Myocardial and skeletal muscle high energy phosphate metabolism is abnormal in heart failure, but the pathophysiology is not understood. Plasma non-esterified fatty acids (NEFA) increase in heart failure due to increased sympathetic drive, and regulate the transcription of mitochondrial uncoupling protein-3 (UCP3), through peroxisome proliferator-activated receptor-α. The aim of the work in this thesis was to determine whether cardiac PCr/ATP ratios and skeletal muscle PCr kinetics during exercise were related to cardiac and skeletal muscle UCP3 levels respectively, thus providing a mechanism for the apparent mitochondrial dysfunction observed in heart failure. Patients having cardiac surgery underwent pre-operative testing, including cardiac and gastrocnemius 31P magnetic resonance spectroscopy. Intra-operatively, ventricular, atrial and skeletal muscle biopsies were taken for measurement of mitochondrial protein levels by immunoblotting, along with mitochondrial function by tissue respiration rates. Fasting plasma NEFA concentrations increased in patients with ventricular dysfunction and with New York Heart Association (NYHA) class. Ventricular UCP3 levels increased and cardiac PCr/ATP decreased with NYHA class, however, demonstrated no relationship to each other. In skeletal muscle, maximal rates of oxidative ATP synthesis (Qmax) related to functional capacity. Skeletal muscle UCP3 levels increased with NYHA class but were unrelated to skeletal muscle Qmax. Tissue respiration experiments revealed no relationship between ventricular function and indices of mitochondrial coupling, furthermore, indices of mitochondrial coupling were unrelated to tissue UCP3 levels. No evidence was found to support mitochondrial uncoupling, mediated through UCP3, as a cause of the abnormalities in cardiac and skeletal muscle high energy phosphate metabolism.

Background: Right ventricular failure is a serious complication after left ventricular assist device placement. Case Presentation: A 70-year-old male in decompensated heart failure with right ventricular failure after the placement of a left ventricular assist device. A single dual-lumen PROTEKDuo cannula was inserted percutaneously via the internal jugular vein to draw blood from the right atrium and return into the pulmonary artery using the CentriMag system, by passing the failing ventricle. The patient was successfully weaned from right ventricular assist device. Conclusions: In comparison to two-cannula conventional procedures, this right ventrivular assist device system improves patient rehabilitation and minimizes blood loss and risk of infection, while shortening procedure time and improving clinical outcomes in right ventricular failure.

Bakgrund: Hjärtsvikt är vanligt förekommande sjukdom i den svenska befolkningen och även en vanlig orsak till sjukhusinläggning. Egenvård är en viktig del i behandlingen. Bristande egenvård kan vara en bidragande orsak till försämring vid hjärtsvikt vilket både kan leda till onödigt lidande för patienten och leda till stora kostnader för sjukvården. Syfte: Syftet med litteraturstudien var att beskriva patienters erfarenheter av egenvård i samband med hjärtsvikt, samt beskriva de inkluderade artiklarnas datainsamlingsmetod. Metod: Deskriptiv litteraturstudie. Elva vetenskapliga artiklar inkluderades. Artiklarna söktes via databaserna Pub Med. Artiklar med kvalitativ och kvantitativ ansats inkluderades. Resultatet analyserades genom att bearbeta artiklarna två tabeller och markera med färg och sammanställdes. Resultat: Resultatet i studien visar på att patienter med hjärtsvikt ofta lider av någon form av psykisk ohälsa. Patienter med hjärtsvikt har ofta goda kunskaper i egenvård. Dock medverkar depression eller annan form av psykisk ohälsa till minskad följsamhet i egenvård på grund av sänkt initiativförmåga. Slutsats: Att sjukdomen hjärtsvikt är multidimensionell och påverkar psyket negativt leder till minskad förmåga i att utföra egenvård. Familjestöd, patientutbildning och snabb respons från sjukvård har visat sig ha goda effekter på egenvård. Likaså bidrar en stark familj och god ekonomi till bättre egenvård. / Background: Heart failure is a common disease in the Swedish population and also a common cause of hospitalization. The self-care is an important part of the treatment. Lack of self-care can be a contributing factor to the worsening of heart failure, which both can lead to unnecessary suffering for the patient and lead to large costs for health care Aim: The purpose of this study was to describe patients' experiences of self-care associated with heart failure and describe the articles included data collection method. Method: Descriptive literature. Eleven scientific articles were included. Articles were searched using PubMed. Articles with qualitative and quantitative approach included. The results were analyzed by processing the articles two tables and mark with paint and compiled Result: The results of the study show that patients with heart failure often suffer from some form of mental illness. Patients with heart failure often have good knowledge of self-care. However participates depression or other forms of mental illness to reduced adherence to self-care because of reduced initiative. Conclusion: Disease heart failure is multidimensional and affects the psyche negatively leading to reduced ability in performing self-care. Family support, patient education and quick response from health care have been shown to have positive effects on self-care. Also contributing a strong family and good economics to better self-care.

Hospital readmissions are a source of reduced payment as mandated by the Centers for Medicare and Medicaid Services as part of the Affordable Care Act (ACA). The number of dollars used for hospital readmissions has sky rocketed above $17 million for heart failure alone. The changes in the ACA reimbursement guidelines has put stress on many hospitals as they are facing reduced income, increased use of resources, and increased length of stay. This project evaluated the implementation of Project BOOST, its components, and their predictability for hospital readmission. Sample groups were evaluated both pre- and post-implementation of Project BOOST, which included individuals aged 18 and older, who were of Anglo, Hispanic or Native American descent, and living in Northern Arizona. A retrospective chart review was performed and descriptive and predictive statistics were used to analyze obtained data. Patients with cardiovascular disease admitted to the study hospital have high risks for readmission, such as problem medications, polypharmacy, psychological Issues, and principal diagnoses. Integrating elements from Project BOOST significantly decreased 30-day hospital readmissions. Data from this study revealed a statistically significant reduction in 30-day hospital readmission rates from 22% in the pre-intervention period to just 4% in the post-intervention period. Patients who did not receive the risk assessment tool were 14 times more likely to be readmitted to the hospital within 30 days of the index hospitalization.

No description available.

Although it is well known that self-care reduces the frequency of hospital admissions and exacerbations and enhances quality of life (QOL) in heart failure (HF) patients, little is known about self-care in this population. Therefore, the study purpose was to examine relationships among selected individual characteristics (demographics, severity of illness, comorbidities, and social support), self-care strategies, and QOL using Reigel's Model of Self Care in Patients with Heart Failure as the guiding framework. In this descriptive correlational study, self-care was measured using the Self-Care of Heart Failure Index (SCHFI), which measures self-care maintenance (SC-Mt), self-care management (SC-Mn), and self-care self-confidence (SC-Sc). QOL was measured using a disease-specific instrument, the Minnesota Living with Heart Failure Questionnaire (LHFQ), and a generic instrument, the Short-Form Health Survey (SF-12) characterizing physical and mental-emotional functioning. Multiple regression analysis was used to identify predictors of QOL.Data were collected using Dillman's tailored design method for surveys. One hundred and sixty-five patients with HF were invited through a mailed letter and a survey packet to participate in this study. Five potential participants requested not to take part in the study, seven were reported as being deceased, and 23 letters were returned as undeliverable. After the initial mailing, we discontinued mailings to them. Thus, out of a possible sample of 130 subjects, 98 participants completed and returned questionnaires for a response rate of 75.38%.The sample (mean age = 56.33 years, SD = 13.65) included 56.1% males and 43.9% females and consisted of 48% Caucasians and 52% non-Caucasians. Approximately 55.1% were married and 60.2% had an annual income less than $30,000. The majority of the sample (72.5%) had at least a high school education. Half of the sample were somewhat functionally impaired (NYHA Class 11) and had an ejection fraction less than 30%. Ninety-three percent of the sample had been diagnosed with HF less than 10 years (mean = 5.05, SD = 3.34). Seventy percent of the sample had 0 to 4 comorbidities, and 17.7% reported that they only had HF and no other diagnoses. In addition, the sample reported mean score of social support at 71.72 (SD = 17.30) indicating good social support. On average, participants reported that they frequently performed self-care in order to maintain a healthy lifestyle: SC-Mt (mean = 69.59, SD = 15.56). They responded quickly and were likely to manage signs and symptoms that occurred: SC-Mn (mean = 61.69, SD = 19.91). Sixty-two percent reported that they recognized signs and symptoms of HF that occurred in the last month. They were very confident they could perform self-care: SC-Sc (mean = 66.11, SD = 17.02). The results showed that the participants' perceived their QOL as good (mean = 49.44, SD = 27.82). On average, participants perceived their physical functioning as fair (mean = 45.38, SD = 22.47), as was their mental-emotional functioning (mean = 53.32, SD = 22.36).Multiple regression analyses demonstrated that better disease-specific QOL was predicted by being less likely to use SC-Mn strategies (β = .325; p = 0.003), better SC-Sc (β = -.251; p = 0.012), better NYHA functional class (β = .246; p = 0.008), and less comorbidity (β = .236; p = 0.014) (R 2 = .334; F = 7.269, p = 0.000). Better generic QOL (physical functioning) was predicted by better NYHA functional class (β = -.309; p = 0.001), better SC-Mt (β = .205; p = 0.037), better SC-Se (β = .296; p = 0.003), and being less likely to try SC-Mn strategies (β = -.165; p = 0.000) (R 2 = .361; F = 9.602, p = 0.000). Better generic QOL (mental-emotional functioning) was predicted by better NYHA functional class (β = -.229; p = 0.024) and being male (β = -.204; p = .047) (R 2 = .277; F = 4.548, p = 0.000).Findings suggest that better QOL is associated with being male displaying better NYHA functional class, less co-morbidity, and better performance of self-care activities in order to maintain health (SC-Mt), being less likely to identify and respond quickly to signs and symptoms of HF (SC-Mn), having and confidence in performing of self-care strategies (SC-Se). The findings add to the scientific body of knowledge in self-care.

The purpose of this study was to evaluate graded exercise responses to treadmill exercise in patients with a total artificial heat (SynCardia, Tucson, AZ). Additionally, this study sought to compare the exercise response in total artificial heart (TAH) patients to both advanced heart failure (HF) patients on medical management only and HeartMate II (Thoratec Corp., Pleasanton, CA) left‐ventricular assist device (HMII) patients. For patients with biventricular heart failure the TAH is a viable option to bridge patients until transplant becomes available. Its demonstrated improvement in mortality and increasing usage necessitates a shift in focus to quality of life in the TAH patient including functional ability. The evaluation of cardiorespiratory responses to graded exercise provides an objective measure of functional ability. There is very limited information in the literature on the exercise response of the mechanical circulatory support (MCS) device patient, particularly the TAH patient. A review was performed on MCS patients who underwent symptom‐limited cardiopulmonary exercise testing (CPET) following device implant of either TAH or HMII. ANOVA was performed to compare differences between the two device groups and HF patients listed for heart transplant. Fourteen TAH patients underwent CPET (9 male, 5 female) with peak oxygen consumption (VȩO2) of 0.926 + .168 L∙min, 36 + 8% % predicted, 11.0 + 2.3 ml.kg.min or 3.1 + 0.7 METs. Ventilatory anaerobic threshold (VAT) was 0.706 + .181 L∙min. Peak (VȩO2, % pred. (VȩO2 and VAT were significantly lower in the TAH compared with HMII and advanced HF (p = 0.0012, p = 0.0106, p = 0.0009, respectively). Peak RER was significantly higher (p = <.0001) and OUES was significantly lower (p = 0.0004) in the TAH. Exercise capacity is significantly reduced in the TAH patient below that observed in HMII LVAD and advanced HF patients. This provides a baseline for expected functional status and has implications on the ADL tolerance of these individuals. The next step is to develop strategies to ameliorate this continued exercise intolerance. The documents herein contain a review of literature including a background in heart failure and the use of the exercise response in the heart failure patient. An overview is also presented on the use of MCS describing physiology, device function, and exercise physiology of the MCS device patient. A manuscript has also been included detailing a cross‐sectional review of the effects of graded exercise in the TAH patient and comparing it to the HMII and advanced HF patient.

Prior studies have demonstrated the effect of diazoxide in protecting against apoptosis via mitochondrial KATP channel opening in vitro. The current investigations are designed to determine if sildenafil, a phosphodiesterase-5 inhibitor and known mitochondrial KATP channel opener, would protect against chronic doxorubicin cardiomyopathy both in vivo and in vitro.Male ICR mice were randomized to 1 of 4 treatments: saline, sildenafil (0.7 mg/kg IP), doxorubicin (5 mg/kg IP), and sildenafil (0.7 mg/kg IP)+doxorubicin. Apoptosis was determined using the terminal deoxynucleotidyl transferase mediated dUTP nick-end labeling and in situ oligo ligation methods. Desmin distribution was determined via immunofluorescence. Bcl-2 was analyzed by Western blot. Left ventricular function was measured in Langendorff mode. Electrocardiographical analysis measured changes indicative of doxorubicin cardiotoxicity (ST-prolongation). In vitro studies using adult ventricular cardiomyocytes were exposed to doxorubicin (1 μM), sildenafil (1 μM) with or without NG-nitro-L-arginine methyl ester (L-NAME; 100 μM), or 5-hydroxydecanoate (5-HD; 100 μM) 1 hour before doxorubicin and incubated for 18 hours. Doxorubicin-treated mice demonstrated increased apoptosis and desmin disruption, which was attenuated in the sildenafil+doxorubicin group. Bcl-2 decreased in the doxorubicin group but was maintained at basal levels in the sildenafil+doxorubicin group. Left ventricular developed pressure and rate pressure product were significantly depressed in the doxorubicin group but attenuated in the sildenafil+doxorubicin group. ST-interval significantly increased in the doxorubicin group over 8 weeks. In the sildenafil+doxorubicin group, ST-interval remained unchanged from baseline. Doxorubicin significantly increased apoptosis, caspase-3 activation, and disruption of mitochondrial membrane potential in vitro,. In contrast, sildenafil significantly protected against doxorubicin cardiotoxicity; however, protection was abolished by both L-NAME and 5-HD. Cell viability studies using spectrophotometer and flow cytometric techniques demonstrated that sildenafil did not affect the antitumor efficacy of doxorubicin in PC-3 cells in vitro. In fact, flow cytometry data indicate that sildenafil, when combined with doxorubicin, was synergistic in the antineoplastic action of doxorubicin. Prophylactic treatment with sildenafil prevented apoptosis and left ventricular dysfunction in a chronic model of doxorubicin-induced cardiomyopathy. Moreover, these studies provide relevant clinical data on the safety and efficacy of sildenafil, leading the way for clinical trials in humans receiving doxorubicin chemotherapy.

The presented dissertation concerns of extracorporeal membrane oxygenation (ECMO) in adults within the University hospital in Pilsen. The ECMO has been used in Pilsen from 2011. The first part (theoretical one) illustrates in general the ECMO, a life saving method for a treatment of failured lungs or heart. The sites of cannulation, the management and monitoring of ECMO patient are then described. Possible complications as a result of ECMO application and its settlement are mentioned. The second part consists of a retrospective insight, which shows data of 43 ECMO patients for a period of three years 2011- 2013 in the University Hospital Pilsen and a questionary survey. The survey involves 83 non- medical healthcare workers, who are in charge of the ECMO patients, at three intensive care and resuscitation units where the ECMO is used. It finds out what do the medics know about the method. The outcome of this dissertation is a guideline of nursing care of an adult patient on ECMO and most common difficult situations and solutions, that could be faced in the course of nursing an ECMO patient. KEY WORDS ECMO support, heart failure, pulmonary failure, complication, knowledge

Ce travail de thèse avait pour objectif d'évaluer l'intérêt des peptides collagéniques sanguins dans différentes populations à haut risque de développer une insuffisance cardiaque (patients présentant une obésité abdominale ou en post-infarctus du myocarde) ou déjà symptomatiques (post-infarctus du myocarde). En effet la fibrose myocardique est un élément essentiel de l'évolution péjorative de l'insuffisance cardiaque.Ces travaux ont permis de montrer la pertinence clinique des dosages sanguins des peptides collagéniques tout au long du processus de l'insuffisance cardiaque : du stade asymptomatique aux stades symptomatiques. Nous avons mis en évidence, à travers l'expression des peptides collagéniques que : 1/ des patients asymptomatiques ayant une obésité abdominale présentent un remodelage cardiaque précoce tant structurel que fonctionnel (augmentation de la masse ventriculaire gauche, dysfonction diastolique associée au PIIINP) : R2C2 Study. 2/ le ratio PIIINP/ICTP ≤ 1, mesuré 1 mois après un infarctus, est indépendamment associé à la survenue d'un remodelage ventriculaire gauche à un an et améliore la prédiction de survenue d'évènements cardiovasculaires (décès cardiovasculaires et hospitalisation pour décompensation cardiaque) à 3 ans : REVE-2 study. 3/ les antagonistes des récepteurs aux minéralocorticoïdes (éplérénone), traitement anti-fibrotique par excellence, sont efficaces et sûrs (hyperkaliémie et insuffisance rénale) chez des patients à haut risque de remodelage et de complications: EMPHASIS-HF study. Ce travail doit conduire à la validation dans d'autres populations du rôle prépondérant de la fibrose mais surtout au bénéfice thérapeutique des classes anti-fibrotiques dans l'insuffisance cardiaque. / No abstract available