Constrictive pericarditis arises as a result of the fibrous thickening of the pericardium due to chronic inflammatory changes from various injuries. Increased pulmonary and systemic venous pressures manifest clinical features of left and right heart failure. Idiopathic or post-viral pericarditis is the most common cause followed by postpericardiotomy, radiation-induced causes. Right-sided heart failure symptoms predominate over left-sided heart failure symptoms due to the equalization of pressures. No single diagnostic test can provide a definitive diagnosis or evidence of constrictive pericarditis. Medical management is difficult for constrictive pericarditis. The treatment of choice for constrictive pericarditis is pericardiectomy.

Problem: Heart failure is the most frequent cause for hospital readmissions in Medicare recipients, with an estimated annual cost of $12 billion. Heart failure hospitalizations are also an independent risk factor for increased mortality. Self-care, thought to be enhanced by perceived social support, is key to managing this syndrome, and up to 50% of readmissions are considered the result of inadequate self-care. Purpose: To evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure, and to compare these characteristics with a study of ambulatory patients with heart failure. In addition, to assess the relationship between perceived social support and self-care. Methods: This was a multi-site descriptive comparative study. Following informed consent, participants were screened for sufficient cognition to consent. Patients were then administered the Medical Outcome Study-Social Support emotional/informational subscale, and the three Self-Care of Heart Failure Index subscales. Two-sample t tests and multiple regression were utilized to analyze the data. Results were compared with a sample of community-dwelling heart failure patients in another study. Results: Of 161 consented patients 121 passed the cognition screening and were included in the study. Average age was 71 years; gender and type of heart failure was evenly split. Mean Charlson Comorbidity Score was 7.43, and the mean six month number of hospitalizations was 2.43. Approximately 31% of participants were African American. Both perceived social support (t=-4.007, df=211, p < .001) and self-care maintenance (t=-3.343, df=220, p < .002) scores were lower in the hospitalized participants than the comparison group of community dwellers. Perceived social support was associated with self-care confidence (?=.210, t=-2.210, p < .029), but not self-care maintenance or self-care management. Forty-six percent of participants scored higher than the 70% cut point for adequate self-care confidence, which was 1.4 times higher than in the community participants. Self-care confidence was also related to self-care maintenance (?=.388, t=4.676, p < .001) and self-care management (?=.327, t=3.793, p < .001). Conclusions: Results have implications for facilitating self-care knowledge and skills in heart failure patients. Patient education during hospitalization may not be the ideal timing to promote understanding and retention. Interventions to enhance self-care confidence may assist patients to develop self-care skills more than current teaching techniques. Because cognitive deficiencies were found in 25% of pre-screened participants for this study, further research is recommended to determine if hospitalized patients have transient cognitive issues or if cognitive impairments are more prevalent in all heart failure patients.

Rationale: G protein-coupled receptor (GPCR) kinases (GRKs) are important regulators of cardiac function whose primary role is the phosphorylation of GPCRs and attenuation of downstream signaling, and GRK2 is upregulated after cardiac stress, injury, and during heart failure (HF). Recent studies have identified novel non-GPCR roles for GRKs such as cytoskeletal assembly, insulin signaling, fibrosis and pro-death signaling. One of the most compelling discoveries regarding novel roles of GRK2 in HF pathogenesis is its mitochondrial translocation (mtGRK2) following cardiac injury, which is associated with increased ROS production, decreased FA metabolic oxygen consumption, and pro-death signaling. Moreover, this localization is dependent on phosphorylation of serine 670 (S670) by kinases such as ERK1/2. Of note, expression of a GRK2 C-terminus peptide, βARKct, which contains S670 but no kinase domain or activity, is cardioprotective following injury in part due to inhibition of endogenous mtGRK2. This is significant because growing evidence demonstrates that cardiomyocyte metabolism is regulated by levels and activities of individual mitochondrial proteins Objective: This study sought to identify mitochondrial proteins which GRK2 interacts with either basally or after injury- or stress-induced translocation, and to determine whether functional regulation of mitochondrial function via phosphorylation of these proteins contributes to the phenomenon of bioenergetic defects during the development of HF. Methods and Results: Co-immunoprecipitation of GRK2 in vitro from primary ventricular cardiomyocytes and a human transformed cardiomyocyte-derived cell line was followed by liquid-chromatography mass-spectroscopy identification of all GRK2- interacting proteins. We followed this with proteomics analysis using DAVID and iv Ingenuity software to identify main pathways altered by GRK2 during stress or injury, focusing on mitochondrial dysfunction which revealed that GRK2 interacts with all major components of the electron transport chain (ETC). Using recombinant proteins as well as in vitro and in vivo models of myocardial infarction (MI), we demonstrate that GRK2 is able to phosphorylate the catalytic barrel of mitochondrial ATP synthase (complex V). Moreover, reduction of GRK2 levels in vivo using a GRK2 knockdown mouse model appears to protect against injury-induced bioenergetic deficits, whereas increased GRK2 levels in a transgenic GRK2 overexpression mouse model reveals both baseline deficits in ATP production as well as worsened post-MI outcomes. Conclusions: These collective data highlight the significance of the mitochondrial GRK2 interactome as a driver of cardiac bioenergetic deficits, particularly as a response to MI injury which progresses to HF. Given the current lack of effective HF treatments, this highly novel mechanism of GRK2 regulation of the mitochondrial ETC emphasizes the need for GRK2-targeting therapies for treating HF. / Molecular & Cellular Biosciences

Background: Heart failure is a complex condition that causes, among other things, shortness of breath and fatigue. The disease challenge patients physically, mentally and socially. Self-care for heart failure is a central part of the treatment process. Heart failure requires a lifestyle change to promote the patient's health, increase well-being and prevent complications. Aim: the aim was to describe patients' experience of self-care in heart failure. Method: This is a literature study that is based on ten qualitative studies, the authors have used the CINAHL and PubMed databases to retrieve scientific articles. Results: The results were divided into one main themes, "obstacles in self-care". Conclusion: Heart failure patients experienced several barriers that negatively affected the quality of their life including physical, psychological and social aspects. The patients also experienced problems financially and many of the patients had too little information about their illness, which was an obstacle to self-care.

Bakgrund: I Sverige lever närmare 350 000 människor med diagnosen hjärtsvikt och med en åldrande befolkning kommer antalet drabbade att öka. Hjärtsvikt är en av de vanligaste folksjukdomarna och innebär en hög mortalitet. Syfte: Att beskriva patienters erfarenheter av att leva med hjärtsvikt. Metod: Detta är en litteraturöversikt som använder sig av Polit och Becks niostegsmodell samt en tematisk analys. Vetenskapliga artiklar införskaffades via Cinahl och PubMed.  Resultat: Efter genomgång och noggrann analys av artiklarna valdes tre teman med tillhörande underteman. Temat Fysisk påverkan i vardagslivet skildrades av två underteman, fysiska upplevelser av sjukdomen samt att ha ett begränsat liv. Temat Hjärtsvikts påverkan på känslolivet skildrades utifrån två underteman, förändringar i känslolivet efter insjuknande samt att kunna ha ett socialt nätverk. Temat Möten med hälso- och sjukvården skildrades utifrån tre underteman, brist från hälso- och sjukvården, att förlora kontrollen av sitt eget liv samt egenvård är viktigt för mig. Slutsats: Patienter med hjärtsvikt kämpar med fysiska och psykiska utmaningar. De fysiska begränsningarna har en inverkan i dagliga rutiner. Den psykiska ohälsan hos dessa patienter kan främjas genom att motivera till att bibehålla de sociala nätverken som de har. Sjuksköterskan behöver förbättra kvalitén på patientutbildning så att patienterna känner sig trygga med att sköta sin egenvård. / Background: In Sweden live roughly 350 000 citizens with diagnosed heart failure and with an aging population comes an increase in those cases. Heart failure is one of the most common “Folksjukdom” which also causes a higher mortality.  Aim: To describe patient´s experiences living with heart failure. Method: This study is a literature review using Polit and Beck’s nine step model and a thematic analysis. Scientific articles were gathered using Cinahl and PubMed. Result:  After a thorough analysis of articles three themes were chosen with added subthemes. The themes Physical constraints in daily life, was depicted into two subthemes, physical experiences of the illness, and to live a limited life. The theme Heart failures effect on the emotional life was also depicted in to two subthemes: changes in feelings after falling ill and to have a social network. The theme Meetings with healthcare services was depicted based on three subthemes, shortcomings from healthcare, to lose control over your own life and lastly self-care is important to me. Conclusion: Patients with heart failure struggle with physical and mental challenges. The physical limitations imposed challenges in their daily routines. The poor mental health among these patients can be improved by motivating them to maintain their social network. Healthcare staff need to increase the quality of patient education so that patients feel confident in managing their own self-care. Keywords: Experiences, heart failure and patients

Att leva med hjärtsvikt innefattar flera olika utmaningar eftersom det är en allvarlig diagnos med många olika symtom som kan begränsa vardagslivet. Behandlingen består av flera delar med bland annat egenvård som är en del av patientutbildningen. Egenvård kan ge möjlighet för patienter att behandla symtom på egen hand och öka självständigheten. Sjuksköterskan kan finnas som stöd vid egenvård genom att informera och motivera. Syftet med studien är att belysa patientens upplevelse av egenvård vid hjärtsvikt. Metoden är en litteraturstudie med inriktning mot kvalitativa artiklar som sökts fram i CINAHL och MEDLINE. Därifrån valdes nio artiklar ut som svarade an på syftet. Resultatet visade varierade upplevelser av egenvård som grundades i patientens egenskaper. För att utföra egenvård krävdes motivation som utformades på olika sätt. Att ha kunskap och stöd var viktiga faktorer för att utföra egenvård, men många patienter upplevde brist på stöd från hälso- och sjukvårdspersonal och att vården inte var personcentrerad. / Living with heart failure involves several different challenges because it is a serious diagnosis with many different symptoms that can limit everyday life. The treatment consists of several parts, including self-care, which is part of patient education. Self-care can give patients the opportunity to treat symptoms on their own and increase independence. The nurse can provide support in self-care by informing and motivating. The purpose of the study is to shed light on the patient's experience of self-care in heart failure. The method is a literature study with a focus on qualitative articles searched in CINAHL and MEDLINE. From there, nine articles were selected that answered the purpose. The results showed varied experiences of self-care that were based on the patient's characteristics. In order to carry out self-care, motivation was required which was designed in different ways. Having knowledge and support were important factors in carrying out self-care, but many patients experienced a lack of support from healthcare professionals and that the care was not person-centered.

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