Psychological Characteristics of Patients with Takotsubo Syndrome and Patients with Acute Coronary Syndrome: An Explorative Study toward a Better Personalized Care

During an acute cardiac event, Takotsubo Syndrome (TTS) and Acute Coronary Syndrome (ACS) apparently share very similar clinical characteristics. Since only a few inconsistent studies have evaluated the psychological features that characterize these different patients, the aim of the present explorative research was to investigate if post-recovery TTS and ACS patients present different psychological profiles. We also investigated whether the occurrence of acute psychological stressful episodes that had occurred prior to the cardiac event could be found in either syndrome. Twenty TTS and twenty ACS female patients were recruited. All patients completed self-report questionnaires about anxiety and depressive symptoms, perceived stress, type-D personality and post-traumatic symptoms. Results showed that only three subscales of health anxiety (i.e., Fear of Death/Diseases, Interference and Reassurance) significantly differed between the two groups, while no differences were found in the other psychological measurements. Moreover, personality traits seem to not be associated with the impact of the cardiac traumatic event. Finally, only TTS patients reported the presence of a significant emotional trigger preceding the acute cardiac event. In conclusion, post-recovery TTS patients differ from ACS patients in their level of concern about their health and in their need of reassurance and information only, probably as a result of the different clinical characteristics of the two illnesses.

Patient’s Transition Experiences from Hospital to Home after an Acute Cardiac Event

BACKGROUND: Care transition after hospital discharge is challenging for patients and their families. For post an acute cardiac event patients, the 0–14 days period is a vulnerable period. After hospitalization, patients and their families report having unmet information needs at a time of hospital discharge. It can increase the complication and hospital readmission. AIM: This study aim to explore the patient’s transition experiences from hospital to home after an acute cardiac event. METHODS: An exploratory qualitative research design with phenomenological approach was used in the study. The data were collected from April to July 2020, using semi-structured interviews with 15 patients diagnosed with acute coronary syndrome (ACS). Transcribed interview data were thematically analyzed. RESULTS: There are five themes obtained from the study: Positive perception after an acute cardiac event, the changes experienced, the knowledge which was required, the support needs, and expectations and goals. CONCLUSION: Transition from hospital to home depends on the perceptions of the participants themselves. The experience of transitioning patients from hospital to home was influenced by the existence of support from family, spiritual meaning, and social environment to be able to adapt to health conditions. The finding of this study can assist the nurses in understanding better the needs of patients to prepare the care transition from the hospital to home.

The significance of lipid profile and positive troponin-I in predicting cardiac event

Background: Diagnosis of acute cardiac event in the early stage of its onset is important in the treatment process. The development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac troponin-I had made it possible. However troponin indicates cardiac events only after its onset or after cardiac tissue necrosis. Traditionally such high risk subjects were identified using lipid profiles. The identification of subjects with high risk of developing cardiac event in the future is more significant as it will provide time to prevent such incidents.Methods: In this retrospective study data of the 250 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both troponin-I and lipid profiles tests were compared with the lipid profiles of 100 normal healthy subjects (controls). The troponin-I was detected quantitatively when a specimen contains troponin-I above the 99th percentile (TnI >0.3 ng/ml). The total cholesterol, high density lipoproteins cholesterol, very low density lipoproteins cholesterol and triacylglycerol levels were also analyzed and low density lipoprotein cholesterol level was calculated using Friedewald’s formula.Results: Patients with chest pain and positive troponin-I test (with confirmed cardiac event) were found to have significantly elevated levels of total cholesterol, triacylglycerols, low density lipoprotein cholesterol level and significantly reduced high density lipoproteins cholesterol levels when compared to the patients who experienced only chest pain with (negative troponin-I) and healthy controls.Conclusions: An acute cardiac event is best diagnosed by highly sensitive and specific positive troponin-I test (by quantitative method). However, traditional lipid profile levels still can be used in screening the populations to identify those subjects with high risk of developing cardiac event, in those centres where troponin-I test facility is unavailable.

Cardiac assessment

It is essential that the cardiac nurse can carry out a comprehensive cardiac assessment of their patient. The nursing assessment aims to describe the patient’s condition and help determine an accurate diagnosis, so that an effective and timely clinical management plan is implemented. The focus of the initial assessment varies according to the setting and clinical presentation of the patient. However, the priority is always to determine whether the patient is haemodynamically stable, whether they are suffering from an acute cardiac event that would benefit from time-dependent therapy, and the need for symptom management. A thorough cardiac assessment requires the nurse to use a wide range of interpersonal, observational, and technical skills. Additionally, the nurse needs an in-depth knowledge of cardiac anatomy, physiology, and pathophysiology to determine the significance of the findings. This chapter outlines how to assess key symptoms and signs of cardiac disease. Symptoms are things that the patient reports as troublesome issues; signs are associated physiological changes that the health professional might discover during the course of their assessment.

Abstract 14540: Preliminary Efficacy and Feasibility of an Emotion Regulation Intervention on Physical Activity and Depressive and Anxious Symptoms in Individuals in Cardiac Rehabilitation

Cardiac rehabilitation (CR) is an important part of overcoming an acute cardiac event, but can be undermined by debilitating levels of depression and anxiety, which can leave cardiac patients at risk for diminished functional capacity. The purpose of this randomized control trial was to evaluate the development and early efficacy testing of a theoretically based emotion regulation treatment (RENEwS) designed to assist people in CR to optimize recovery following acute cardiac events. CR participants (n=30, 83% men) were randomized to 5 one-hour, in-person group sessions of RENEwS or a phone-based active-control group. Participants completed measures of depression and anxiety symptoms at three timepoints. PA was objectively measured for 7 days at each time point using waist-worn actigraphy monitors. Between-group differences were calculated using linear mixed models to evaluate initial efficacy. Qualitative data were collected during RENEwS sessions and analyzed using content analysis with a directed approach to assess intervention feasibility and acceptability. Compared to active-control participants, RENEwS participants showed greater reductions in depression (Cohen’s f = .34) and anxiety symptoms (Cohen’s f = .40) but only modest improvements in PA from baseline to 5 months (Cohen’s f = .08). Descriptive exploratory analysis of within-group changes in the RENEwS group reveals individuals with above mean depressive symptoms and individuals with above mean anxiety symptoms experienced clinically meaningful decreases in psychological symptoms and increases in PA at 5 months. Qualitative analysis of feasibility indicated strengths in acceptability, demand, adaptation, integration, and implementation. Findings show that RENEwS is a promising emotion regulation intervention for CR patients, though revisions are needed to address practicality, expansion, and efficacy.

The Effect of Lacrosse Protective Equipment on Cardiopulmonary Resuscitation and Automated External Defibrillator Shock

Context: In the event of an acute cardiac event, on-field equipment removal is suggested, although it remains unknown how lacrosse equipment removal may alter time to first chest compression and time to first AED shock. Objective: To determine time to first chest compression and first AED shock in 2 chest exposure procedures with 2 different pad types. Design: Crossover study Setting: Simulation laboratory Participants: Thirty-six athletic trainers (21 females, 15 males; age=30.58±7.81) Main Outcome Measures: Participants worked in pairs to provide 2 rescuer CPR intervention on a simulation manikin (QCPR manikin, Laerdal Medical, Wappingers Falls, NY) outfitted with lacrosse pads and helmet. Participants completed a total of 8 trials per pair (2 chest exposure procedures X 2 pad types X 2 participant roles). The dependent variables were time to first compression (s) and time to first AED shock (s). The independent variables were chest exposure procedure with 2 levels (procedure 1: removal of helmet while initiating CPR over the pads followed by pad retraction and AED application; procedure 2: removal of helmet and removal of pads followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). Results: We found a statistically significant interaction between chest exposure procedure and pad type for time to first compression (F1,35=4.66, P=0.04, ω2p=0.10) with significantly faster times during procedure 1 for both the Nemesis pads (16.1±3.4 s) and the Hitman pads (16.1±4.5 s) compared to procedure 2 (Nemesis pads: 49.6±12.9 s, P<0.0001; Hitman pads: 53.8±14.5 s, P<0.0001). Conclusions: Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens time to first chest compression without diminishing CPR quality which may improve patient outcomes. Time to first AED shock was not different between equipment procedure or pad type.

Return to work

The vocational reintegration of patients after an acute cardiac event is a crucial step towards complete convalescence from both the social and individual point of view. Residual job ability (partial, total/temporary, or permanent disability) depends on existing cardiac, psycho-cognitive and professional barriers. Return to work (RTW) rates are determined by left ventricular function, residual ischaemia, and heart rhythm stability, as well as by the occupational requirement profile, such as blue- or white-collar work, night shifts, and the ability to commute. Psychosocial factors, including depression, self-perceived health situation, and pre-existing cognitive impairment, determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified early in the rehabilitation process in order to avoid failure of reintegration and to prevent social and professional exclusion with adverse psychological and financial consequences.