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Rationale: In the breast cancer setting, anti-cancer therapies, including Doxorubicin (DOX) and Trastuzumab (TRZ), are associated with an increased risk of cardiotoxicity. There is a need to develop prophylactic cardioprotective agents to mitigate the cardiotoxic side effects of these common anti-cancer drugs. Objective: To investigate whether the anti-oxidant, N-acetylcysteine amide (NACA), can attenuate the drug-induced heart failure caused by DOX+TRZ in a murine model. Methods: A total of 100 female mice received one of the following drug regimens: i) saline; ii) NACA; iii) DOX; iv) TRZ; v) DOX+TRZ; vi) NACA+DOX; vii) NACA+TRZ; and viii) NACA+DOX+TRZ. Serial echocardiography was performed over a 10-day study period, after which the mice were euthanized for histological and biochemical analyses. Results: In mice receiving DOX, left ventricular ejection fraction (LVEF) decreased from 73±4% to 43±2% at day 10. In mice receiving DOX+TRZ, LVEF decreased from 72±3% to 32±2% at day 10. Prophylactic administration of NACA to mice receiving DOX or DOX+TRZ was cardio-protective with an LVEF of 62±3% and 55±3% at day 10, respectively. Histological and biochemical analyses demonstrated loss of cellular integrity, increased oxidative stress (OS), and increased cardiac apoptosis in mice treated with DOX+TRZ which was attenuated by the prophylactic administration of NACA. Conclusion: NACA attenuates the cardiotoxic side effects of DOX+TRZ in a murine model of chemotherapy induced cardiac dysfunction by decreasing OS and apoptosis. / October 2015

Bakgrund: Hjärtsvikt är en allvarlig sjukdom som drabbar många äldre personer. Olika orsaker gör att hjärtats förmåga att tillförse kroppen med tillräcklig mängd blod minskat. Sjukdomen är kronisk och de drabbade tvingas ofta leva med flera fysiska och psykiska symtom. Att drabbas av en kronisk sjukdom kan på flera sätt vara omskakande för många och påverka livskvaliten. Syfte: Syftet med litteraturstudien var att belysa hur äldre personer med hjärtsvikt upplever livskvalitet. Metod: En allmän litteraturstudie baserad på nio artiklar med kvalitativ ansats. Resultat: Fyra huvudkategorier identifierades där upplevelsen av hjärtsvikt baseras på: Förlust av tidigare förmågor; Betydelsen av stöd och att vara beroende av andra; Att bli begränsad i sin vardag; Det kunde varit värre. Slutsats: Upplevelsen av livskvalitet påverkas såväl av den fysiska begränsning som uppstår genom sjukdomens olika symtom som av personens sociala stöd och inställning till livet. Genom en god förståelse för hur äldre personer med hjärtsvikt upplever livskvalitet ökar sjuksköterskans möjlighet att stötta dessa personer och hjälpa till att bevara en god livskvalitet trots sjukdomen. / Background: Heart failure is a serious condition that affects many elderly people. Different causes reduce the heart's ability to provide the body with enough blood. The disease is chronic and the patients are often forced to live with multiple physical and psychological symptoms. To suffer from a chronic illness can in many ways be shattering for many and affect quality of life. Aim: The aim of this study was to illuminate how older people with heart failure experience quality of life. Method: A literature review based on nine articles with qualitative approach. Results: Four main categories were identified where the experience of heart failure based on: Loss of previous abilities; The importance of support and being dependent; To be limited in their everyday lives; It could have been worse. Conclusion: The experience of quality of life is affected by both the psychological limitation caused by the disease different symptoms, the person's social support and approach to life. Through a good understanding of how older people with heart failure experiences the quality of life gives the nurse the opportunity to support these people and help to preserve a good quality of life despite the disease.

Mechanical circulatory support (MCS) is a viable therapy for end stage heart failure. However, despite clinical success, the ability to compare MCS devices in vitro and perform training scenarios is extremely limited. Comparative studies are limited as different devices cannot be interchanged in a patient due to the surgical nature of implant. Further, training and failure scenarios cannot be performed on patients with devices as this would subject a patient to a failure mode. A need exists for a readily available mock system that can perform comparative testing and training scenarios with MCS devices. Previously, our group has fabricated a well characterized mock circulation system consisting of a SynCardia temporary Total Artificial Heart (TAH) and Donovan Mock Circulation tank (DMC tank). Further, utilizing this system with the TAH operating in reduced output mode, a heart failure model was developed. In the present study, three ventricular assist devices (VADs) were independently attached to the heart failure model to compare device performances over a range of preloads and afterloads. In addition, specific clinical scenarios were created with the system to analyze how VAD-displayed waveforms from the system correlate with clinical scenarios. Finally, each VAD was powered off while attached to the heart failure model to compare fluid flow through the VAD in a pump-failure scenario. We demonstrated that this system can successfully be utilized to compare MCS devices (i.e. ventricular assist devices) and for successful training of patients and clinicians.

The most recognized risk associated with the HeartMate II is thrombosis. In the presence of developing clot, the HeartMate II Display Monitor and System Controller senses a decrease in pump flow and is accompanied by audible and visual alarms when flow rates drop below a certain threshold; however, when flow is completely inhibited, the Display Monitor and System Controller both fail to indicate that flow has reduced to zero and does not produce any corresponding alarms. To test the efficacy of the HeartMate II alarms, the Donavan Mock was used to simulate the hemodynamics of a typical heart failure patient. The hemodynamics were then improved by the addition of the HeartMate II LVAS. Partially occluding the inflow and outflow of the HeartMate II did display changes in flow and presented with alarms when appropriate; however, complete occlusions of the device failed to produce any alarms or accurate changes in flow.

No description available.

Low levels of physical activity (PA) are a significant predictor of early death among recipients of implantable cardioverter defibrillators (ICDs). Regular, moderate PA is associated with improved quality of life (QOL), reduced arrhythmia burden, and improved health outcomes in ICD recipients yet many do not engage in PA and the reasons for lack of engagement are unclear. The purpose of this descriptive, cross-sectional study was to examine health beliefs related to PA and QOL in adults living with ICDs. The Health Belief Model provided the theoretical framework for this study. A convenience sample of 107 adult, ICD recipients (26 females and 81 males) were recruited from five cardiology clinic settings within the same private practice. Seventy-seven percent completed the study tasks (N=81). Subjects completed a Demographic Data Questionnaire, Self-Efficacy Expectations after ICD Scale, Exercise Self-Efficacy Scale, Health Belief Questionnaire, Incidental and Planned Exercise Questionnaire and Quality of Life Medical Outcomes Survey-SF36®. Clinical data was collected from the medical record. Mean age of the subjects was 70.23 yrs. ± 11.76 yrs. The majority were male (71.6 percent) and 77.8 percent were White, non-Hispanic. Most were insured by Medicare (79 percent), were retired (50 percent) and reported incomes less than 20,000 dollars/year (39 percent). Over 98 percent were diagnosed with heart failure and almost 40 percent reported their physical activity had decreased since having an ICD implanted. There were no differences in health beliefs and QOL scores between subjects who had an ICD as a primary or secondary prevention of sudden cardiac death. Predictors of PA participation in this population were Self-Efficacy for Exercise (SEE) beliefs, Self-Efficacy ICD (SEICD) beliefs, age and NYHA Class. Almost 33 percent of variance in PA participation can be explained by SEE (b = 2.407, β = .390, t = 3.911, p<.01); SEICD (b =2.304, β = .215, t = 2.149, p<.05); age (b = -.394, β = -.234, t =-2.277, p<.05); and NYHA Class (b = -6.373, β =-.198, t = -1.998, p =<.05). Findings indicate the strength of self-confidence in influencing healthy behavior. Findings support the need for more research in identifying barriers and predictors of PA participation in adult, ICD recipients.

The aim: To examinate depressive symptoms among heart failure patients. Another aim was to examinate the differences in depressive symptoms between gender and between heart failure patients and the population. METHOD: The self-assassment formula MADRS was answered by twenty patients with heart failure at the University hospital in Uppsala. MAIN RESULT: Among the participants 31,3 % showed diffrent levels of depressive symptoms. Mild depression was more common in women. Moderate depression was exclusively shown among the female participants, while severe depression only was shown in one man. The result suggested that heart failure patients have more depressive symptoms than the population. CONCLUSION: A large proportion of the patients with heart failure showed signs of depressive symptoms. This was particulary shown in the women. The results suggest that heart failure patients exhibit more depressive symptoms than the population.

No description available.

No description available.