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The management of acute myocardial infarction (AMI) has been improved by the realisation that the size of infarction can influence mortality (Sobel et al, 1972) and that the infarct size can be altered by subsequent therapy (Maroko et al, 1972). The identification of any factor which may have adverse effects on the ischaemic myocardium and which is amenable to treatment would therefore have important prognostic implications. Elevation of circulating free fatty acid (FFA) concentrations is a consistent feature (Kurien and Oliver, 1966; Oliver et al, 1968) of the profound, non-specific metabolic reaction associated with the onset of AMI (Opie, 1975). The FFA rise has been correlated with the development of arrhythmias (Oliver et al, 1968) after AMI, and with the severity of ischaemic damage (Oliver et al, 1968; Gupta et al, 1969; Russell & Oliver, 1978) on clinical grounds. The method of quantifying infarct size developed by Shell et al (1972) has provided a means of correlating the degree of metabolic disturbance with extent of myocardial damage, and of assessing the benefits of metabolic interventions. The purpose of the studies reported in this thesis was to examine in detail the FFA rise in the early phase of AMI and to correlate this rise with the development of arrhythmias and other complications of AMI and with enzymatically estimated infarct size, thus leading to a more rational approach to therapeutic interventions.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

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The accurate exclusion of myocardial ischemia as the cause of acute chest pain is a clinically demanding and resource intensive process. An estimated three to five million patients present to emergency departments in the United States each year with chest pain of uncertain etiology. Emergency departmente valuation of patients presenting with acute chest pain has traditionally involved patient history, physical examination, electrocariography, and cardiac enzyme evaluation. Unfortunately these methods suffer from suboptimal sensitivity and specificity. The majority of these patients will not have myocardial ischemia as the cause of their chest pain. Out of concern for the potential complications and legal consequences of a missed diagnosis of AMI, emergency physicians commonyl recommend hospital admission for all patients at risk of acute ischemia. Resulting in unnecessary admissions and tremendous cost. The goal of this project is to develop a research-based approach to the assessment and management of chest pain patients presenting to the Emergency Department. A chest pain observation unit will be designed for out-patient evaluation of those patients at moderate to low risk of acute coronary ischemia to rule out occult cardiovascular disease. The chest pain center model presented in this project will guide this unit structure. A community outreach educational program to and a continuous quality management program was also developed.

The purpose of this integrative research review is to summarize the research studies of the effect of music therapy on anxiety of cardiovascular patients with acute myocardial infarction in the intensive care unit. Studies from 1990-2000 were examined for inclusion in the review. The initial library search yielded 65 articles; however, only four studies met inclusion criteria. This review covers a description of music therapy including historical, physiological, and psychological aspects. It explores the effects of music therapy on the cardiovascular system and in reducing anxiety. It also analyzes the common and conflicting findings along with the implication for practice and research. Findings support improvement in psychological and physiological parameters with music intervention. Music therapy not only has no adverse effects on ill patients but also has therapeutic effects in relieving anxiety and creating familiarity in intensive care. Recommendations for future research includes evaluating the effectiveness of music therapy with various cultural groups to examine the impact of music on psychoneuroimmunological variables are needed.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.