This report demonstrates the utilization of a new serum factor, Toxicity Preventing Activity (TxPA) in the diagnosis of coronary disease prone individuals. Our laboratory has recently identified TxPA, which offsets the toxicity of very low density lipoproteins (VLDL) upon arterial cells in vitro. In the present study, we measured TxPA activity and serum lipoprotein levels in 73 individuals undergoing coronary angiography. Serum from control subjects demonstrated 270% more TxPA than aged matched individuals with angiographically demonstrable coronary disease (CHD). When TxPA was combined with serum lipoprotein values, a new atherogenic index was generated which further distinguished these individuals with CHD from non-angiographed controls. These results demonstrate that TxPA is a new protective factor in coronary artery disease, and that the new atherogenic index provides for the first time an accurate classification of individuals with coronary artery disease.

No description available.

Coronary artery disease (CAD) remains the leading cause of death in both the United States and the world at large. This is primarily due to the extreme difficulty associated with preemptive diagnosis of CAD. Currently, only about 20% of all patients are diagnosed with CAD prior to the occurrence of a heart attack. This is the result of limitations in current techniques, which are either noninvasive, extremely expensive, or have very poor correlation with the actual disease state of the patient. Phonoangiography is an alternative approach to the diagnosis of CAD that relies upon detection of the sound generated by turbulent flow downstream from occlusions. Although the technique is commonly used for the carotid arteries, in the case of the coronary arteries the technique is hampered by signal-to-noise problems as well as uncertainty regarding the spectral characteristics associated with CAD. To date, these signal processing difficulties have prevented the use of the technique clinically. This research introduces an alternative approach to the processing of phonoangiographic data based upon knowledge of the acoustic transfer within the chest. The validity of the proposed approach was examined using transfer functions which were calculated for 14 physiologically relevant locations within the chest using a 2-D Finite Element Model (FEM) generated from physiologic data. These transfer functions were then used to demonstrate the technique using test cases generated with the FEM. Finally, the vulnerability of the technique to noise was quantified through calculation of matrix condition numbers for the chest acoustic transfer at each frequency. These results show that while in general the technique is susceptible to noise; noise tolerance is greatly improved within the frequency range most likely to correspond to an occlusion. Taken together, these results suggest that the proposed technique has the potential to make phonoangiography viable as a screening technique for CAD. Such a technique would greatly reduce the cost of CAD, measured in terms of both financial cost as well as lives. / Master of Science

Cardiovascular diseases (CVD) are the leading cause of death in the world. According to the World Health Organization (WHO) 17.3 million people died from cardiovascular disease in 2008, representing 30% of all global deaths. The most common modality of treatment of occluded arteries is the use of stents. Despite the widespread use of stents, the incidence of post-stent restenosis is still high. The study of stents in conditions that are similar to in-vivo conditions is limited. This work tries to address the behavior of stents in conditions similar to in-vivo conditions in a generalized framework, thus providing insights for stent design and deployment. Three dimensional, time accurate computational fluid dynamics (CFD) simulations in a pulsatile flow with fluid-structure interaction (FSI) were carried out in realistic coronary arteries, with physiologically relevant flow parameters and dynamics due to induced motion of the heart. In addition, the geometric effects of the stent on the artery were studied to point towards possible beneficial stent deployment strategies. The results suggest that discontinuities in compliance and dynamic geometry cause critical changes in local hemodynamics, namely altering the local pressure and velocity gradients. Increasing the stent length, reducing the transition length and increasing the overexpansion caused adverse flow conditions. From this work, detailed flow characteristics and hemodynamic characteristics due to the compliance mismatch and applied motion were obtained that gave insights towards better stent design and deployment. / Ph. D.

Coronary artery bypass graft (CABG) är en väl etablerad behandling för patienter med kranskärlssjukdom. Operationen är utmanande och påfrestande för patienten och upplevelserna efter genomgången operation är varierade. Att som sjuksköterska ha kännedom om patienters upplevelser tiden efter operationen är av betydelse för att möjliggöra god omvårdnad och återhämtning för patienten. Syftet var att belysa patienters upplevelser tiden efter en CABG. Studien grundades på 11 vetenskapliga artiklar och genomfördes som en litteraturstudie. Fyra teman framkom i resultatet; den relationella upplevelsen, den kroppsliga upplevelsen, den mentala skörheten och en ny syn på livet. Det framkom att patienterna upplevde stödet från omgivningen som det viktigaste för god återhämtning. Information från vårdpersonalen ansågs till viss del bristfällig av patienterna. Flera upplevde smärta efter operationen och hade delvis symtom kvar, men dessa avtog med tiden. Centralt efter operationen var även oro, men med tiden kom förbättrad livskvalitet och motivation. Det framkom att en CABG var en stor påfrestning för patienten och upplevelserna var både positiva och negativa. Kunskapsluckor avseende patientupplevelser efter operationen finns och ytterligare forskning bör fokusera på området för att ge sjuksköterskestudenter och sjuksköterskor ökad kunskap i mötet med denna patientgrupp. / Coronary artery bypass graft (CABG) is a well-established treatment for patients with coronary artery disease. The surgery is challenging and stressful for the patient and experiences varied after surgery. It’s important for the nurse to be aware of patients’ experiences after surgery to enable good care and recovery for the patient. The aim was to illuminate patients’ experiences during the time after a CABG. The study was based on 11 scientific articles and was conducted as a literature review. Four themes emerged; the relational experience, the bodily experience, the mental fragility and a new view on life. The result showed that patients' experienced the support from the surroundings as the most important for good recovery. Information given by caregivers were in some cases considered inadequate by the patients. Patients experienced pain after surgery and had partial symptoms left, which subsided with time. Concern was a central experience after surgery, but over time came improved quality of life and motivation. A CABG is a major strain for the patients and the experiences were both positive and negative. There are gaps in knowledge regarding patient experiences after the surgery and further research should focus on that area to give nursing students and nurses knowledge in the meeting with these patients.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

The present project investigated the effect of glucose, high dose insulin and normoglycemia (GIN) therapy in patients undergoing coronary revascularization surgery. A reduction in myocardial injury as measured by cardiac troponin I was the primary end point. Cardiac function based on hemodynamics and vasoactive drug requirements as well as clinical outcome were evaluated. Hormones and metabolites and cardiac metabolism were investigated concurrently as potential mechanisms of GIN therapy. The major findings of the present study are that GIN therapy reduced post-operative myocardial injury and myocardial dysfunction leading to a decrease in major complications following coronary artery bypass grafting surgery. The mechanism of the overall improvement in cardiac function and decreased morbidity following CABG with GIN therapy is likely to be multi-factorial, but from the present results, is influenced by improved myocardial metabolism. GIN therapy is thus an effective diet for the ischemic heart.

With the decreasing length of hospitalization for the Coronary Artery Bypass Graft (CABG) patient population, it is becoming increasingly difficult to provide patients with necessary education. The purpose of this study was to examine patients' perceptions of the importance of patient teaching information, and how realistic they perceive it is to learn the information following CABG surgery. Patients' learning and understanding are increased when the information is perceived as important.The findings of this study indicated that CABG patients rated the areas of medication, diet and activity information as the most important to learn during the early recovery period. The patients indicated that it was less realistic to learn in the areas of anatomy and physiology, risk factors, medications, diet, activity, post surgical care, psychological factors, and other pertinent information during the early recovery period. The information gained from this study could be used to enhance educational content for patients who have undertaken CABG surgeries. / School of Nursing

The aim of the thesis was to study cardiovascular side effects of radiotherapy (RT) in breast cancer (BC). In a study base of 25,171 women with BC diagnosed 1970-2000, we found a statistically significant 12% increase of stroke, compared to the stroke incidence in the background population. A case-control study of 282 cases with BC followed by a stroke and 1:1 matched controls with BC but not stroke was performed. In women irradiated to internal mammary chain (IMC) and supraclavicular lymph nodes (SCL) vs. a pooled group of women not irradiated or irradiated to targets other than IMC and SCL, a statistically significant increase of stroke with an odds ratio of 1.8 was observed. There were no associations between BC laterality, targets of RT, and hemisphere location of stroke. The radiation targets IMC and SCL, showed a statistically significant trend for an increased risk of stroke with daily fraction dose. A study of 199 patients with BC, examined by coronary angiography, detected a four- to seven-fold increase of high grade coronary artery stenosis in mid and distal left anterior descending artery (LAD), including distal diagonal branch, when comparing women with irradiated left-sided BC to those with right-sided. An increase of clinically significant coronary artery stenosis was found in pre-specified hotspot areas for radiation among women irradiated to the left breast/chest wall or to the IMC. Thus, the coronary arteries should be regarded as organs at risk in RT of BC. In a study of 15 BC patients treated with 3D conformal RT, a marked difference in dose distribution in mid and distal LAD between left- and right-sided BC was demonstrated. Irradiated right-sided BC mainly received low doses of scattered and transmitted radiation to the coronary arteries. On the contrary, tangential RT to the left breast without regional lymph node irradiation yielded coronary artery max doses of approximately 50 Gray to distal LAD, probably not safe concerning late radiation vascular effects. To conclude, we found cardiovascular side effects in women irradiated for BC, resulting in stroke and coronary artery disease, and showed an association between the targets for RT and the anatomical location of these vascular events.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.