Mitral valve prolapse (MVP) is thought to be one of the causes of unexplained cardiac arrest (UCA). However, previous studies are limited by the lack of a standardized evaluation of UCA and the absence of a control group to identify predictors of cardiac arrest. We performed a systematic review of studies that examined the yield UCA evaluation. We then reported the prevalence and characteristics of MVP patients from a multi-centre registry of patients with UCA. Lastly, we completed a protocol of a matched case-control study aiming at comparing echocardiographic features of MVP patients with and without cardiac arrest. As a result of these studies, we proposed a standardized algorithm for UCA evaluation and a definition for idiopathic ventricular fibrillation. Also, we reported the prevalence of MVP in patients with UCA and described few features that could potentially help distinguish patients with MVP at risk for cardiac arrest.

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.

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<p> Exercise programs designed for cardiac patients frequently report high dropout rates. Little is known about the reasons for this high rate of dropout; further, little is known about health behavior patterns including physical activity subsequent to graduation or dropout from exercise programs. Identification of reasons for dropout and the pattern of physical activity after participation in formal exercise rehabilitation would provide information regarding achievement and maintenance of treatment goals.</p> <p> Entry characteristics were determined for 84 male cardiac patients (45 compliers and 39 dropouts) from the McMaster Cardiac Rehabilitation Exercise Program. Follow-up information pertaining to areas of: a) health; b) employment, smoking, activity, and dietary status; c) reasons for joining the program; d) perceived benefits achieved; and e) factors contributing to compliance with or dropout from the exercise program was obtained from 63 subjects (41 compliers and 22 dropouts) who responded to a questionnaire by mail.</p> <p> The dropout rate at the end of the 6 month program was 46.4% (39 of 84 subjects) with one-half of all dropout occurring within the first 2 months of the 6 month program. Upon entry into the exercise program, a significantly greater proportion of dropouts (43.6%, n=17) than compliers (8.9%, n=4) were found to be regular smokers. Likewise, a significantly greater proportion of dropouts (82.1%, n=32) than compliers (55.6%, n=25) were found to be inactive in their leisure habits upon entry. Dropouts were also more likely to be blue collar workers (71.8%, n=28), and younger in age (x̅ age = 48.4 years) when compared to compliers (37.8%, n=17; x̅ age = 54.3 years) upon entry into the exercise program. Upon follow-up, compliers were significantly more likely to report active leisure habits (85.4%, n=35) than were responding dropouts (45.5%, n=10). Compliers were also significantly more likely to report moderate work activity levels upon follow-up (54.8%, n=17) compared to dropouts (22.2%, n=4). Reasons for compliance to and withdrawal from the exercise program provided by respondents centred around psychosocial and personal convenience categories.</p> <p> Although statistically significant, the greater follow-up activity levels noted among compliers in this study appear to be only temporary, short-term patterns which tend to diminish with time. It is suggested that compliance-improving strategies be developed through further study with the aim of encouraging the long-term maintenance of desired behavior change.</p> / Thesis / Master of Science (MSc)

Considering that both cardiovascular disease (CVD) and congenital heart diseases (CHD) are still the leading cause of morbidity and mortality worldwide, there is a need for a robust and reliable cardiac model. Cardiac organoids are complex, three-dimensional cellular constructs that recapitulate the processes of the human embryonic heart. However, certain vital morphological features within the fetus are not yet replicable with cardiac organoids. Here we report our investigation to generate cardiac organoids with chamber formations. Our method involves modulating the Wnt pathway at two different instances while also implementing two cell seeding densities, all to determine the most optimized that to produce chamber formations within cardiac organoids.

Hypoxia as a stressor has physiological implications that have been a focal point for many physiological studies in recent years. In some studies, hypoxia had large effects on the organ tissue degeneration, which ultimately effects multiple ecological processes. These organ tissue studies played a part in the development of new fields like neurocardiology, a specialty that studied the relationship between the brain and the heart. This thesis focuses on how hypoxia-induced cardiac arrest alters the amounts of GLYT2, a glycine reuptake transporter, in the central nervous system of zebrafish, Danio rerio. At 7 days post-fertilization (dpf), zebrafish were exposed to acute, severe hypoxia until they lost equilibrium, and minutes later, subsequent cardiac arrest occurred. Zebrafish were then placed into recovery groups to measure the GLYT2 levels at multiple points in zebrafish recovery. Fish were then sacrificed, and their brains dissected. Using immunofluorescence, the outer left optic tectum of the zebrafish was imaged, and mean image pixel fluorescent intensity was taken. There were significant changes (one-way ANOVA) in the levels of GLYT2 compared to that of the control groups during the course of recovery. GLYT2 levels continued to rise through the 24-hour recovery mark but did not show significant difference after 3 hours of recovery. This suggest that GLYT2 levels increased rapidly in the first 3 hours of recovery and continued to increase through 24 hours at a slower rate. Changes in GLYT2 levels may affect motor and sensory information, movement, visualization, and audition in these zebrafish. Further research should be conducted to determine how long it takes for GLYT2 levels to return to baseline, as well as behavioral measurements through each recovery period as it relates to glycine function.

Thesis (M.D.)—Boston University