Η πρόσφατη άποψη, ότι η ποιότητα της HDL αποτελεί μια σημαντική παράμετρο στην αθηροπροστασία, κερδίζει όλο και περισσότερο έδαφος με ελάχιστα όμως δεδομένα να την υποστηρίζουν. Στην προσπάθεια μας να προσδιορίσουμε τις ποιοτικές παραμέτρους της HDL που σχετίζονται με αυξημένο κίνδυνο πρώιμης εμφάνισης εμφράγματος του μυοκαρδίου (ΜΙ), μελετήσαμε τα δομικά χαρακτηριστικά της HDL νεαρών ασθενών (≤35 ετών) με οξύ έμφραγμα του μυοκαρδίου. Μελετήσαμε 20 ΜΙ ασθενείς και 20 υγιείς εθελοντές ως ομάδα αναφοράς. Η HDL των ασθενών παρουσίαζε μειωμένα επίπεδα απολιποπρωτεΐνης Α-Ι(apoA-I), απολιποπρωτεΐνης Μ, και παραοξονάσης 1 και σημαντικά αθξημένα επίπεδα της απολιποπρωτεΐνης C-III(apo-CIII)(όλα p<0.005). Συγκεκριμένα ο HDL apoA-I/apoC-III λόγος ήταν 0.24±0.01 στους ασθενείς έναντι 4.88±0.90 της ομάδας αναφοράς (p<0.001). Οι δομικές αυτές αλλαγές σχετίζοντια με αυξημένη οξειδωτική ισχύ της HDL των νεαρών εμφραγματιών, συγκριτικά με την ομάδα αναφοράς (2.5 φορές, p=0.026). Η ηλεκτρονική μικροσκοπία δεν έδειξε σημαντική διαφορά στην μέση διάμετρο της HDL μεταξύ των δύο ομάδων, ωστόσο παρατηρήθηκε σημαντική διαφορά στην κατανομή των HDL διαμέτρων, υποδηλώνοντας την παρουσία διαφορετικών HDL υποπληθυσμών μεταξύ ΜΙ και της ομάδας αναφοράς. Η υπόθεση μας αυτή επιβεβαιώθηκε μετά από ανάλυση της HDL με μη αποδιατακτική δισδιάστατη ηλεκτροφόρηση, καθώς οι ΜΙ ασθενείς εμφάνιζαν μειωμένα επίπεδα pre-β1α, pre-pre-β1b και α2, και αυξημένα επίπεδα α1, α3, και pre-α4 HDL. Μείωση στον λόγο apoA-I/apoC-III HDL, έδειξε αλλαγές στην κατανομή των HDL υποπληθυσμών και αύξηση στην οξειδωτική ισχύ της HDL, παράγοντες που σχετίζονται με την ανάπτυξη εμφράγματος του μυοκαρδίου στους νεαρούς εμφραγματίες. Η πιθανότητα οι αλλαγές αυτές να δρουν ως βιοδείκτες για την πρώιμη πρόγνωση της νόσου, πρέπει να διερευνηθεί περεταίρω. / Recently, the concept that HDL quality is an important parameter for atheroprotection is gaining ground, though little data exists so far to support it. In an attempt to identify measurable qualitative parameters of HDL associated with increased risk for premature myocardial infraction (MI), we studied the structural characteristics of HDL from patients who survived an MI at a young age (≤35 years). We studied 20 MI patients and 20 healthy control subjects. HDL of patients had reduced apolipoprotein A-I (apoA-I), apolipoprotein M, and paraoxonase 1 levels and significantly elevated Apolipoprotein C-III (apoCIII) levels (all p<0.05). Specifically, the HDL apoA-I/apoC-III ratio was 0.240.01 in patients versus 4.880.90 in controls (p<0.001). These structural alterations correlated with increased oxidation potential of HDL of the MI group compared to controls (2.5 fold, p=0.026). Electron microscopy showed no significant difference in average HDL particle diameter between the two groups though a significant difference existed in HDL diameter distribution, suggesting the presence of different HDL subpopulations in MI and control subjects. Indeed, non-denaturing two-dimensional electrophoresis revealed that MI patients had reduced pre-β1α, pre-β1b and α2, and elevated α1, α3, and pre-α4 HDL. Reduction in the HDL apoA-I/apoC-III, changes in the HDL subpopulation distribution and an increase in HDL oxidation potential correlated with the development of MI in young patients. The possibility that such changes may serve as markers for the early identification of young individuals at high risk for an acute coronary event should be further explored.

The primary purpose of this study was to examine the effects of preparatory information regarding the cycle ergometer exercise tolerance test on self-efficacy and anxiety of patients following a myocardial infarction (MI). The study also examined the effect self-efficacy on exercise test performance. A secondary purpose of the study was to investigate the effects of preparatory information and coping style on anxiety associated with the exercise test. Male cardiac patients ( N =30) ages 40-66 years (X=55 yrs.) who had documented MI based on at least two of the following: 1. a significant increase in cardiac enzyme levels 2. ECG diagnostic of HI or 3. chest pain and who were referred for a maximum performance exercise tolerance test two to six weeks post-infarction (X=4 weeks) were eligible for the study. Exclusion criteria consisted of unstable angina and/or uncontrolled dysrhythmias. All patients completed three self-report psychological questionnaires upon arrival at the laboratory: the A-state and A-trait portions of the Spielberger State-Trait Anxiety Inventory (STAI), the Miller Behavioral Style Scale (MBSS) and the physical self-efficacy assessment. Based on their pre-intervention cycling self-efficacy scores, patients were then randomly assigned to the experimental or control conditions. The experimental videotape included detailed procedural and sensory information about the exercise tolerance test as it was being performed by a cardiac patient. The control videotape included information about nutrition as it relates to coronary heart disease. Subsequent to viewing either the experimental or control videotapes, the A-state portion of the STAI and the self-efficacy assessment were re-administered. Patients then performed the exercise tolerance test on the cycle ergometer. Cycling self-efficacy of patients in the experimental condition (preparatory information) decreased whereas the cycling self-efficacy of patients in the control condition increased minimally resulting in a significant difference in self-efficacy between the two intervention groups ( p <.04). Anxiety of patients in the experimental intervention increased while there was virtually no change in anxiety in patients in the control condition ( p <.01). Patients with high pre-intervention cycling self-efficacy achieved higher mean maximum power output ( p <.001) than patients with low pre-intervention cycling self-efficacy. No interactions were found between coping style and preparatory information on the relative change in state anxiety. Anxiety in patients in the experimental group increased whereas anxiety in patients in the control group remained virtually unchanged, regardless of coping style ( p <.01). The data suggest that there is no basis for providing preparatory information regarding the exercise tolerance test to increase self-efficacy and to lower anxiety. The results indicate that self-efficacy is important in predicting exercise test performance. Preparatory information about the exercise tolerance test appears to increase anxiety regardless of coping style. / Thesis / Master of Science (MS)

Le choc septique est une pathologie fréquente associée à un taux de mortalité dépassant les 50%. Il s’agit de la première cause de mortalité en réanimation. Malgré les avancées des connaissances physiopathologiques sur le sepsis, le taux de mortalité reste très élevé. La majorité des recherches pré-cliniques sont réalisées sur des animaux jeunes et sains et sans antécédents cardiovasculaires, alors qu’il est bien établi que l’incidence et le taux de mortalité du sepsis augmente sévèrement avec l’âge. L’objectif de cette étude est la mise au point d’un modèle animal de sepsis ayant plusieurs antécédents cardiovasculaires, et l’évaluation des effets de la combinaison de deux maladies (hypertension et infarctus du myocarde (IDM)) chez des rats septiques sur la fonction cardiovasculaire et sur les voies de signalisation responsables de la réponse inflammatoire et apoptotique. L’étude a été réalisée sur des rats normotendus Wistar-Kyoto (WKY) et des rats Hypertendus Spontaneously Hypertensive (SHR) qui ont subi l’induction d’un IDM par ligature de l’artère coronaire gauche suivie ou non par l’induction d’un sepsis par ligature et perforation du caecum. Nous avons montré que les rats polypathologiques SHR, ayant subi un IDM préalable au choc septique, présentent une diminution drastique des paramètres cardiaques et hémodynamiques par rapport aux rats WKY ayant subi seulement un choc septique. En effet, le débit cardiaque, la pression artérielle moyenne et la fraction d’éjection sont diminuées respectivement de 70 %, 60 % et 67 % chez les rats SHR polypathologiques par rapport aux rats WKY ayant seulement un sepsis. On a observé également une hypo-réactivité vasculaire aux vasopresseurs plus importante chez les rats SHR-IDM-CLP comparée à celle des rats WKY-CLP. L’expression génique des récepteurs adrénergiques alpha-1 est fortement diminuée chez les rats SHR-IDM-CLP par rapport aux rats WKY-CLP. L’étude du taux d’expression des protéines impliquées dans l’apoptose révèle une surexpression des protéines caspase 3, caspase 8 et Pp38 chez les rats SHR polypathologiques des rats SHR-IDM-CLP par rapport aux rats WKY-CLP ayant seulement un sepsis. De plus, on remarque une forte diminution de l’expression des protéines eNOS et Akt chez les rats SHR-IDM-CLP comparés aux rats WKY-CLP. L’hypertension artérielle associée à l’insuffisance cardiaque a conduit à une plus grande sensibilité des rats au sepsis. Les rats SHR polypathologiques ont développé une insuffisance cardiaque aggravée par rapport aux rats WKY ayant seulement un sepsis. Le modèle de rats SHR ayant subi un IDM préalable au sepsis se rapproche d’avantage des situations cliniques observées quotidiennement dans les services de réanimation. Ce modèle pourrait servir de bon candidat pour les études pré-cliniques / Septic shock is considered as the most common cause of death among patients admitted in medical intensive care units. Mortality remains very high (50%) despite advances in physiopathological knowledge of this disease. In fact, most experimental studies are often conducted on young and healthy animals, whereas it is well established that the incidence and mortality rates dramatically increase with age. The goal of this study was to evaluate the effect of the combination of two diseases (hypertension and myocardial infarction) in a septic rat model, on cardiovascular function, cell survival and the inflammatory response. Therefore, we used normotensive Wistar-Kyoto rats (WKY) and Spontaneously Hypertensive Rats (SHR) in which myocardial infarction was induced by left coronary descending artery ligation, followed or not by cecal ligation and perforation-induced sepsis. Our results showed that the polypathological SHR rats in which a myocardial infarction and sepsis were induced, exhibited a significant decrease in cardiac and hemodynamic parameters compared to WKY rats that have sepsis (CLP) only. Indeed, cardiac output, mean arterial pressure and ejection fraction were reduced by 70%, 60% and 67% respectively in the polypathological SHR rats versus the WKY rats with sepsis. We observed also that the vascular hyporeactivity in the polypathological SHR rats was higher than for the WKY CLP rats. A mesure of gene expression level of alpha1 adrenergic receptor shows a relatively low expression level in the rats from SHR IDM CLP rats compared to WKY CLP that could explain the observed vasodilation. The protein level of caspase3 and 8, Pp38 and proteins involved in apoptosis, is upregulated in SHR IDM CLP rats compared to WKY CLP rats. However, the polypathological SHR rats show a significant decrease in the expression of eNOS and Akt protein compared to WKY CLP rats. The combination of hypertension with myocardial infarct is associated with higher sensitivity of the rats to sepsis. The polypathological SHR rats developed a severe heart failure compared to WKY rats having sepsis only. Our animal model, the polypathological SHR rats is very close to observed clinical situations in intensive care units. This model could serve as a good candidate for pre-clinical studies.

Bakgrund: Hjärtinfarkt är en av de vanligaste hjärt-kärlsjukdomarna i världen, i Sverige drabbas ungefär 40 000 personer varje år. En av orsakerna är åderförkalkning.  Behandlingsmetoderna Percutan coronar intervention (PCI) och Coronary artery bypassgrafting (CABG) är de vanligaste. Hjärtinfarkt förändrar patientens livsvärld och skapar lidande. Via information blir patienten delaktig i vården. Att tillgodose patientens behov av information är en del av sjuksköterskans profession. Syfte: Att ur ett patientperspektiv undersöka upplevelser av informationens betydelse i samband med hjärtinfarkt. Metod: Litteraturstudie baserad på elva kvalitativa artiklar. Resultat: Det framkom tre teman; Akuta fasen - känslan av kontrollförlust, Sjukhusvistelsen/Utskrivningen- trygghet blir till en osäkerhet och Rehabiliteringsfasen- oro inför framtiden. Konklusion: Information är viktigt i alla faserna av en hjärtinfarkt. I början bör informationen vara kortfattad då mottagligheten är begränsad. Ges information redan från början leder det till att patienten får en högre compliance, blir mer delaktig och utför bättre egenvård. Den givna informationen anses vara tillräcklig, dock finns en önskan om mer individanpassning. Sjuksköterskans förmåga att ge information är väsentlig för patientens välbefinnande och livskvalité. / Background: Myocardial infarction (MI) is one of the most common cardiovascular diseases in the world, in Sweden approximately 40,000 people are affected every year. One of the causes is atherosclerosis. Treatment like PCI and CABG are the most common. MI changes the patient's life and creates suffering. Through information, the patient becomes involved in the care. Meeting the patient's need for information is part of the nurse's profession. Aim: To examine from a patient perspective experience of the importance of information in relation to a myocardial infraction. Method: Literature study based on eleven qualitative articles. Findings: Three themes emerged; The acute phase - the feeling of loss of control, the hospital stay / discharge - security becomes an uncertainty and the rehabilitation phase - worries about the future. Conclusion: Information is important in all phases of a MI. In the beginning, the information should be concise as the susceptibility is limited. Early given informationleads to a higher level of trust, more involvement and better self-care. The given information is considered sufficient, however, there is a desire for more individualization. Nurse's ability to provide information is essential for the patient's wellbeing and quality of life.

Mirbazel SH. Jämförelse mellan kvinnor och mäns överlevnad baserad på resultat från arbetsprov och myokardscintigrafi. Examensarbete i Biomedicinsk Laboratorievetenskap, 15 högskolepoäng. Malmö högskola: Hälsa och Samhälle, utbildningsområde för Biomedicinsk Laboratorievetenskap, 2011.En av de vanligaste orsakerna till död både i utvecklingsländerna och i västvärlden är hjärtinfarkt som drabbar vanligtvis individer över 65 år. Hjärtischemi är den vanligaste orsaken till hjärtinfarkt/ plötsligt hjärtstopp. För diagnostik av hjärtischemi används oftast arbetsprov som förstahandsval, eftersom metoden är billig, icke-invasiv och relativt ofarlig. Myokardscintigrafi utförs ofta efter arbetsprovet, om detta varit inkonklusivt. Syftet i denna retrospektiva studie var att ta reda på om prognosen och överlevnaden skiljer sig åt mellan kvinnor och män beroende på undersökningsresultat från arbetsprov och myokardscintigrafi. I denna studie analyserades 2045 patienter som var registrerade att utföra arbetsprov för misstänkt eller tidigare känd koronarkärlssjukdom under 2006 & 2007. Patienternas resultat delades i tre grupper: normalt, patologiskt och intermediärt enligt bestämda kriterier. Intermediärgruppen analyserades också om de hade utfört ett myokardscintigrafi inom 6 månader. Intermediärgruppen delades därefter in i tre grupper: de med normal myokardscintigrafi, de med patologisk och de som inte hade utfört någon. Patienter med normalt arbetsprov var 1110, med intermediärt arbetsprov 540 och med patologiskt arbetsprov 254 personer. Det finns statistiskt signifikanta skillnader av antal levande och avlidna mellan män och kvinnor i intermediärt arbetsprov (p < 0,001) och i undergruppen, intermediär utan utförd myokardscintigrafi (p < 0,001). Det finns också en statistiskt signifikant skillnad i överlevnad i huvudgruppen med intermediärt arbetsprov(p < 0,01). Inga analyser av överlevad utfördes för undergrupperna. Sammanfattningsvis har denna studie visat att det inte finns några statistiskt säkerställda skillnader i överlevnad mellan män och kvinnor med normalt och patologiskt arbetsprov däremot finns det en signifikant skillnad i intermediärgruppen. / Mirbazel SH. Comparison between men and women’s survival based on the results from the exercise tests and myocardial perfusion imaging. Degree Project in Biomedical Laboratory Science, 15 points. Malmö University: Health and Society, Department of Biomedical Laboratory Science, 2011.One of the most common causes of death in both developing countries and in the Western world is heart attack that hits usually individuals over 65 years. Cardiac ischemia is the most common cause of myocardial infarction/sudden cardiac arrest. For the diagnosis of cardiac ischemia, exercise test is the first choice, because the method is inexpensive, non-invasive and relatively harmless. Myocardial perfusion imaging is often performed after an inconclusive exercise test. The purpose of this retrospective study was to determine if the prognosis and survival differ between women and men depending on the outcome of the investigation from the exercise test, and the myocardial perfusion imaging. In this study 2045 patients were analyzed who were registered to perform the exercise tests for a suspected or previously known coronary artery disease in 2006/2007. Patient’s results were divided into three groups: normal, pathological and intermediate findings. The intermediary group was further divided according to results of myocardial perfusion imaging within 6 months of the exercise test: those with normal, those with pathologic and those who had not carried out any myocardial perfusion imaging. Patients with normal exercise test were 1110, with intermediate exercise test 540 and with pathologic exercise test were 254 people. There are statistically significant differences in the number of living and deceased between men and women in intermediate exercise tests (p < 0, 001) and in the subgroup, intermediary without myocardial perfusion imaging (p < 0,001). There is also a statistically significant difference in survival in the main group with the intermediate exercise tests (p < 0.01). No analysis was performed for sub-groups. In conclusion, this study has shown that there are no statistically significant differences in survival between men and women with normal and pathological exercise test. However there is a significant difference in intermediary group.

No description available.