest kring döden och sjukdomens oförutsägbara natur.Slutsats: Upplevelse av hälsa och livskvalitet är individuellt. Tydlig information om sjukdomen och egenvård till patienten är nödvändigt för bättre kontroll, upplevelse av hälsa och livskvalitet. / Background: The majority of the epidemiological studies show that heart failure is increasing all over the Western world. The increase of patients with heart failure increases the need for healthcare to understand how patients live with this disease, which is important in the process for the patients to adjust to the distressing illness experience.Aim: The aim of this study is to describe patient's with heart failure experience how their disease affect their daily life.Method: Literature based study with qualitative research that follows Friberg (2006) method of analyzing which 14 articles were reviewed.Result: Five themes was identified: (1) a new and uncertain situation, (2) changes of patient’s psychological and physical abilities, (3) changes of the social life, (4) adjustment and acceptance of the situation with new meaning and identity, (5) anxiety about death and the unpredictable nature of the disease. Living with heart failure was characterized by distressing symptoms, restrictions in daily life, changes in social life and their identity, and anxiety about death and the unpredictable nature of the disease.Conclusion: The experience of health and quality of life is individual. Distinct information about the disease and self care to the patient is needed for improved control, experience of health and quality of life.

Ένας μεγάλος αριθμός μελετών παρατήρησης καθώς και τυχαιοποιημένων ελεγχομένων κλινικών δοκιμών έχει πλέον τεκμηριώσει την ασφάλεια, την αποτελεσματικότητα, καθώς και τις μακροπρόθεσμες επιδράσεις της θεραπείας καρδιακού επανασυγχρονισμού (ΘΚΕ) σε ασθενείς με προχωρημένη καρδιακή ανεπάρκεια, επηρεασμένη συσταλτικότητα της αριστεράς κοιλίας (ΑΚ) και ευρύ σύμπλεγμα QRS. Οι περισσότερες τυχαιοποιημένες κλινικές μελέτες με ΘΚΕ αναφέρουν την αποτελεσματικότητα της θεραπείας αυτής σε περίοδο 3 έως 12 μηνών. Αντίθετα, τα δεδομένα σχετικά με την μακροπρόθεσμη έκβαση, ειδικά των ασθενών με προχωρημένη καρδιακή ανεπάρκεια (λειτουργική κλάση III και IV), είναι περιορισμένα και όχι εντελώς σαφή. Σε αντίθεση με τον πλούτο των δεδομένων που αφορούν την αποτελεσματικότητα της ΘΚΕ όμως, και τα οποία έχουν προέλθει από πολλαπλές κλινικές δοκιμές, οι αναφορές σχετικά με την απόδοση της ΘΚΕ στην κλινική πράξη (εκτός δηλαδή ερευνητικών πρωτοκόλλων) είναι σχετικά περιορισμένες και οι μελέτες μακροχρόνιας παρακολούθησης είναι ακόμα λιγότερες. Οι μελέτες που έχουν ασχοληθεί ειδικά με την ηχοκαρδιογραφική ανταπόκριση μετά από ΘΚΕ είναι ως επί το πλείστον μέρος μιας μεγαλύτερης κλινικής δοκιμής. Τόσο σε μελέτες στα πλαίσια κλινικών δοκιμών όσο και σε μελέτες παρατήρησης όμως, οι έρευνες έχουν επικεντρώσει κυρίως σε περιόδους παρακολούθησης 3 έως 6 μηνών, ενώ λίγα μόνο δεδομένα υπάρχουν πέραν των 12 μηνών. Η αντίστροφη αναδιαμόρφωση της ΑΚ, κυρίως κατά την άμεση περίοδο μετά την εμφύτευση, φαίνεται να είναι και ο ισχυρότερος προγνωστικός δείκτης επιβίωσης των ασθενών με καρδιακή ανεπάρκεια που λαμβάνουν ΘΚΕ. Ωστόσο, καθώς η ΑΚ συνεχίζει να αναδιαμορφώνεται και μετά την εμφύτευση, είναι ασαφές κατά πόσον η βραχυπρόθεσμη ευνοϊκή ανταπόκριση που παρατηρείται στο 60% -70% των ασθενών διατηρείται μακροπρόθεσμα. Η ηχοκαρδιογραφία παραμόρφωσης έχει χρησιμοποιηθεί για την εξαγωγή δεικτών καρδιακού δυσυγχρονισμού και την εκτίμηση της λειτουργίας της ΑΚ πριν την εμφύτευση συσκευής ΘΚΕ (αμφικοιλιακού βηματοδότη με ή χωρίς δυνατότητα απινιδωτή). Η ανταπό-κριση των δεικτών παραμόρφωσης της ΑΚ μπορεί να έχει σημαντικές προγνωστικές επιπτώσεις για τους ασθενείς που υποβάλλονται σε ΘΚΕ, λαμβάνοντας υπ’ όψιν ότι οι δείκτες παραμόρφωσης πρόσφατα εδείχθησαν να έχουν ισχυρότερη συσχέτιση με την πρόγνωση των ασθενών με καρδιακή ανεπάρκεια σε σχέση με το κλάσμα εξώθησης ή άλλους κλασσικούς δείκτες της λειτουργικής κατάστασης της ΑΚ. Παρ’ όλα αυτά, ελάχιστα ηχοκαρδιογραφικά δεδομένα υπάρχουν σχετικά με την ανταπόκριση των δεικτών παραμόρφωσης μετά από θεραπεία επανασυγχρονισμού, ενώ δεν υπάρχουν καθόλου στοιχεία πέραν των 6 μηνών. Σε αυτή τη μελέτη, εκτιμήσαμε τη μακροπρόθεσμη ανταπόκριση της λειτουργίας της ΑΚ, όπως αυτή καταγράφεται ηχο¬καρδιο¬γραφικά μετά από τουλάχιστον 12 μήνες παρακολούθησης, μετά από εμφύτευση συσκευής καρδιακού επανασυγχρονισμού με δυνατότητες απινιδωτή (CRT-D). Ο πρωτογενής μας στόχος ήταν να καταγράψουμε συστηματικά, χρησιμοποιώντας συμβατικούς αλλά και νεώτερους ηχοκαρδιογραφικούς δείκτες (απεικόνιση παρα-μόρφωσης), τη μακροπρόθεσμη ανταπόκριση της λειτουργίας της ΑΚ μετά από εμφύτευση συσκευής ΘΚΕ με δυνατότητες απινιδωτή (CRT device with defibrillator capacity, CRT-D) σε ασθενείς με προχωρημένη καρδιακή ανεπάρκεια οι οποίοι λαμβάνουν βέλτιστη φαρμακευτική αγωγή. Οι δευτερογενείς μας στόχοι ήταν (α) να καταγράψουμε τη μακροπρόθεσμη (>12 μήνες) ανταπόκριση του δυσσυγχρονισμού της ΑΚ, όπως αυτή καταγράφεται με ηχοκαρδιογραφική απεικόνιση παραμόρφωσης (β) να συσχετίσουμε τους δείκτες δυσσυγχρονισμού της ΑΚ πριν από την εμφύτευση με τη μακροπρόθεσμη ανταπόκριση της λειτουργίας της ΑΚ, και (γ) να συσχετίσουμε τους συμβατικούς και νεώτερους ηχοκαρδιογραφικούς δείκτες λειτουργίας της αριστεράς κοιλίας πριν από την εμφύτευση με τη μακροπρόθεσμη ανταπόκριση της λειτουργίας της ΑΚ. / Several observational studies and randomized controlled trials (RCTs) have demonstrated the safety, efficacy, and long-term effects of cardiac resynchronization therapy (CRT) in patients with advanced heart failure, reduced left ventricular systolic function, and wide QRS complex. Most clinical trials with CRT report efficacy within a 3-to-12 month time frame. However, data on long-term effects, especially for advanced heart failure patients with NYHA class III-IV, are limited and unclear. In contrast to the wealth of data on efficacy of CRT, reports on effectiveness of CRT in clinical practice (i.e. outside the context of RCTs) are limited and data on long-term effectiveness are scarce. Studies dealing with echocardio-graphic responses come largely from sub-studies of larger RCTs. However, both these sub-studies as well as observational studies have focused on short-term echocardiographic responses, whereas very limited data exist beyond 12 months. Reverse remodeling of the left ventricle in response to CRT in the immediate post-implant period is the strongest predictor of long-term prognosis in these patients. However, as the left ventricle continues to remodel long after CRT device implantation, it is unclear whether the initial favorable response observed in 60% to 70% of CRT recipients is maintained long term. Deformation echocardiography has been used to derive ventricular dyssynchrony indices and assess left ventricular function prior to CRT device implantation (biventricular pacemaker with or without defibrillator capacity). The response of myocardial deformation indices of the left ventricle may have important prognostic implications for CRT recipients, considering that deformation parameters have been shown to have a stronger association with prognosis compared with ejection fraction or other conventional indices of left ventricular function. Nevertheless, limited echocardiographic data exist on the response of myocardial deformation indices to CRT, whereas no data exist beyond 6 months post CRT. In this study, we have evaluated the long-term echocardiographic response of left ventricle to CRT after a minimum of 12 months of follow up after implantation of a CRT device with defibrillator capacity (CRT-D). Our primary aim was to systematically record, using both conventional and novel echocardiographic indices (myocardial deformation), the long-term (12 months or longer) response of the left ventricle after CRT-D device implantation in patients with advanced heart failure receiving optimal medical therapy. Our secondary aims were to (a) record the long-term response of left ventricular dyssynchrony assessed with myocardial deformation indices in these patients; (b) correlate left ventricular dyssynchrony indices before CRT-D device implantation with long-term response of the left ventricle, and (c) correlate both conventional and novel left ventricular function indices before implantation with long-term response of the left ventricle after CRT-D device implantation.

No description available.

No description available.

Ziel der Arbeit war es, zu untersuchen, ob parodontalpathogene Mikroorganismen im Myokard des Herzens nachweisbar sind. Dabei wurde die Wechselwirkung der Toxine (Lipopolysaccharide) am myokardialen Gewebe erfasst und auf diese Weise mögliche Entzündungsreaktionen in den Myokardzellen untersucht. Material und Methoden: 30 Patienten (20 Männer, 10 Frauen) mit Aortenklappenstenosen bzw. -insuffizienzen wurden zahnärztlich auf den aktuellen Zahnstatus und Parodontalstatus untersucht. Gingivale Erkrankungen wurden mit Hilfe des PBI erhoben. Anhand der Sondierungstiefen und des klinischen Attachmentlevels erfolgte die Einteilung in keine/ milde Parodontitis, moderate Parodontitis und schwere Parodontitis. Das Herzgewebe wurde mittels Gewebeschnitten von Ventrikel, Atrium und Klappe histologisch aufbereitet und mittels Lichtmikroskop über eine Kamera aufgezeichnet. Für einen Probanden ergaben sich pro Gewebeschnitt und pro Färbung 12 Aufnahmen. Insgesamt ergaben sich nach allen Färbungen aller Gewebeschnitte für einen Patienten 84 Bilder. Es wurde ein Inflammationsscore (0-3) erhoben für die Bewertung der H.E.-Färbung. Parameter für die immunhistochemischen Färbungen wurden durchgeführt für CD68/ Makrophagen und CD14/ LPS- Bindungsprotein-Rezeptor. Diese dienten dem Nachweis von möglichen Wechselwirkungen zwischen Parodontalpathogenen und myokardialen Geweben. Es erfolgte die direkte Zählung der Makrophagen pro Mikroskopie-Gesichtsfeld. Ergebnisse: Bei zahnärztlicher Untersuchung wurde festgestellt, dass 22 Probanden eine leichte oder keine gingivale Erkrankung hatten (Gruppe PBI 1) und 8 Patienten eine fortgeschrittene gingivale Erkrankung vorwiesen (Gruppe PBI 2). An einer schweren parodontalen Erkrankung litten 23 Patienten (Gruppe Parodontitis 2) und nur 7 Patienten wiesen ein moderate, milde oder keine Parodontitis auf (Gruppe Parodontitis 1). Die Ergebnisse der histologischen Untersuchungen der H.E.-Färbung zeigten, dass im Median im Atrium und Ventrikel der Score 2 dominiert. Desweiteren konnten für CD68 und CD14 signifikante Mittelwertunterschiede zwischen der Gruppe Parodontitis 1 und 2 gezeigt werden. Für die Gruppe PBI 1 und 2 konnte weder für den Parameter CD68 noch für CD14 das Signifikanzniveau erreicht werden. Schlussfolgerung: Die histologischen Färbemethoden lassen die Tendenz erahnen, dass höhere Scores und Mittelwerte mit höheren Entzündungsgraden und Destruktionen in Zusammenhang stehen. Gesündere parodontale Verhältnisse sind mit niedrigeren Scores und Mittelwerten verbunden. Zwischen den Gruppen PBI 1 und 2 lag kein statistisch nachweisbarer Unterschied vor. Anders ergab es sich in den Gruppen Parodontitis 1 und 2. Für CD68 (Monozyten/Makrophagen) lag die Signifikanz bei 3% und für CD14 (LPS-Bindungsprotein-Rezeptor) bei 0,8% zwischen den Parodontitis Gruppen. Die entzündlich bedingte Genese von Parodontitis und Herzinsuffizienz lässt schlussfolgern, dass die Parodontitis als Ursache nicht auszuschließen war. Durch die multifaktorielle Entwicklung beider Leiden lässt sich mittels vorliegender Untersuchung kein eindeutiger Kausalzusammenhang nachweisen. Die genauen, noch ungeklärten Assoziationen sollten in weiterführenden Studien erforscht werden.