<p>Att drabbas av en hjärtinfarkt innebär psykisk och fysisk påfrestning för patienten, och efterföljande hjärtrehabilitering ställer krav på livsstilsförändringar. Stödet från vårdpersonal och socialt nätverk har betydelse för patientens förmåga att hantera sjukdomen och dess konsekvenser. Syftet med föreliggande litteraturstudie var att beskriva patienters behov av stöd i samband med rehabilitering efter en hjärtinfarkt. Studiens resultat baseras på 13 vetenskapliga artiklar. Resultatet visar att patienterna är i behov av professionellt stöd, stöd i det dagliga livet samt stöd genom delade upplevelser. Stödet från familjen är betydelsefullt för genomförandet av livsstilsförändringar, och rehabiliteringen kan påverkas negativt om anhöriga ställer för höga krav eller agerar överbeskyddande. Patienterna fann stöd i gemenskapen i rehabiliterings- eller stödgrupper och lyckades i större utsträckning med företagna livsstilsförändringar. Dock ansågs grupperna vara svåra att anpassa efter deltagarnas individuella behov. Individanpassad information och hjälp med strategier att hantera stress i det dagliga livet efterfrågas av patienterna. För att erbjuda optimala rehabiliteringsmöjligheter krävs att sjukvården tar hänsyn till varje enskild patient och individanpassar rehabiliteringsprocessen inom ramen för befintliga riktlinjer och möjligheter. Vidare forskning inom stöd och rehabilitering efter hjärtinfarkt är önskvärd för att utreda hur rehabiliterings- respektive stödgrupper optimalt kan anpassas efter deltagarnas olika behov.</p> / <p>To be stricken with a myocardial infarction implies psychological and physical strain for the patient, and the following cardiac rehabilitation make demands on lifestyle changes. Support from nursing staff and social network are of importance for the patient's ability to deal with the disease and its consequences. The aim of this study was to describe patients need for social support in rehabilitation following a myocardial infarction. The results are based on 13 research articles. The results indicate that the patients are in need of professional support, support in the daily life and support through shared experiences. The social support from the family is significant for the accomplishment of lifestyle changes, and the rehabilitation is negatively affected if the family makes too high demands or act overprotective. The patients found social support in the fellowship of rehabilitation- or support groups and succeed to a greater extent in achieving lifestyle changes. However there are difficulties in adjusting these groups to the participants’ individual needs. Individually adjusted information and assistance with strategies to handle stress in the daily life are demanded by the patients. To be able to offer optimum rehabilitation, the healthcare needs to take into consideration every patient and individualize the rehabilitation process within available guidelines and possibilities. Further research in support and rehabilitation after a myocardial infarction is desirable to investigate how rehabilitation- and support groups can be adjusted based on the different needs of the participants.</p>

<p>The aim of the study was to describe how women and men with diagnosed heart disease experience their health-related quality of life and what differences there is between genders in their quality of life and also describe problems after receiving the diagnosis. The study also aimed to describe rehabilitation of patients with heart disease. The study was a descriptive literature study based on scientific articles. It emerged that both women and men with heart disease experienced lower quality of life compared to normative data. There was a significant difference between women and men both one year and three years after receiving the diagnosis heart disease, which showed that women experienced lower quality of life than men. The most common psychological reaction to heart disease was anxiety. Women were more anxious than men. Women were also, generally, more depressed than men after diagnosis. To suffer from heart disease resulted in great changes in lifestyle. How the patient was affected seems to depend on the social roll of the patient prior the heart disease and how the disease affected it.</p> / <p>Syftet med studien var att beskriva hur kvinnor och män med diagnostiserad hjärtsjukdom upplever sin hälsorelaterade livskvalitet och vad som skiljer i livskvaliteten mellan könen samt att beskriva efterföljande problem. Studien syftade också till att beskriva rehabilitering av patienter med hjärtsjukdom. Studien gjordes som en deskriptiv litteraturstudie baserad på vetenskapliga artiklar. I studien framkom att både män och kvinnor med hjärtsjukdom upplever lägre livskvalitet än normativ data. Det fanns en signifikant skillnad mellan män och kvinnor både 1 och 3 år efter hjärtsjukdom, som visade att kvinnor upplever lägre livskvalitet än män. Den vanligaste psykologiska reaktionen till hjärtsjukdom var oro. Kvinnor upplevde oro i större utsträckning än män. Kvinnor var även generellt mer deprimerade än män efter hjärtsjukdom. Att drabbas av hjärtsjukdom medförde stora livsstilsförändringar och hur patienten påverkades tycktes bero på den samhällsroll som patienten tidigare haft och hur mycket den förändrats.</p>

<p>Syftet med denna studie var att beskriva patienters psykiska hälsa efter en hjärtinfarkt.</p><p>Studien genomfördes som en litteraturstudie. Sökorden myocardial infarction, mental health, experience, psychological health och quality of life kombinerades för att hitta artiklar. Arton artiklar inkluderades i studien och hittades i databaserna PubMed och Cinahl och genom andra artiklars referenslista. Undersökningarna i artiklarna var genomförda med intervjuer, enkäter och observationer. Resultatet visade att män upplevde en bättre hälsorelaterad livskvalitet än kvinnor samt att kvinnors psykiska hälsa påverkades mer efter en hjärtinfarkt. Kvinnorna ansåg det var svårare att göra livsstilsförändringar än männen, de förmodade att deras förändringar kunde ha negativ inverkan på familjen. Undersökningarna i artiklarna visade att det är vanligt med depressioner efter hjärtinfarkt och att många upplever det som arbetsamt att göra livsstilsförändringar. Patienterna ansåg att det är viktigt att ha nära relationer med deras anhöriga för att få det stöd de behöver under tillfrisknandet.</p> / <p>The aim of this study was to describe patient's mental health status after a myocardial infarction. The study was preformed as a literature study. The words myocardial infarction, mental health, experience, psychological health and quality of life were used in combinations to find the articles. Eighteen articles included in the study which were found in the databases Cinahl and PubMed and from other article references. The interventions in the articles were made by interviews, questionnaires and observations. The results showed that men experience better health related quality of life than women and that women's mental health was more affected after a myocardial infarction. The women thought it was harder to change their life style than men, because the women believed that it would have a bad influence on the family. The interventions in the articles showed that it is usual with depressions after a myocardial infarction and that many experience it hard perform life style changes. The patients think it is important with close relations to their relatives to get the support they need under the recovery period.</p>

<p><strong>Sammanfattning</strong></p><p>Syftet med denna litteraturstudie var att undersöka och beskriva hur hjärtinfarktsymtom yttrar sig och upplevs av kvinnor och vilka atypiska symtom sjuksköterskan bör vara uppmärksam på i mötet med kvinnor i sjukvården. En beskrivande litteraturstudie genomfördes där vetenskapliga artiklar av kvalitativ och kvantitativ karaktär analyserades. Huvudresultatet visade att central bröstsmärta var ett vanligt rapporterat symtom men att många kvinnor inte hade bröstsmärta som det enda och huvudsakliga symtomet. Kvinnor tenderade mer ofta än män att uppleva besvär från käke, hals och nacke. Rygg och skulderbladsmärta visade sig förekomma i liknande utsträckning som bröstsmärta hos kvinnor med hjärtinfarkt. Extrem trötthet tillsammans med dyspné var två av de mest frekvent rapporterade <em>tidiga</em> teckenen vid hjärtinfarkt, dessa upplevdes ofta lång tid innan hjärtinfarkten men var för kvinnorna svåra att sammankoppla med hjärtinfarkt. Illamående och kräkning var frekvent rapporterande symtom som framför allt visade sig i den akuta fasen av hjärtinfarkt. Svettningar i kombination med andra symtom var också vanligt i den akuta fasen av hjärtinfarkten, kraftig svettning var något som fick kvinnor att reagera på att något var allvarligt fel och det påverkade kvinnors beslut att söka sjukvård.</p> / <p><strong>Abstract</strong></p><p>The aim of this literature study was to explore and describe how the heart attack symptoms manifested and were experienced by women and the atypical symptoms the nurse should be alert to when meeting women in health care. A descriptive literature review was conducted in which scientific papers of qualitative and quantitative characteristics were analyzed. The main results showed that central chest pain was a commonly reported symptom, but that many women did not have it as the only and main symptom. Women tended more often than men to experience symptoms of jaw, neck and throat. Back and shoulder pain were found to occur in a similar extent as chest pain in women with myocardial infarction. Extreme fatigue with dyspnoea' were two frequently reported early signs of heart attack, often felt long before the heart attack but difficult for women to connect with myocardial infarction. Nausea and vomiting were symptoms that mainly appeared in the acute phase of myocardial infarction. Sweating in combination with other symptoms were also common in the acute phase of myocardial infarction, excessive sweating was something that got women to respond to that something was seriously wrong and it affected women's decisions to seek care.</p><p> </p><p> </p>

<p>Syftet med denna kvalitativa litteraturstudie var att undersöka och sammanställa befintlig</p><p>forskning från 2000-talet om patienters behov av olika stöd efter en hjärtinfarkt.</p><p>Litteraturstudien innefattade14 vetenskapliga artiklar som analyserades. Resultatet visade två</p><p>huvudkategorier; individuellt/informationsstöd samt grupp/socialt stöd. Kategorin</p><p>individuellt/informationsstöd innehöll en önskan om mer information gällande hjärtat, dess</p><p>funktion och konsekvenserna av hjärtinfarkten. Råd och information angående förändringar i</p><p>livsstil, återanpassning till vardagsliv och stresshantering efterfrågades också liksom mer</p><p>information om läkemedlen och dess effekter. Allt detta skulle hjälpt till under</p><p>tillfrisknandefasen. Under kategorin grupp/socialt stöd framkom att stödgrupper och</p><p>rehabiliteringsprogram hade en betydande roll för tillfrisknandet efter hjärtinfarkten. Genom</p><p>att dela upplevelser med andra i samma situation, inte känna sig ensam och att ha en</p><p>kontinuerlig kontakt med professionell sjukvårdspersonal ökade också livsglädjen. Stöd från</p><p>familj och vänner hade också en viktig mening för tillfrisknandet.</p><p>Samtidigt framkom också ofta en överbeskyddarroll hos anhöriga vilket hos de flesta</p><p>upplevdes ha en negativ effekt och inverkan på tillfrisknandet. Slutsatsen visar att</p><p>sjuksköterskor har en betydande roll i att kunna hantera, bemöta, visa förståelse och stödja</p><p>varje individs individuella behov.</p><p>Nyckelord:</p> / <p>The aim of this literature review was to examine and compile existing research from the</p><p>beginning of the 21 st century about patients needs for different kind of support after a</p><p>myocardial infarction. This literature review included 14 scientific articles who where</p><p>analyzed. The result showed two main categories; individual/information support and</p><p>group/social support. Individual/information support showed a wish for more information</p><p>about the heart, its function and the consequences of the myocardial infarction. Advice and</p><p>information about lifestyle changes, readjustment to daily life and to cope with stress as well</p><p>as information about the medical treatment and its effects was asked for. That would have</p><p>helpt uring the process of recovery. Under the category of group/social support it emerged</p><p>that supportgroups and rehabilitationprograms had an significant part for the recovery after</p><p>the myocardial infarction. Through sharing experiences with others in the same situation, not</p><p>feeling alone and to have a continuous contact with health care professionals the zest for life</p><p>increased. Support from family and friends also had an important meaning for recovery. At</p><p>the same time it also often emerged an overprotective role in relatives that by most of the</p><p>patients seemed to have a negative effect and influence on the recovery. The conclusion</p><p>show´s that nurses have an important role to handle, treat, show understanding and support</p><p>every persons individual needs.</p><p>Keywords:</p>

<p>In 101 patients with ST-elevation myocardial infarction treated with streptokinase the additional effects of lmw-heparin (dalteparin) were investigated. The prognostic value of troponin-T (TnT) was elucidated and the development of myocardial damage was investigated with Positron Emission Tomography (PET).</p><p>Dalteparin tended to provide a higher rate of TIMI grade 3 flow in the infarct-related artery at 24 h compared to placebo. In patients with signs of early reperfusion there was a higher rate of TIMI grade 3 flow in the dalteparin group compared to placebo. There were significantly fewer patients with ischemic episodes at 6-24 h in the dalteparin compared to placebo group.</p><p>The increase in coagulation activity was attenuated in the dalteparin group. There was a tendency to more ischemic episodes and lower frequency of TIMI grade 3 flow in patients with persistent elevation of coagulation activity at 18 h. Among deceased patients the coagulation activity was significantly higher than in survivors. </p><p>The association between elevated TnT on admission and long-term mortality might be explained by longer delay, episodes of chest pain during the last 24 h, less non-invasive signs of reperfusion at 90 minutes, and lower patency in the infarct-related artery at 24 h. </p><p>Eight patients were investigated with PET at 3h, 24 h and after 3 weeks. PET outlines the infarct region with reduced perfusion and metabolism. The oxidative metabolism in the infarct region at 3 h correlated with the water-Perfusable Tissue Fraction (PTF) and its improvement over time.</p><p>Dalteparin seems to improve maintenance of coronary patency, which can be explained by attenuation of the increased coagulation activity. Elevated TnT level on admission is associated with a worse outcome, which can partly be explained by less successful fibrinolytic treatment. PET investigations might to be a useful method in future trials evaluating new agents in the treatment of acute myocardial infarction.</p>

Myocardial infarction (MI) is often caused by a disruption of an atherosclerotic plaque with activation of coagulation, platelets and inflammation. The aims were; to investigate whether the oral direct thrombin inhibitor, ximelagatran affected markers for coagulation, platelet and inflammation in a patient cohort with recent MI and if the coagulation markers could identify patients with increased risk of new ischemic events; to evaluate some of the mechanisms involved in formation of platelet-monocyte aggregates (PMAs). In a biomarker substudy patients with recent MI were randomized to 24-60 mg of ximelagatran or placebo for six months. There was a persistent dose-independent reduction of coagulation markers (F1+2, D-dimer) by ximelagatran treatment. 60 % reduced their D-dimer levels after one week and that group had less ischemic events during treatment. There was an early increase of the platelet activation marker and ximelagatran in higher doses attenuated these increased levels. Both in vivo and in vitro the direct thrombin inhibitor diminished procoagulant activity and tissue factor (TF) presenting microparticles. In contrast, the inflammatory markers increased after six months of ximelagatran treatment. The PMA-levels were elevated for long-term after MI. In vitro thrombin inhibition diminished formation of PMAs. Formation of PMAs in stimulated whole blood was P-selectin dependent and induced TF expression through phosphorylation of the Src-family member Lyn in monocytes. Addition of an oral direct thrombin inhibitor reduces coagulation and platelet activation markers for long-term after a MI together with reduced procoagulant activity which may contribute to the clinical benefit of the drug. Early reduction of D-dimer levels seems to be suitable to identify patients with reduced risk of new ischemic events independent of antithrombotic treatment. Circulating PMAs persist after a MI connecting coagulation to inflammation. Within these aggregates P-selectin induces TF, the main initiator of coagulation, partly through phosphorylation of Lyn.

A high percentage of unrecognized myocardial infarctions (UMIs) seen at delayed-enhanced magnetic resonance imaging (DE-MRI) are not detected by ECG. DE-MRI-detected UMIs are independent predictors of cardiovascular events in patients with coronary artery disease. In an elderly population, subjects with DE-MRI-detected UMIs do not have increased Framingham risk score or increased prevalence of artery stenosis in whole-body MR angiography as patients with recognized myocardial infarctions (RMI). Further investigation on the pathogenesis of DE-MRI-detected UMIs focus on the need to decide the management of these subjects. From the Prospective Investigation of the Vasculature in Uppsala Seniors, 248 subjects underwent cardiac MRI at age 70 and from these, 185 underwent a 5-year follow-up MR. DE-MRI-detected UMIs had lower signal intensity than RMIs probably reflecting different composition of their tissues. Subjects with UMI scar had increased levels of NT-proBNP, a predictor of increased risk of cardiovascular events. After 5 years, UMI scars were in their majority seen on the same location and with the same size, and their prevalence increased. Subjects with an UMI did not differ from subjects without a scar in terms of coronary stenosis assessed by computed tomography angiography or signs of ischemia on exercise test. In conclusion, DE-MRI-detected UMI scars are a frequent finding in an elderly population and its prevalence increases with age. The increased levels of NT-proBNP indicate that subjects with an UMI might have an increased rate of future cardiovascular events but the findings that these scars might have a different contrast distribution volume on MRI and that they are not related to CAD are indicators that they probably have a different etiology from RMIs. The prognosis of DE-MRI detected UMI scars in the general population is still unknown and therefore the clinical management of these individuals is yet to be defined.

Background: Acute coronary syndrome is known for its effect on cardiac function and can lead to impaired segmental and even global myocardial function. Evidence exists that myocardial revascularisation whether pharmacological, interventional or surgical results in improvement of systolic and diastolic left ventricular (LV) function, particularly that of the long axis which represents the sub-endocardial function, known as the most sensitive layer to ischaemia. Objective: We sought to gain more insight into the early effect of pharmacological and interventional myocardial revascularisation on various aspects of cardiac function including endocrine, electrical, segmental, twist, right ventricular (RV) and left atrial (LA) function. In particular, we aimed to assess the response of ventricular electromechanical function to thrombolysis and its relationship with peptides levels. We also investigated the behaviour of RV function in the setting of LV inferior myocardial infarction (IMI) during the acute insult and early recovery. In addition, we aimed to assess in detail LA electrical and mechanical function in such patients. Finally, we studied the early effect of surgical revascularisation on the LV mechanics using the recent novel of speckle tracking echocardiography technology to assess rotation, twist and torsion and the strain deformation parameters as a tool of identifying global ventricular function. Methods: We used conventionally Doppler echocardiographic transthoracic techniques including M-mode, 2-Dimentional, myocardial tissue Doppler, and speckle tracking techniques. Commercially available SPSS as a software was used for statistical analysis. Results: 1-The elevated peptide levels at 7 days post-myocardial infarction correlated with the reduced mechanical activity of the adjacent non-infarcted segment thus making natriuretic peptides related to failure of compensatory hyperdynamic activity of the non-infarcted area rather than the injured myocardial segments. 2-RV segmental and global functions were impaired in acute IMI, and recovered in 87% of patients following thrombolysis. In the absence of clear evidence for RV infarction the disturbances in the remaining 13% may represent stunned myocardium with its known delayed recovery. 3-LA electromechanical function was impaired in acute inferior STEMI and improved after thrombolysis. The partial functional recovery suggests either reversible ischaemic pathology or a response to a non-compliant LV segment. The residual LA electromechanical and pump dysfunction suggest intrinsic pathology, likely to be ischaemic in origin. 4-LV function was maintained in a group of patients with multivessel coronary artery disease who underwent coronary artery bypass graft (CABG) surgery. Surgical myocardial revascularisation did not result in any early detectable change in the three functional components of the myocardium, including twist and torsion, as opposite to conventional percutaneous coronary intervention (PCI). Conclusion: The studied different materials in this thesis provide significant knowledge on various aspects of acute ischaemic cardiac pathology and early effect of revascularisation. The use of non-invasive imaging, particularly echocardiography with its different modalities, in studying such patients should offer immediate thorough bed-side assessment and assist in offering optimum management.

In 101 patients with ST-elevation myocardial infarction treated with streptokinase the additional effects of lmw-heparin (dalteparin) were investigated. The prognostic value of troponin-T (TnT) was elucidated and the development of myocardial damage was investigated with Positron Emission Tomography (PET). Dalteparin tended to provide a higher rate of TIMI grade 3 flow in the infarct-related artery at 24 h compared to placebo. In patients with signs of early reperfusion there was a higher rate of TIMI grade 3 flow in the dalteparin group compared to placebo. There were significantly fewer patients with ischemic episodes at 6-24 h in the dalteparin compared to placebo group. The increase in coagulation activity was attenuated in the dalteparin group. There was a tendency to more ischemic episodes and lower frequency of TIMI grade 3 flow in patients with persistent elevation of coagulation activity at 18 h. Among deceased patients the coagulation activity was significantly higher than in survivors. The association between elevated TnT on admission and long-term mortality might be explained by longer delay, episodes of chest pain during the last 24 h, less non-invasive signs of reperfusion at 90 minutes, and lower patency in the infarct-related artery at 24 h. Eight patients were investigated with PET at 3h, 24 h and after 3 weeks. PET outlines the infarct region with reduced perfusion and metabolism. The oxidative metabolism in the infarct region at 3 h correlated with the water-Perfusable Tissue Fraction (PTF) and its improvement over time. Dalteparin seems to improve maintenance of coronary patency, which can be explained by attenuation of the increased coagulation activity. Elevated TnT level on admission is associated with a worse outcome, which can partly be explained by less successful fibrinolytic treatment. PET investigations might to be a useful method in future trials evaluating new agents in the treatment of acute myocardial infarction.