Iranian Heart Journal
Volume:16 Issue: 3, Fall 2015

Although the changes in QT interval during and after exercise have been frequently investigated, the variations in the ventricular repolarization parameters during the exercise test have not been clearly evaluated. The present study aimed to assess the changes in these electrocardiographic (ECG) parameters as one of the main helpful criteria for interpreting the exercise test results. Forty-four suspected patients with a positive exercise test were considered as the case group and 25 with a negative exercise test were selected as the control group. All the participants were subjected to the treadmill stress test, which was performed according to the Bruce Protocol. In both groups, the changes in QT interval remained insignificant. QT dispersion was increased in 45.5% of the cases and in 28.0% of the controls, whereas this parameter was reduced in 34.1% of the cases and in 64.0% of the controls. Among the myocardial repolarization parameters in the case group, positive QT dispersion was more observed at recovery time than at rest (6.8% vs. 22.7%; P=0.004), while delta QT interval and QT dispersion ratio were adversely reduced at recovery time compared with resting. In the control group, the changes in all the parameters remained unchanged following exercise testing. Myocardial repolarization parameters exhibited different behaviors following exercise testing in both suspected ischemic and healthy conditions. The increase in QT dispersion, but an adverse decrease in QT dispersion ratio and delta QT interval, can be considered valuable parameters for discriminating ischemic from normal conditions.

Activated clotting time (ACT) is most commonly measured for monitoring the anticoagulation effect of heparin during cardiopulmonary bypass (CPB). The aim of this study was to compare the standard heparin dose (300 IU/kg) with lower doses to achieve ACT of 480 sec during CPB. In this prospective, randomized, double-blind clinical trial, 120 patients (40/group) who underwent first-time elective coronary artery bypass grafting were randomized into 3 groups A, B, and C receiving an initial heparin dose of 200, 250, and 300 IU/kg. Extra incremental heparin (50 IU/kg) was added if required to achieve a target ACT of 480 sec before initiating CPB. Postoperative blood loss was measured from the time of heparin reversal until the chest drains were removed 48 h after operation in the intensive care unit. The study groups were similar in demographic data. Target ACT was achieved in 32.5%, 50%, and 65% of the patients in groups A, B, and C — respectively — after the initial dose of heparin (P=0.051). The postoperative mean blood loss in the 2 groups of B and C (13.14±1.07 and 12.5±0.79 mL/kg, respectively) was lower than that in group A (15.97±1.31 mL/kg) (P=0.58). However, this difference between the 3 groups was not statically significant. The mean total dose of heparin in groups A and B was lower than that in group C (P=0.002). The patients receiving lower doses of heparin to achieve the target ACT did not have lower postoperative blood loss. An initial heparin dose of 300 IU/kg was most often sufficient to reach the target ACT with the lowest incremental dose of heparin

Adherence to blood storage, preparation, and administration standards has an important role in preventing blood-transfusion errors. In addition, the blood-transfusion rate following open-heart surgery is quite high. The aim of this study was to assess the adherence to hemovigilance standards on blood storage, preparation, and administration among nurses in the intensive care unit (ICU). One hundred nurses of the Open-Heart ICU of Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran, participated in this descriptive study. The nurses’ practice was supervised from the time of the entrance of the blood unit to the ICU until the end of the transfusion process. The ICU nurses’ hemovigilance practice was compared with the Iranian Ministry of Health and Medical Education’s standards. The nurse's demographic and occupational characteristics were evaluated regarding the scores of the hemovigilance standards in their practice. Concerning the standards of blood transfusion, 93% of the study nurses adhered to the protocols on blood-unit preservation, 84% on preparation, and 92% on transfusion. There were no statistically significant differences between the nurses’ age, sex, work experience, education, last transfusion workshop participation and practice assessment, number of blood-transfusion procedures performed per month, and achieved standard scores on blood storage, preparation, and administration (all P>0.05). The study nurses achieved 85% of the standard scores on the preservation, preparation, and transfusion of blood units. The demographic and occupational characteristics of the ICU nurses had no effect on their hemovigilance practice.

Among patients with heart failure, patients with depressive symptoms 2-3 times higher than in patients without symptoms of depression are at increased risk of mortality. The aim of this study was to determine depression status and related factors in patients with heart failure in 2012-13. In this descriptive cross-sectional study, 239 patients with heart failure who referred to Dr. Heshmat hospital in Rasht in 2012-13 were assessed. Data were collected using the Cardiac Depression Scale, Charlson Comorbidity Index, and NYHA classification system. Data were analyzed with SPSS using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (Kolmogorov–Smirnov test for normal distribution of data, correlation chi-square, t-test, and logistic regression). The results showed that 138 (57.7%) patients had depressive symptoms. In the logistic regression analysis, only education and supplementary insurance as a significant predictor of cognitive status were identified, which indicated that the patients with supplementary insurance and higher education levels were more likely to maintain an optimal cognitive function. Since more than half of the subjects had depressive symptoms, we recommend that depressive symptoms be assessed and care plans be planned based on it.)

Heart failure is a common and dangerous life-threatening disease, with an impact on various aspects of life such as sleep quality. This study was conducted to determine sleep quality in patients with heart failure (HF) and its correlates. This case-control study was conducted on 160 individuals referring to Afshar Heart Hospital in Yazd through convenience sampling. After diagnostic tests (i.e., angiography and echocardiography) and examinations by physicians, 80 patients with HF and 80 healthy individuals (control group) were selected. Data were collected using a questionnaire. The statistical analyses included descriptive statistics, the Mann–Whitney test, and the Kruskal– Wallis test using SPSS (version 16). The patients had an average Pittsburgh Sleep Quality Index (PSQI) score of 5.5 (SD=0.3) with a median of 5. Around 43% of the patients compared with around 34% of the comparison group were identified as poor sleepers; these differences, however, were not statistically significant. The educational level (P=0.033), type of job (P=0.028), history of myocardial infarction (P=0.03), severity of pain (P=0.04), and fatigue (P=0.02) were related to sleep quality. The average daily sleep duration reported by the patients was nearly 6 hours. The mean sleep latency was 20 min among the patients. Getting up to urinate was the most common reason for waking up during the night. Increasing the awareness of patients with HF about improving sleep and encouraging them to participate in regular courses can improve the quality of their sleep and prevent sleep disorders.

Vitamin D is a prohormone that has recently been reported to modulate the inflammatory process and probably atherosclerosis. There is conflicting evidence in favor of the impact of hypovitaminosis of vitamin D on coronary artery stenosis. The aim of this study was to evaluate the relationship between 25(OH) vitamin D and the extent and severity of coronary artery stenosis in sample of the Iranian population undergoing elective coronary artery angiography. Patients undergoing elective coronary artery angiography were included in this case control study. Significant coronary artery stenosis was defined as stenosis >60% of any major coronary artery and >50% for the left main artery as evaluated by quantitative coronary angiography. Hypovitaminosis D was observed in 60.2% of 224 patients. The patients were divided according to their vitamin D level (i.e., <10, 11–20, and 21–30) and also based on the percentage of their coronary artery stenosis (i.e., normal coronary artery, insignificant stenosis, and significant stenosis). A higher vitamin D level was associated with age. Hypovitaminosis D had no association with persistence, extent, and severity of coronary artery stenosis. Hypovitaminosis D was not significantly associated with the incidence of diabetes mellitus, hypertension, and dyslipidemia. At present, the data regarding the causal link between vitamin D status and coronary artery stenosis are conflicting. These conflicting findings may be due to factors relating to the study designs, ethnicity, confounding factors, and other coronary artery disease risk factors. Further research is needed to determine whether this association does exist.

Cardiovascular diseases such as coronary artery disease, stroke, and atherosclerosis constitute some of the most challenging problems in the medical field because of their high mortality rates. Nanotechnology in medicine/nanomedicine has several applications in different medical fields, especially in cardiology. Recent advances in nanotechnology and nanomedicine have created many opportunities for cardiovascular diseases, from diagnosis, treatment, and monitoring to drug delivery and nanoscale surgery. We reviewed recent applications of nano-enabled devices in cardiology such as targeted drug delivery, nanocoated drug-eluting stents, injectable peptide nanofibers, anticoagulation applications, and post-surgical monitoring.

We describe a 67-year-old man with a primary diagnosis of left atrial myxoma. Preoperative coronary angiography revealed a significant three-vessel disease. The patient underwent surgery, comprising the complete resection of the left atrial mass concomitant with coronary artery bypass grafting. He had good recovery without any complications in the early and late follow-up. There was no residual tumor or recurrence. The histopathological examination of the mass confirmed the diagnosis of the left atrial myxoma.

Factor V Leiden (FVL) mutation has been identified as a frequent risk factor for life-threatening venous thromboembolic events. We describe a 39-year-old man admitted with sudden-onset blurred vision and mild lower-limb paresthesia with a positive activated protein C resistance test. The polymerase chain reaction confirmed wild-type homozygous FVL mutation. Transthoracic echocardiography revealed a highly elongated mobile mass attached to the akinetic cardiac apex, which extended to the left ventricular outflow tract. The thrombosis was removed by thrombectomy through aortotomy. The patient was in good clinical condition at the last follow-up.