Hjärtinfarkt är en av de vanligaste orsakerna till dödsfall i Sverige. Det är vanligt att de som drabbats har svårt att hantera sin förändrade livssituation eftersom sjukdomen påverkar vardagen fysiskt, psykiskt, socialt och ekonomiskt. Kvinnor har oftare svårare att anpassa sig till livet efter hjärtinfarkten än män. Syftet med studien var att beskriva hur kvinnor upplever det dagliga livet efter en hjärtinfarkt. Metoden för studien var en litteraturöversikt av 10 kvalitativa artiklar. I resultatet framkom fem olika kategorier; En förändrad livssituation som innebär förändrad social roll och hur kvinnan hanterade livet efter hjärtinfarkten. Förändrade relationer beskriver hur relationerna till vänner, familj och arbetskamrater påverkas. Behov av stöd omfattar stödet som kvinnan behöver för att kunna hantera sin nya livssituation. Den förändrade kroppen tar upp vilka kroppsliga symtom som kan komma efter en hjärtinfarkt och Känslomässiga reaktioner beskriver det psykiska måendet som kom med den nya situationen. Slutsatsen är att kvinnorna ofta förlorar kontroll över det dagliga livet och är i behov av stöd både från vårdpersonal och närstående. / Myocardial infarction is one of the most common causes of death in Sweden. It is common for the affected person to have difficulties managing the changes in his or her life situation caused by the disease both physically, mentally, socially and economically. Women have more often difficulties adapting to her life after a myocardial infarction than men do. The aim of this study was to describe how women experience daily life after a myocardial infarction. The methodology for this study was a literature review of ten qualitative studies. The result showed five different categories; A changed life situation, which describes changed social roles and how woman managed life after a myocardial infarction. Changes in relationships, which describes how relationships with friends, family and co-workers are affected. The category Need of support process the assistance that women need in order to manage their new life situation. The changed body, which involves the physical symptoms that can occur after a myocardial infarction and Emotional reactions, which describes the mental condition that accompanies the new situation. The conclusion is that women often lose control over their daily lives and are in need of support from both health care professionals and relatives.

Cardiovascular disease is the leading cause of morbidity and mortality in developed nations, and heart disease is predicted to remain the leading killer for the foreseeable future. Acute myocardial infarctions—nearly 1.1 million annually occurring in the U.S. alone—are the major cardiovascular disease subgroup. Current treatments for myocardial infarction are limited to interventions that serve to mitigate the initial insult, but clinical applications to protect or regenerate damaged myocardium are lacking. This dissertation examines three therapeutic systems to treat the infarcted heart. First, the decoration of a polymeric nanoparticle with N-acetylglucosamine for the uptake of anti-­apoptotic therapeutics to ameliorate cardiomyocyte cell death. Second, novel dendrimeric structure architecture to allow for regio­selected decoration of ligands to induce angiogenesis. Third, exosomes secreted from hypoxic cardiac progenitor cells as a naturally derived therapeuticfor angiogenesis and anti-fibrosis, and to provide bio-inspired clues for future therapies.

The purpose of this thesis was to assess the prevalence and management of established cardiovascular (CV) risk factors and the prevalence and influence of self-reported markers (number of teeth and frequency of gum bleeding) of periodontal disease (PD), a less explored CV risk factor, in patients with stable chronic coronary heart disease (CHD). We studied patients from the global STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial (n=15,828), in which patients with stable chronic CHD were randomized to either darapladib or placebo. Our studies were performed using descriptive statistics and multivariable linear, logistic and Cox regression models. The use of secondary preventive medications was generally high across the whole study population. Despite this, CV risk factors were highly prevalent, including obesity, hypertension and hypercholesterolemia. Achievement of guideline-recommended treatment targets was lacking and little improvement was seen throughout the study duration. Approximately 40% of patients reported having <15 remaining teeth and 25% reported gum bleeding. More tooth loss was associated with a greater CV risk factor burden after adjustment, while the associations for gum bleeding were less evident. After multivariable adjustment for CV risk factors and socioeconomic status, more tooth loss was associated with an increased risk of major adverse CV events (a composite of CV death, myocardial infarction and stroke), CV mortality, all-cause mortality and fatal or non-fatal stroke. We found associations between a higher degree of tooth loss and elevated levels of several prognostic biomarkers known to reflect various pathophysiological mechanisms involved in CV morbidity and mortality. Most biomarkers had little attenuating effect on the relationship between tooth loss and outcomes in a multivariable model. In conclusion, we found an inadequate CV risk factor control despite a high use of evidence-based pharmacological therapies, likely to explain some of the excess risk in CHD patients. Further, we demonstrated a high prevalence of PD markers, tooth loss in particular, that were associated with a wide range of established CV risk factors, prognostic biomarkers and outcomes. Collectively, these findings indicate that tooth loss may be a significant risk factor among patients with stable chronic CHD.

Premature death due to cardiovascular disease, including myocardial infarction, is higher in Hispanics (23.5%) than non-Hispanic White (16.5%) adults. Delaying treatment over 60 minutes increases the risk of sudden death by 50%. The purpose of this study was to describe the perceived benefits and barriers to seeking cardiac emergency care including emergency medical services (EMS) activation during an acute myocardial infarction (MI) in Mexican American adults. A qualitative descriptive design was used wherein semi-structured interviews and sociodemographic questionnaire were conducted with 12 Mexican Americans who had experienced an MI in the last two years. Qualitative conventional content analysis was used to uncover unique perceptions of Mexican Americans seeking emergency care. The overall theme that arose was degree of perceived threat leads to action. This theme was comprised five categories: perceived susceptibility, perceived severity, perceived barriers, perceived benefits, and learned behavior. Perceived severity was closely intertwined with perceived susceptibility. Recent appointments with HCPs facilitated low perceived susceptibility to an MI and acted as a barrier leading to ix decreased initiation of emergency services for MI. Participants attempted self-treatment and evaluation which was a barrier to immediate emergency care. Perceived benefits to initiation of emergency care were using EMS to achieve rapid treatment of MI symptoms. Though several participants initially stated they would activate EMS, further inquiry revealed calling EMS was considered a last resort if the participant were alone. The findings suggest education of lay people and HCPs needs to emphasize that MIs can present in a variety of ways from slow-onset to fast-onset. A goal for nursing practice is to include regular screening on cardiac risk factors along with interventions and evaluation among patients and family. Future research should aim at finding the most successful format to provide public education to Mexican Americans on MI symptom and rapid initiation of EMS. / text

Myocardial Infarction (MI) is one of the most prevalent and deadliest diseases in the United States. Since the host myocardium becomes irreversibly damaged following MI, current research is focused on identification of novel, less invasive, and more effective treatment options for patients. Cellular cardiomyopathy, in which viable cells are transplanted into the necrotic tissue, has the potential to regenerate and integrate with the host myocardium. Stem cells, specifically pluripotent stem cells such as embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSC), are ideal candidates for this procedure because they are pluripotent; however, ESCs must be predifferentiated to avoid teratoma formation in vivo. In this dissertation, our goal was improve upon current protocols to direct differentiation of ESCs into cardiomyocytes using an embryoid body (EB) model. We immobilized pro-cardiomyogenic proteins, specifically Sonic Hedgehog (SHH) and Bone Morphogenetic Protein 4 (BMP4) to paramagnetic beads and delivered them in the interior of the EB. While lineage commitment was indiscriminate, the presence of the beads alone appeared to guide differentiation into cardiomyocytes: there were significantly more contracting areas in EBs containing beads than in the presence of SHH or BMP4. To take advantage of this result, we immobilized Arginine-Glycine-Aspartic Acid (RGD) peptides to the beads and magnetized them following incorporation into the EB. Magnetically mediated strain increased the expression of mechanochemical markers, and in combination with BMP4 increased the percentage of cardiomyocytes. Finally, PEGylated fibrin gels were used to investigate the effect of seeding method and fibrinogen concentration on cardiomyocyte behavior and maturation. Cells seeded on top of compliant hydrogels had the most contracting regions compared to stiffer PEGylated fibrin gels, whereas cardiomyocytes seeded within the hydrogels could not remodel the matrix or maintain contractility. As an alternative to 3D culture, we seeded cardiomyocytes within gel layers, which maintained viability as well as contractile activity. We observed that PEGylated fibrin gels can maintain ESC-derived cardiomyocytes; however, the ratio of cardiomyocytes and non-cardiomyocytes should be optimized to maintain contractile phenotypes. Therefore, this dissertation presents novel methods to differentiate ESCs into cardiomyocytes, and subsequently promote their maturation in vitro, for the treatment of MI. / text

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications globally. There are generally two types: selective (COX-2) and traditional NSAIDs (COX-1). They are primarily used for the treatment of pain. They gained attention after a study about their basic mechanisms highlighted their toxicity. Several studies have reported an association between NSAIDs and risk of myocardial infarction (MI). However, the direction of the relationship is not conclusive. Further studies are needed to ascertain the direction of this relationship and evaluate the present situation with available drugs. Due to the seriousness of cardiovascular diseases as one of the leading cause of death, continuous monitoring of the NSAIDs-MI association is needed. The purpose of this dissertation was to investigate the association between NSAIDs and MI in a younger (30-64 years) Kentucky Medicaid population with a 12 year window of data. The three specific aims were: (1) to understand the characteristics of the Kentucky Medicaid population with respect to NSAID use: (2) to evaluate the NSAID-MI relationship with a 12 year follow-up in a young heavily-burdened population for cardiovascular diseases: and (3) to investigate the MI risk of meloxicam, celecoxib and naproxen compared to no exposure. A retrospective study was conducted employing data from January 1st 2000 and December 31st 2012. The data comprised demographic, prescription and medical files. Within this cohort, a nested case control study was conducted. Cases of MI were matched to four controls on race and gender. The results suggested that exposure to COX 2 presented an increased adjusted risk for MI (1.138(0.983, 1.318)). However, this risk was significantly increased for COX-2 only users compared to COX-1 only users (1.221 (1.03, 1.485)) and 30-40 year olds (1.600 (1.082, 2.367)). Meloxicam, celecoxib and naproxen compared to no exposure showed meloxicam presented a non-significant different risk for MI (1.26 (0.98, 1.63)) and celecoxib presented a significantly increased risk for MI (1.52 (1.26, 1.82)). This study considered pattern of use in determining continuous usage by looking at both continuous and sporadic users of NSAIDs and also considered patient switching patterns between classes of NSAIDs.

Sammanfattning Bakgrund För att kunna tillfriskna och återhämta sig efter en hjärtinfarkt så bör patienten göra en livsstilsförändring. Det är därför är det viktigt att sjuksköterskor får vetskap om, får material och resurser för att kunna hjälpa och stärka patienten med dennes copingresurser. Denna studie belyser olika delar som enligt patienter anses viktiga att förbättra i sjuksköterskans arbete. Syfte Syftet med denna litteraturstudie är att beskriva patienters erfarenheter efter hjärtinfarkt och vad de anser kan förbättras i sjuksköterskans arbete för att främja deras återhämtning. Syftet är även att granska de sökta artiklarnas datainsamlingsmetod. Metod Examensarbetet har gjorts i form av en deskriptivlitteraturstudie utifrån artiklar med kvalitativ och kvantitativ ansats. Huvudresultat Denna studie visar på vikten av information till patienter och deras närstående för att återhämtningen ska bli så lyckad som möjligt. Den belyser även olika delar som enligt patienter anses viktiga att förbättra i sjuksköterskans arbete för att främja återhämtningen. .Slutsats Denna studie visar tydligt på vikten av information, att den är tydlig, tillräcklig och fortlöpande och anpassas efter tid utifrån varje enskild patient för att återhämtningen efter en hjärtinfarkt ska bli så lyckad som möjligt. Då rehabiliteringen ofta ligger på patientens och dess anhörigas ansvar så är det också viktigt att de görs mer delaktiga och att informationsflöde till anhöriga förbättras. / Background To be able to convalesce and recover after a heart attack the patient should make a lifestyle change. It is therefore important that nurses have knowledge, the materials and resources to help and strengthen the patient with his copingresourses. This study highlights various elements which the patients are considered essential to improve the nurse's work. Aim The purpose of this study is to describe the experiences of patients after myocardial infarction and what they think could be improved by nurses to promote their recovery. The aim was also to examine the chosen articles data collection methods. Method The work has been done in the form of a descriptive literature review based articles using qualitative and quantitative approach. Main Results This study shows the importance of information to patients and their families that the recovery will be as successful as possible. It also highlights various elements which the patients are considered essential to improve the nurse's work to promote recovery. Conclusion This study clearly demonstrates the importance of information, that it is direct, sufficient and sustained and to time based to each individual patient, so recovery after a heart attack can be as successful as possible. Rehabilitation is often the patient's and the family's responsibility. That it is why it is important that they become more involved and that the information to relatives is improved.

Timely coronary artery reperfusion is essential to prevent myocyte death following myocardial infarction. The act of restoring blood flow however, paradoxically reduces the beneficial effects of reperfusion. This phenomenon, termed myocardial reperfusion injury, refers to the injury of cardiac myocytes that were viable immediately before reperfusion. Recent studies have shown that the timing and hemodynamic sequence of events which govern reperfusion can help to minimize the severity of reperfusion injury. The term postconditioning describes a modified form of reperfusion that involves a series of flow interruptions which confer significant cardioprotection to the heart. This thesis investigates ischemic postconditioning and endothelial nitric oxide synthase (eNOS) phosphorylation as cardioprotective therapies against reperfusion injury. In the first half of this thesis, we test the hypothesis that phosphorylation of eNOS serves as a cardioprotection nodal point for ischemic postconditioning. We show that phosphorylation of eNOS increases enzyme activity and that its product, nitric oxide, plays a critical role in cardioprotection. A number of cardiac dysfunctions arise after reperfusion and we address the effects of postconditioning on infarct size and myocardial blood flow. The second half of this thesis introduces the use of magnetic relaxometry sensors to detect cardiac biomarkers. The ability to non-invasively measure infarct size in small animals would be helpful in studying models of myocardial ischemia-reperfusion injury. We investigate the use of implantable biosensors in vivo and show that the cumulative detection of cardiac biomarkers correlates with infarct severity. / Engineering and Applied Sciences

published_or_final_version / Medicine / Master / Master of Philosophy

Heart failure, predominately caused by myocardial infarction (MI), is the leading cause of death in the United States. Currently the only treatment for heart failure is cardiac transplantation, but studies show that progenitor cell, biomaterial, or combined therapies have improved cardiac function post-MI. The endogenous environment of CPCs is drastically different from commonly used culture conditions. Further the endogenous environment changes with age and disease state. We evaluated the behavior of CPCs cultured on a naturally-derived, cardiac extracellular matrix (cECM) as compared to the standard culture coating collagen I, that also mimics fibrotic tissue. In this study, CPCs cultured on cECM had improved cell numbers and cardiomyogenic maturation. However, the microenvironmental cues responsible for stimulating CPC activation are largely unknown. During development, aging and disease the myocardium changes in matrix composition and stiffness exposing endogenous cells to a wide variety of stimuli. In a combinatorial study, we evaluated the effect of cyclic strain and extracellular matrix composition on CPC behavior. The response of CPCs to signals from the microenvironment is complex, with more matrix-dependency observed at lower strains. Alignment, cell division and paracrine signaling are extracellular matrix and strain dependent. Extracellular matrix conditions affect CPC maturation and calcium signaling. Mechanotransduction pathways, including focal adhesion kinase and extracellular signal-regulated kinase, are activated through adhesion and maintained under cyclic strain. Insights from this work will advance pragmatic cell therapy attempts to regenerate healthy myocardium post-MI.