Background: Non ST-elevation Acute Coronary Syndromes are the most frequent manifestations of acute ischemic heart disease. Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, difference in outcome between men and women, have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made. The aims of the studies in this thesis were to assess differences between the genders in baseline characteristics, level of care, medical treatment and non-invasive and invasive cardiac procedures. The aims were also to determine gender differences in short and long-term mortality, including impact of level of care, and to determine differences between the genders in benefit from an invasive strategy, with special reference to benefit in women. Method: We used prospectively collected data from the RIKS-HIA registry in two studies (Paper I and IV). In one study we merged data from patients admitted to general wards in the south-east region of Sweden (The AKUT registry), with data from patients admitted to CCU´s (RIKS-HIA) at participating hospitals during the same time (Paper II). We also randomly assigned women to a routine invasive or a selective invasive treatment strategy, and performed a meta-analysis, to determine gender differences in benefit from a routine invasive strategy (Paper III). Results: Women were older than men and more likely to have a history of diabetes and hypertension, while men were more likely to have a history of myocardial infarction and revascularisation. Women were also more likely to have normal coronary arteries on the angiogram. After adjustment for baseline differences there were only minor, and directionally inconsistent, differences between women and men in pharmacological treatment. Men were more often referred for coronary angiography, even after adjustment. While CABG-rate was lower in women, after adjustment PCI-rate was similar or even higher compared to men. After adjustment for differences in age, longterm outcome was better in women. In our small but randomised trial there was no benefit from a routine invasive strategy in women. A meta-analysis indicated interaction between gender and treatment strategy, with lack of benefit in women, in contrast to in men. However, our large observational study indicated no gender difference with an invasive strategy. Moreover, benefit was similar in women and men with invasive treatment. Conclusion: There are substantial differences between women and men in baseline characteristics that affect management and outcome more than gender per se. After adjustment women have better long-term outcome than men. There appear to be a difference in benefit from a routine invasive strategy between the genders, with less benefit in women, but in routine clinical management there was no difference between women and men managed with an invasive strategy.

<p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser</p> / digitalisering@umu

Acute haemorrhage is a leading cause of death in trauma. Young women (YW) seem more susceptible to hypovolemic circulatory stress than young men (YM), but the underlying mechanisms are not clear. Elderly subjects are more vulnerable to haemorrhage, with a decreased defence of central blood volume in elderly men, but the defence has not been evaluated in elderly women  (EW). The aims were to assess differences in cardiovascular responses to hypovolemic circulatory stress, emphasizing compensatory mechanisms to maintain central blood volume in YW, EW and in women prone to vaso‐vagal reaction (VW). Lower body negative pressure (LBNP) was used as a model for haemorrhage and to create acute hypovolemic stress. Volumetric techniques were used to assess venous compliance, capacitance and capillary fluid exchange both caused by LBNP in the calf and the response to maintain central blood volume. LBNP induced a comparable hypovolemic stimulus in YW and YM, with lower calf venous compliance and capacitance but higher net capillary fluid filtration in YW. YW responded with smaller vasoconstriction without association between P‐NE and peripheral vascular resistance in contrast to YM. Venous capacitance response was decreased with time in YW. Further, net capillary fluid absorption from peripheral tissues to central circulation was decreased in YW in response to hypovolemic stress. All in all, this indicates less efficiency to defend central blood volume in young women. Calf venous compliance and capacitance was maintained in EW compared to YW but capillary filtration was decreased, implying reduced capillary function with age. With increasing transmural pressures however, filtration and capillary filtration coefficient (CFC) increased indicating increased capillary susceptibility to transmural pressure load in dependent regions with age. Heart rate increase was attenuated in EW while peripheral vascular conductance was maintained suggesting reduced cardiovagal baroreceptor function in response to hypovolemia with age. Venous capacitance response and fluid absorption from peripheral tissues to central circulation were decreased with age, indicating less efficiency to defend central blood volume. LBNP induced a slower hypovolemic stimulus in VW compared with nonvagal women. Further, the cardiopulmonary baroreflex was less efficient, and the venous capacitance response from peripheral tissues to central circulation was decreased, which may explain their susceptibility to orthostatic challenge.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 4 uppsatser.

digitalisering@umu.se

The spectrum of cardiovascular diseases is the leading cause of morbidity and mortality globally. Early assessment and treatment of these conditions, acquired as well as congenital, is therefore of paramount importance.   The human heart has a great ability to adapt to various hemodynamic conditions by cardiac remodeling. Pathologic cardiac remodeling can occur as a result of cardiovascular disease in an effort to maintain satisfactory cardiac function. With time, cardiac function diminishes leading to disease progression and subsequent heart failure, the end-point of many heart diseases, associated with very poor prognosis.   Within the normal cardiac ventricles blood flows in highly organized patterns, and changes in cardiac configuration or function will affect these flow patterns. Conversely, altered flows and pressures can bring about cardiac remodeling. In congenital heart disease, even after corrective surgery, cardiac anatomy and thereby intracardiac blood flow patterns are inherently altered. The clinically most available imaging technique, ultrasound with Doppler, allows only for one-directional flow assessment and is limited by the need of clear examination windows, thus failing to fully assess the complex three-dimensional blood flow within the beating heart. Cardiovascular magnetic resonance imaging (CMR) with phase-contrast has the ability to acquire three-dimensional (3D), three-directional time resolved velocity data (3D + time = 4D flow data) from which visualization and quantification of blood flow patterns over the complete cardiac cycle can be performed. Four functional blood flow components have previously been defined based on the blood route and distribution through the ventricle, where the inflowing blood that passes directly to the outflow is called Direct flow. From these components, various quantitative measures can be derived, such as component volumes and kinetic energy (KE) throughout the cardiac cycle. In addition, the 4D flow technique has the ability to quantify and visualize turbulent flow with increased velocity fluctuations in the heart and vessels, turbulent kinetic energy (TKE).   The technique has been developed and evaluated for assessment of left ventricular (LV) blood flow in healthy subjects and in patients with dilated dysfunctional left ventricles, showing significant changes in blood flow patterns and energetics with disease. There is however still no study addressing the gap in the spectrum from the healthy cohorts to patients with moderate to severe left ventricular remodeling. In Paper III, 4D flow CMR was utilized to assess LV blood flow in patients with subtle LV dysfunction, and a shift in blood flow component volumes and KE was seen from the Direct flow to the non-ejecting blood flow components.   In patients with both left- and right-sided acquired and congenital heart disease, right ventricular (RV) function is of great prognostic significance, however this ventricle has historically been somewhat overseen. With its complex geometry, advanced physiology and retrosternal location, assessment of the RV is still challenging and the right ventricular blood flow is still incompletely described. In Paper I, the RV blood flow in healthy subjects was assessed, and the proportionally larger Direct flow component was located in the most basal region of the ventricle and possessed higher levels of KE at end-diastole than the other flow components suggesting that this portion of blood was prepared for efficient systolic ejection. In Paper II, the blood flow was assessed in the RV of patients with subtle primary LV disease, and even if conventional echocardiographic or CMR RV parameters did not show any RV dysfunction, alterations of flow patterns suggestive of RV impairment were found in the patients with the more remodeled LVs.   With improvements of the cardiovascular health care, including the surgical techniques, the number of adult patients with surgically corrected complex congenital heart diseases increases, one of which is tetralogy of Fallot (ToF). Surgical repair of ToF involves widening of the pulmonary stenosis, which postoperatively may cause pulmonary insufficiency and regurgitation (PR). Disturbed or turbulent flow patterns are rare in the healthy cardiovascular system. With pathological changes, such as valvular insufficiency, increased amounts of TKE have been demonstrated. Turbulence is known to be harmful to organic tissues and could be significant in the development of ventricular remodeling, such as dilation and other complications seen in Fallot patients. In Paper IV, the RV intraventricular TKE levels were assessed in relation to conventional measures of PR. Results showed that RV TKE was increased in ToF patients with PR compared to healthy controls, and that these 4D flow-specific measures related slightly stronger to indices of RV remodeling than the conventional measures of PR.   4D flow CMR analysis of the intracardiac blood flow has the potential of adding to pathophysiological understanding, and thereby provide useful diagnostic information and contribute to optimization of treatment of heart disease at earlier stages before irreversible and clinically noticeable changes occur. The flow specific measures used in this thesis could be utilized to detect these alterations of intracardiac blood flow and could thus act as potential markers of progressing ventricular dysfunction, pathological remodeling or used for risk stratification in adults with early repair tetralogy of Fallot. Visualizations of intracardiac flow patterns could provide useful information to cardiac/thoracic surgeons pre- and post-operatively.

<p>2022-03-21</p>

<p>Background: Patients with heart failure is a patient group growing in numbers, the most common treatment focuses on reliving symptoms and the only cure is heart transplantation. <strong>Objective:</strong> Aim of the study was to illuminate patients' experiences of living with heart failure at his home. <strong>Method:</strong> Qualitative design, with a manifest content analysis. The results are based on 12 scientific articles.  <strong>Results:</strong> Patients with heart failure find that the disease is limited to their daily lives through mental illness and physical symptoms. The short comings of given information to the Patients are a necessary element to include in the planning for Patients future life. The Patients are experiencing that their lives are hanging on a thread as their life is running out, giving anxiety and worries. The need for palliative care is great, but is experienced by patients as containing large gaps. <strong>Discussion:</strong> Heart failure is a hidden disease, where patients with heart failure often feel like a burden on the environment. Dependence on other people gives a feeling of hope and hopelessness. <strong>Conclusion:</strong> information plays a large role in how patients with heart failure are able to live with their everyday lives.</p>

Background: Patients with heart failure is a patient group growing in numbers, the most common treatment focuses on reliving symptoms and the only cure is heart transplantation. Objective: Aim of the study was to illuminate patients' experiences of living with heart failure at his home. Method: Qualitative design, with a manifest content analysis. The results are based on 12 scientific articles.  Results: Patients with heart failure find that the disease is limited to their daily lives through mental illness and physical symptoms. The short comings of given information to the Patients are a necessary element to include in the planning for Patients future life. The Patients are experiencing that their lives are hanging on a thread as their life is running out, giving anxiety and worries. The need for palliative care is great, but is experienced by patients as containing large gaps. Discussion: Heart failure is a hidden disease, where patients with heart failure often feel like a burden on the environment. Dependence on other people gives a feeling of hope and hopelessness. Conclusion: information plays a large role in how patients with heart failure are able to live with their everyday lives.

SAMMANFATTNING Bakgrund: Hjärtinfarkt är en av våra vanligaste folksjukdomar som drabbar den vuxna befolkningen och är en vanlig dödsorsak. Sjukdomen kan vara ärftligt betingad men är även en välfärdssjukdom, där det går att påverka riskfaktorer för att insjukna och återinsjukna i hjärtinfarkt. Syfte: Syftet var att beskriva sekundärpreventiva omvårdnadsåtgärder i primärvården för att förebygga återinsjuknande i hjärtinfarkt hos vuxna. Metod: En litteraturstudie med strukturerad systematisk sökstrategi som är baserad på 12 stycken kvantitativa vetenskapliga artiklar med experimentell design. Sökningen gjordes i databasen PubMed. Kvalitetsgranskning skedde med hjälp av Joanna Briggs Checklist for Randomized control trials. Huvudresultat: De flesta studierna visade att interventioner i form av stöd och utbildning gav positiva effekter på återinsjuknande i hjärtinfarkt och patientrelaterade riskfaktorer. Genom interventioner kan de uppnå högre livskvalité, minskat återinsjuknande, hälsosammare liv med mindre stress, bättre motionsvanor, lägre BMI, minskat rökande, bättre följsamhet till läkemedelsanvändning och bättre egenvårdsförmåga. Interventionerna bestod av olika utbildningsprogram som sjuksköterskeledda egenvårdsprogram eller teoribaserade program, webbaserade fjärrutbildningar, telefonapplikationer, telefonuppföljningssamtal, handböcker, mail eller hemutbildningskit med informationsbroschyrer. Denna litteraturstudie visar att genom sekundärpreventiva omvårdnadsåtgärder så kan patienternas hälsa förbättras och de får högre livskvalité och mindre risk att återinsjukna i hjärtinfarkt. Genom att ge patienten information, utbildning och råd så kan sjuksköterskan vägleda och stödja patienterna att utveckla sin förmåga till egenvård. Detta stämmer överens med Orems teori om egenvårdsbalans. Slutsats: Utbildningsinsatser i någon form efter en hjärtinfarkt har visat ge goda effekter på patienters hälsa och minska risken för återinsjuknande.  Nyckelord: förebyggande hälsovård, hjärtinfarkt, hälsofrämjande arbete, sekundär sjukdomsprevention.