The literature has demonstrated that depression is a significant predictor of morbidity and mortality for individuals who have experienced an acute myocardial infarction (AMI). Despite this robust relationship, few studies have systematically examined the demographic, psychosocial, neuroimmunological and hormonal predictors of depression amung post-AMI individuals in a longitudinal design...

The purpose of this thesis investigation was to determine the responsiveness and validity of a previously developed evaluative instrument (QL-SP), purported to measure quality of life in spouses of patients who have suffered a myocardial infarction. The 26 questions of the index address emotional concerns, functional limitations, sleep disturbances, and lifestyle changes; they are categorized into the Emotional Function Dimension (EFD) , and the Physical and Social Function Dimension (PSFD). Subjects (n=39) completed the QL-SP and a battery of established questionnaires during home visitations, 1-2 weeks after the patient member of the pair had been discharged from the hospital, and 8 weeks later. Predicted associations were derived according to standardized consensus methods suggesting how changes in the QL-SP dimensions should correlate with changes in the other indexes. Scores on the QL-SP between admission to the study and the second visit were improved for both the emotional function (t = 5.56, p < 0.001), and physical and social function (t = 6.11, p < 0.001) dimensions. The agreement between predicted and observed relationships, as measured statistically by a Kappa with Cicchetti weights, was significant (Kw = 0.43, p = 0.0012). The QL-SP appears to be a responsive and valid measure of quality of life in spouses of MI patients related to their partner's illness. It may be useful in clinical practice as a routine periodic assessment throughout the post-MI convalescent period, and as an evaluation tool for intervention strategies. / Thesis / Master of Science (MS)

Hjärtinfarkt är den dominerande dödliga sjukdomen i Sverige, vilket fler kvinnor än män avlider i. Kvinnor insjuknar senare i livet och upplever fler och mer diffusa symptom än män. Stress är en vanlig förekommande riskfaktor, vilket kan skapas från samhällets förväntningar på kvinnor. Det finns förväntningar om omsorgsfulla kvinnor som samtidigt ska prestera bra både på arbetet och i hemmet, vilket genererar stress. Förväntningar från samhället och kroppens biologi skiljer sig mellan män och kvinnor. Män har historiskt sett representerat normen för människan i forskning och därför är det viktigt att uppmärksamma kvinnors erfarenheter. Syftet med studien var att belysa kvinnors erfarenheter av livet efter hjärtinfarkt. En litteraturstudie användes som metod, vilket genererade tio vetenskapliga artiklar som resulterade i tre teman och nio kategorier. Kvinnornas erfarenheter visade att hjärtinfarkt medförde ett avbrott i livet och med hjälp av närstående samt egna reflektioner lärde kvinnorna känna sig själva igen. En ny prioriteringsordning skapades med fokus på kvinnornas hälsa och liv. Studien visar att stress är en stor faktor i kvinnors erfarenheter efter hjärtinfarkt och att kvinnors erfarenheter behöver uppmärksammas för att vårdpersonal ska kunna ge adekvat vård. Det hade varit betydelsefullt om framtida forskning hade uppmärksammat hur stress skiljer sig mellan könen vid hjärtinfarkt, eftersom stress är en riskfaktor.

Bakgrund: Hjärt- kärlsjukdom är i dag den främsta dödsorsaken i Sverige för både kvinnor och män. Hjärtinfarkt uppkommer när en åderförkalkning i hjärtats kranskärl brister och det bildas en propp. Kvinnors och mäns symtombild under den akuta fasen skiljer sig mycket åt och det kan även erfarenheterna efter hjärtinfarkten göra.   Syfte: Syftet med denna studie var att beskriva kvinnors erfarenheter efter att ha drabbats av en hjärtinfarkt.   Metod: En litteraturstudie baserad på elva kvalitativa studier. Artikelsökningen genomfördes i Cinahl, PubMed och APA PsycINFO. Därefter analyserades studierna med hjälp av Fribergs analysmodell.   Resultat: Resultatet visar att kvinnor kan uppleva olika erfarenheter efter en hjärtinfarkt. De upplevde fysiska-, psykiska-, sociala- och existentiella förändringar i vardagen och resultatet kunde delas in i tre kategorier och nio subkategorier. Kategorierna var: Påverkan på återhämtningen, Förändringar i det vardagliga livet och Förändrad syn på livet. Konklusion: Litteraturstudien visar att kvinnor upplevde hjärtinfarkten som en dramatisk omställning i livet. Flera olika symtom var vanligt förekommande och kunde hålla i sig i flera år. Kvinnorna lärde sig hantera och acceptera situationen efter en tid men var i behov av stöd från familj, vänner, vård och rehabiliteringsgrupper. / Background: Myocardial infarction is today the leading cause of death in Sweden for both women and men. Myocardial infarction occurs when atherosclerosis in the coronary arteries of the heart ruptures and a blockage forms. The symptoms of women and men during the acute phase are very different and so can the experiences after the myocardial infarction.  Aim: The purpose of this study was to describe women's experiences after suffering a myocardial infarction.  Methods: A litterature study based on eleven qualitative studies. The article search was conducted in Cinahl, PubMed and APA PsycINFO. The studies were then analyzed using Friberg’s analysis model.   Results: The results show that women can have different experiences after a myocardial infarction. They experienced physical, mental, social and existential changes in everyday life and the result could be divided into three categories and nine subcategories. The categories were; Impact on recovery, Changes in everyday life and Changed outlook on life. Conclusion: The literature study shows that women experienced the myocardial infarction as a dramatic change in life. Several different symptoms were common and could persist for years.  The women learned to handle and accept the situation after a while but were in need of support from family, friends, care and rehabilitationgroups.

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Introduction: Myocardial infarction (MI) remains the leading cause of morbidity and mortality worldwide. Induced by cardiomyocyte death, MI initiates a prolonged and uncontrolled inflammatory response which impairs the healing process. Immune cells, such as macrophages, play a central role in organizing the early post-MI inflammatory response and the subsequent repair phase. Two activation states of macrophages have been identified with distinct and complementary functions (inflammatory vs. reparatory). This bimodal pattern of macrophage activation is an attractive therapeutic target to favorably resolve post-MI inflammation and enhance recovery. It has been demonstrated that azithromycin (AZM), a commonly used antibiotic with immunomodulatory effects, polarizes macrophages towards the reparatory phenotype. AZM has an excellent safety profile and has been approved for human use. We hypothesize that AZM reduces inflammation and improves heart function in MI. Methods and results: In our initial studies, we demonstrated that oral free AZM (160 mg/kg daily for 7 days), initiated 3 days prior to MI, enhances post-MI cardiac recovery as a result of shifting macrophages to the reparatory state. We observed a significant reduction in mortality with AZM therapy. AZM-treated mice showed a significant decrease in pro-inflammatory and an increase in reparative macrophages, decreasing the pro-inflammatory/reparative macrophage ratio. Macrophage changes were associated with a significant decline in pro- and an increase in anti-inflammatory cytokines. Additionally, AZM treatment was correlated with a distinct decrease in neutrophil count due to apoptosis, a known signal for shifting macrophages towards the reparative phenotype. Finally, AZM treatment improved cardiac recovery, scar size, and angiogenesis. We designed this proof of concept study using pre-MI AZM therapy to achieve steady state levels prior to injury. Therefore, in our follow-up studies we targeted inflammatory macrophages using a non-Pegylated liposomal formulation of AZM (Lazm) which has been shown in multiple studies to promote drug efficacy and minimize off-target effects. To test the hypothesis that Lazm is more effective and safer than free AZM, low doses of free/liposomal AZM (10 or 40 mg/kg, administered intravenously) were initiated immediately after MI. We observed that Lazm induces early resolution of the post-MI inflammatory response as evidenced by switching of the activation state of monocytes/macrophages towards the reparatory phenotype. Neutrophils were substantially decreased, particularly pro-inflammatory neutrophils. Cytokine profiles were also shifted to the anti-inflammatory status with Lazm therapy. Taken together, AZM treatment resulted in a significant shift in macrophage activation towards the reparatory state. The shift in inflammatory state was accompanied by a decrease in apoptosis and infarct size in the injured heart, as well as enhanced angiogenesis and LV functional recovery in our long-term studies. In addition, Lazm was protective against off-target effects of AZM on the heart. Conclusion: This is the first evidence of a novel and clinically-relevant therapeutic strategy to modulate post-MI inflammation. We found that AZM reduces cardiac inflammation and improves adverse cardiac remodeling after infarction via promoting a shift of macrophage activation state. The overarching significance of this work is the modulation of sterile inflammation, which can be a viable therapeutic target in many conditions including stroke and heart attack. Additionally, this is the first study to demonstrate the immune modulation properties of liposomal AZM, which has wide potential therapeutic applications beyond the cardiovascular field. Importantly, liposomal formulation of AZM is protective from its cardiac off-target effects. Our findings strongly support clinical trials using AZM as a novel and clinically relevant therapeutic target to improve cardiac recovery and reduce heart failure post-MI in humans.