No description available.

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.

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. / 2999-01-01

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 4 uppsatser.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 2001. / Typescript. Bibliography: leaves 89-104.

Aim. The overall aims of this study were to develop a Chinese version Heart Manual and to examine its effectiveness in enhancing the health-related quality of life (HRQL) and psychological status of Chinese patients recovering from AMI. / Conclusion. The findings of this study provide evidence of areas, including the development of a culturally relevant needs-based Heart Manual, and the consideration of a home-based rehabilitation strategy, that could contribute to the development and improvement of cardiac rehabilitation in China. The study provides a unique tool to help Chinese nurses to meet the cardiac rehabilitative care needs of AMI patients. The study can also generate a much-needed impetus and indicate the direction for the development of cardiac rehabilitation nursing, especially home-based self-managed rehabilitative care in China. / Methods. In the first place, qualitative research was conducted to generate data regarding the experiences and needs of Chinese patients and their spouses immediately after their discharge from hospital following a first heart attack, and the views and beliefs of Chinese health professionals' concerning cardiac rehabilitative care in the hospitals of China. The information gained from the couples and health professionals was used to develop a Chinese version Heart Manual that is tailored to patient needs and adapted to the local culture. / Patients in the experimental group demonstrated better progress across a 6-month period than the control group, in terms of: significantly greater improvements in seven of eight domains of generic HRQL (p = 0.031-0.002) as assessed by the Chinese Mandarin version of Short Form 36-item healthy survey (CM:SF-36) and in five of seven dimensions of disease-specific HRQL (p = 0.008-0.000) as measured by the Chinese Mandarin version of Myocardial Infarction Dimensional Assessment Scale (CM-MIDAS); a significantly greater reduction in anxiety (p = 0.046) as assessed by the Chinese version of Hospital Anxiety and Depression Scale (C-HADS); a significantly greater reduction in the serum lipids of triglyceride (p = 0.04), total cholesterol (p = 0.01) and low-density lipoprotein (p = 0.01); a significantly better control of diastolic blood pressure (p = 0.02); and significantly fewer unplanned cardiac-related medical consultations (p = 0.035). However, the effects of the rehabilitation programme on depression, smoking cessation, serum lipids of high-density lipoprotein, systolic blood pressure, body mass index and blood glucose, as well as unplanned cardiac-related hospital readmissions and emergency room visits were not confirmed in this study. / Results. The Chinese version Heart Manual contains three sections. The first section consists of six weekly topics to educate the patient on coronary heart disease. The second section answers commonly asked questions about medication, Percutaneous Coronary Intervention (PCI), sexual life after a heart attack, and anxiety and depression after a heart attack. The third section presents information on the normal values for blood pressure, blood glucose and serum lipids, as well as on the saturated and unsaturated fats to be found in daily foods. A panel of experts and the potential users were invited to evaluate the validity of the contents in terms of the accuracy, appropriateness and applicability of the Manual. All of the content was considered to be accurate and appropriate by the expert panel, and the potential users found it was easy to understand and to follow. / Then, a randomized control group study with repeated measures was used to examine the effectiveness of a six-week home-based cardiac rehabilitation programme using the Chinese version Heart Manual. A total of 160 participants were recruited, and randomly assigned to either the experimental or the control group. Participants in the experimental group received the Chinese version Heart Manual at their discharge, and both groups received the usual care from the hospital. A telephone follow-up to both groups was made 3 weeks after hospital discharge. The outcomes measured included health-related quality of life, psychological status, smoking status, cardiac physiological risk parameters and unplanned health service use. Data collection was conducted at the baseline, at 6 weeks when the programme ended, and at 3 months and 6 months after hospital discharge. Inferential statistics, such as the multivariate repeated measures ANOVA, the Chi-square test, the Mann-Whitney U test and the Friedman test, were used to compare the differences of outcome variables between the experimental and the control group across the 6 months of the study period. / Wang, Wenru. / "November 2007." / Advisers: Sheila Twinn; Sek Ying Chair. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4671. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 297-337). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Bakgrund: Hjärt-kärlsjukdomar är den vanligaste dödsorsaken bland kvinnor i Sverige och drabbar tiotusentals kvinnor årligen. Både män och kvinnor kan drabbas av en hjärtinfarkt, men forskning visar att symtom i den akuta fasen och efterföljande konsekvenser kan skilja mellan kvinnor och män. Syfte: Syftet med litteraturstudien var att belysa kvinnors erfarenheter av att ha drabbats av hjärtinfarkt. Metod: Elva kvalitativa studier har analyserats, kvalitetsgranskats och sammanställts till ett resultat. Resultatet har sammanställts i kategorier och underkategorier. Resultat: Resultatet visar att kvinnor upplever att livet förändras efter en hjärtinfarkt och de måste lära sig att omprioritera vardagen. Stora förändringar sker i familjerollerna och behovet av stöd och information om sjukdomen är stor. Efter en hjärtinfarkt följer livsstilsförändringar för att förhindra ett återinsjuknande, och dessa kan medföra svårigheter för kvinnorna. Att efter en hjärtinfarkt uppleva olika fysiska och psykiska förändringar som fatigue, svaghet och utmattning samt en påtaglig oro över att döden varit så nära och att drabbas av ytterligare en hjärtinfarkt, påverkar kvinnors livskvalitet negativt. Konklusion: Att som kvinna drabbas av en hjärtinfarkt innebär stora livsomställningar. Brist på information leder till oro och ångest samt svårigheter att genomföra livsstilsförändringar. Stöd av familj, vänner och sjuksköterskan är en viktig del i återhämtningsprocessen. En viktig uppgift för sjuksköterskan är att identifiera egenvårdskapaciteten hos patienten och därefter kunna ge ändamålsenligt stöd. / Backround: Cardiovascular disease is the leading cause of death among women in Sweden, affecting tens of thousands of women yearly. Both men and women can be diagnosed with heart attack, but research shows that symptoms in the acute phase and subsequent impact may vary among women and men. Aim: The purpose of this study was to highlight women's experiences of having suffered a heart attack. Method: Eleven qualitative studies have been analyzed, quality reviewed and compiled to a result. The results have been compiled into categories and subcategories. Results: The results show that women feel that life is altered after a heart attack and they must learn to repriotize every-day life. Major changes occur in family roles and the need for support and information about the disease is extensive. After a heart attack follows lifestyle changes to prevent relapse, and these changes may cause difficulties. The fact that after a heart attack live trough a variety of physical and psychological changes such as fatigue, weakness and substantial concern that death was so close and to suffer another heart attack, affects women’s quality of life negatively. Conclusion: As a woman, suffer from a heart attack means major life changes. Lack of information leads to anxiety and difficulties to implement lifestyle changes. The support from family, friends and the nurse is an important part of the recovery process. An important task for the nurse is to identify the patients self-treatment capacity and subsequently be able to implement effective support.

Acute myocardial infarction (AMI) results in the activation of the innate immune system with monocytes playing critical roles in both the initial inflammation following myocardial ischaemia and subsequent recovery. Monocytes are a heterogeneous cell population and observations from experimental models demonstrate that immediately following myocardial injury, classical inflammatory monocytes, which are highly phagocytic, are recruited to ischaemic myocardium from the bone marrow and spleen and peak at 48 hours. This is followed by the recruitment of non-classical monocytes that are involved in repair and healing, peaking at day 5. The monocyte response in humans following AMI is currently poorly understood. Due to their central role in the pathogenesis of AMI, monocytes are attractive both as potential biomarkers to inform of extent of myocardial injury (and recovery) and also as therapeutic targets with the specific targeting of monocytes in experimental models resulting in reduced infarction size and improved LV remodelling. However, in spite of these promising results and our greater understanding of the pathogenesis of AMI, no immune-modulating therapeutic has been translated into routine clinical practice. We therefore hypothesized that characterisation of the monocyte response to AMI by flow cytometry and gene expression profiling in both experimental models and humans would give novel insights into underlying biological processes and function (both locally in the myocardium and systemically), identify novel therapeutic targets, enable their use as cellular biomarkers of disease, and test conservation between species validating the experimental model for future investigation. Classical inflammatory monocytes were found to significantly increase in the peripheral blood 48 hours following AMI in both mice and humans, with the magnitude of the monocyte response correlating with the extent of myocardial injury in both species. Gene expression profiling of peripheral circulating monocytes following AMI identified a number of candidate genes, biological pathways and upstream regulators that were conserved between species and that could represent novel therapeutic targets. Furthermore, in an experimental model of AMI, leukocytes appeared to have effects beyond the ischaemic myocardium, with leukocyte recruitment in remote myocardium and in kidneys associated with elevated inflammatory markers and endothelial activation.

One of the most prevalent pollutants in urban cities is diesel exhaust particulate (DEP). Air pollution has been linked with increased risk of recurrent myocardial infarction (MI) and MI related death (Brook, 2008). This may be due, in part, to effects on atherosclerotic plaque stability and blood clotting tendency. Whether exposure to DEP changes the response of the heart to ischaemia, resulting in increased damage after MI is less well documented. The work described in this thesis was designed to investigate the hypothesis that pulmonary instillation of DEP would increase vulnerability of the heart to subsequent myocardial reperfusion injury secondary to activation of a systemic inflammatory response, endothelial dysfunction and triggering of transient receptor potential vanilloid 1 (TRPV1) mediated autonomic reflexes in the lung. Examination of bronchoalveolar lavage (BAL) fluid revealed pulmonary inflammation 6 h after exposure to DEP, characterised by neutrophil infiltration, raised levels of the inflammatory mediator interleukin-6 (IL-6) and an increase in alveolar permeability demonstrated by increased levels of protein in the lavage fluid. Pulmonary inflammation was largely resolved 24 h after exposure. While there was no indication of systemic inflammation at 6 h after DEP instillation, the levels of two inflammatory mediators, IL-6 and tumour necrosis factor alpha (TNFα) were increased in the plasma by 24 h after exposure. DEP had no affect on blood flow responses to the endothelium dependent dilator acetylcholine (ACh) in rat hind-limb vasculature in vivo at 6 or 24 h. In summary, while exposure of rats to DEP can induce both pulmonary and systemic inflammation, it does not modify endothelium-dependent vasodilatation. Ischaemia-reperfusion (I/R) was induced in vivo in anaesthetised rats and ex vivo in buffer perfused hearts from rats that had received DEP in vivo 6 h earlier. In both in vivo and ex vivo I/R models, infarct size (unstained by triphenyltetrazolium choride) was significantly increased in hearts from DEP-instilled rats relative to hearts from saline-instilled or non-instilled rats. Baseline oxidant stress, determined by electron paramagnetic spin resonance (EPR) in heart perfusate, was also significantly higher in perfusate of hearts from DEP-instilled rats. In summary, a single exposure of the lung to DEP leads to priming of the myocardium for I/R injury. As the results cited above illustrated, priming of hearts appeared unlikely to be due to either coronary vascular endothelial dysfunction or systemic inflammation. At 6 h post exposure, DEP was associated with increased blood pressure and myocardial hypersensitivity to ischaemia-induced arrhythmias, both suggestive of sympathetic activation. The beta 1 (β1) selective blocker metoprolol was used to investigate the role of the sympathetic nervous system (SNS) in transmitting the influence of DEP in the lung to the myocardium via β1 adrenoceptor activation. Administration of metoprolol (10 mg/kg, intraperotineal) at the time of DEP instillation into the lung was found to protect the heart from potentiation of ex vivo reperfusion injury. Metoprolol was also effective in reducing oxygen free radical generation from these hearts. The TRPV1 antagonist AMG 9810 was also used to study the role of TRPV1 receptors in mediating the priming influence of pulmonary DEP to the myocardium since activation of sensory receptors have been reported to modify sympathetic output via feedback to the central nervous system (Widdicombe et al., 2001). Coadministration of AMG 9810 (30 mg/kg) in vivo with DEP into the lung was found to prevent enhancement of ex vivo reperfusion injury associated with DEP instillation alone. Collectively these results have demonstrated that a single exposure of the lung to DEP leads to priming of the myocardium for I/R injury. Furthermore, this priming occurs via activation of a pulmonary sensory reflex that is likely to involve secondary activation of systemic β1 adrenoceptors.