Waiting for a heart or lung transplant: Relatives' experience of information and support.

To describe the relatives' experiences of information and support while heart or lung transplant candidates were waiting for a transplantation

Perceptions of received information, social support, and coping in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension.

Patients with a life-limiting diagnosis of pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) need disease-specific information, ability to cope, and functioning social networks. This cohort study investigated the experiences of PAH and CTEPH patients who received information about their diagnosis, treatment, and management, in addition to coping and social support. Sixty-eight adult patients (mean ± SD, age 67 ± 14; 66% women) were included. A total of 54% of the patients wanted more information. Patients received information mostly in areas concerning medical test procedures, the diagnosis, disease severity, possible disease causes, and how to manage their disease. Coping ability was significantly better in patients who were satisfied with the received information (P = 0.0045). The information given to PAH or CTEPH patients and their communication with healthcare professionals can be greatly improved. Gaps in information and misunderstandings can be avoided by working in cooperation with the patients, their relatives, and within the PAH team

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Background: An early sign of heart failure (HF) is a decreased cardiac reserve or inability to adequately increase cardiac output during exercise. Under normal circumstances maximal cardiac output is closely related to peak oxygen uptake (VO(2)peak) which has previously been shown to be closely related to total heart volume (THV). Thus, the aim of this study was to derive a VO(2)peak/THV ratio and to test the hypothesis that this ratio can be used to distinguish patients with HF from healthy volunteers and endurance athletes. Thirty-one patients with HF of different etiologies were retrospectively included and 131 control subjects (60 healthy volunteers and 71 athletes) were prospectively enrolled. Peak oxygen uptake was determined by maximal exercise test and THV was determined by cardiovascular magnetic resonance. The VO(2)peak/THV ratio was then derived and tested. Results: Peak oxygen uptake was strongly correlated to THV (r(2) = 0.74, p < 0.001) in the control subjects, but not for the patients (r(2) = 0.0002, p = 0.95). The VO(2)peak/THV ratio differed significantly between control subjects and patients, even in patients with normal ejection fraction and after normalizing for hemoglobin levels (p < 0.001). In a multivariate analysis the VO(2)peak/THV ratio was the only independent predictor of presence of HF (p < 0.001). Conclusions: The VO(2)peak/THV ratio can be used to distinguish patients with clinically diagnosed HF from healthy volunteers and athletes, even in patients with preserved systolic left ventricular function and after normalizing for hemoglobin levels

Shortening velocity, myosin light chain phosphorylation and Ca2+ dependence of force during metabolic inhibition in smooth muscle of rat portal vein

The concentration-response relation for Ca2+ (0.2-5.0 mM) of high-K+ contractures (40 mM) in the rat portal vein during respiratory inhibition by 0.2 mM cyanide was investigated. A reduction of force in the presence of cyanide to about 30% of control was associated with a leftward shift of the normalized concentration-response relation. When force at the plateau of high-K+ contractures (at about 2 min) was reduced to 65 +/- 2% due to the addition of cyanide, the maximal shortening velocity (Vmax) was 94 +/- 5% of control (n = 6). In electrically (AC) stimulated preparations giving short tetanic contractions, a reduction of active force to 58 +/- 2% of control in the presence of cyanide was associated with a reduction of Vmax to 83 +/- 5% (n = 7). Phosphorylation of the 20-kDa regulatory light chains (LC20) of the myosin molecule was studied in the relaxed state and at the plateau of high-K+ contractures for comparison with the mechanical data. Both control and cyanide-treated preparations showed 9% LC20 phosphorylation in nominally Ca2+-free solution (n = 6). After activation the level of phosphorylation increased to 30 +/- 3% (n = 9) in the control veins. In cyanide-treated veins, where force was reduced to 42 +/- 6% compared to a preceding control period, the phosphorylation level was 17 +/- 2% (n = 7). The study suggests that the mechanical changes caused by inhibition of cellular respiration may involve the combined effect of several metabolic alterations, including decreased LC20 phosphorylation during contraction, but apparently not decreased intracellular Ca2+ concentration or sensitivity of the contractile system to Ca2+

Relative's experiences before and after a heart or lung transplantation.

Relatives take on great responsibilities during patients' heart or lung transplant process and an understanding for their situation is required

Contractile and metabolic characteristics of creatine-depleted vascular smooth muscle of the rat portal vein

The functional consequences of phosphocreatine (PCr) depletion for mechanical properties, O2 consumption, and lactate production of the rat portal vein were investigated. After feeding rats for 8-9 weeks on a diet containing 2% beta-guanidino propionic acid (BGPA), PCr of the portal vein was reduced to 14% of control, whereas ATP was unchanged. No significant change was found in the level of spontaneous contractile activity or the force developed in a high-K+ contracture. Lactate production and the relationship between contractile force and O2 consumption were uninfluenced by BGPA treatment. The force-velocity relation of electrically stimulated portal veins showed no influence of BGPA treatment on Vmax. To investigate whether decrease in PCr influenced the response to metabolic stress, portal veins were exposed to graded concentrations (0.1-0.5 mM) of cyanide to depress cellular respiration. Veins from control and BGPA-treated rats showed the same relative decrease of contractile activity and O2 consumption, and the same increase in lactate production. Cyanide treatment resulting in a reduction of electrically stimulated force to 70-80% of the original gave a reduction of Vmax to 85-90%. The relative degree of reduction was uninfluenced by BGPA treatment. Reduction of PCr content thus does not affect the functional properties of metabolism or contractility under normoxic conditions. Furthermore, it can be inferred that the PCr reduction known to occur in smooth muscle exposed to hypoxia (Lovgren & Hellstrand 1985) is not in itself the major factor causing hypoxic inhibition of mechanical activity

Support Experienced by Patients Living with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension.

As pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are debilitating and fatal diseases it is essential to increase the understanding of patients' experience of support. The aim was to describe patients' experiences of support while living with PAH or CTEPH