Arya Atherosclerosis
Volume:7 Issue: 3, Autumn 2011

This study aimed to compare the anxiety of cardiac patients candidate for angiography with normal population in Isfahan province. The study population included 109 people, 53 cardiac patients referring to Chamran Cardiology Hospital in Isfahan for angiography and 56 people without cardiac disease. Data were collected by Cattle anxiety scale. In addition, demographic data of the sample population were collected at the same time using another questionnaire. Independent t-test showed a significant difference between the anxiety of cardiac patients candidate for angiography and non-cardiac people (P < 0.001). Moreover, the differences between the amount of obvious anxiety and hidden anxiety in the two groups were significant (P < 0.001 for both). The results showed that cardiac disease and diagnosis instruments, especially angiography, cause anxiety in patients. Therefore, evaluating this anxiety and applying proper techniques to reduce this anxiety is necessary.

The objective of this study was to evaluate the association of some factors such as serum levels of homocysteine, folate and B12 vitamin with stroke in acute ischemic stroke patients. In this case control study, serum levels of homocysteine, folate and B12 vitamin in 93 patients with acute ischemic stroke admitted to Imam Khomeini Hospital between September 2008 and January 2010, and 93 healthy controls were measured. Cerebrovascular risk factors including age, sex, hypertension, hyperlipidemia, smoking, diabetes mellitus, alcohol consumption, coronary artery disease and obesity were recorded. The results were compared between the case and control groups. The mean ± standard deviation (SD) of fasting total homocysteine (tHcy) level in acute ischemic stroke patients was 20.58 ± 19.6 0mol/L, which was significantly higher than that of control group being 14.11 ± 9.5 0mol/L (P = 0.002). 39 (41.9%) stroke cases and 25 (26.8%) controls had hyperhomocysteinemia. There were no significant relationships between tHcy, folate and B12 vitamin levels with the above mentioned cerebrovascular risk factors except for smoking (p> 0.05). No significant difference in B12 vitamin and folate levels between patients and healthy controls were detected (P> 0.05). Hyperhomocysteinemia is common in Iranian patients with acute ischemic stroke and might play a role as an independent risk factor in stroke.

Hypertension (HTN) is one of the most important problems in all parts of the world. Although the disease is usually asymptomatic, its diagnosis and treatment are easy. The aim of this study was to compare the effect of Nifedipine (Adalat®), Captopril and sublingual Nitroglycerin on reducing blood pressure (BP). This study was a parallel group randomized controlled trial. From the patients referred to our heart clinic, 120 patients with severe HTN were enrolled in the study. The patients were randomly allocated into 3 groups A, B, and C. The patients were advised to use 5 drops of Adalat in group A, Captopril 25 mg sublingually in group B, and 1 sublingual Nitroglycerin pearl in group C. The BP was measured every 20 minutes during one hour. Systolic BP was reduced significantly by Adalat and Captopril compared with sublingual Nitroglycerin in the 20th, 40th and 60th minutes (P= 0.001), but there was no significant difference between Adalat and captopril in reducing systolic BP. In addition, the result of reducing diastolic BP was not significantly different among the three groups. We saw the same effect on reducing BP by Captopril, Adalat, and sublingual Nitroglycerin. Among these three drugs, the side effects of Captopril were the least frequent. Adalat caused headache and flushing. Thus, it seems Captopril can be used instead of Adalat in medical centers.

The polymorphisms of cytochrome P450 2C19 (CYP2C19) gene are major prognostic factors for the response to clopidogrel therapy in patients with coronary artery diseases (CAD). The CYP2C19*2 is the most important allele responsible for resistance to clopidogrel therapy. This study examined CYP2C19 gene polymorphism (CYP2C19*1 and *2) in Iranian patients. This cross-sectional study was performed on 43 Iranian patients with CAD who underwent percutaneous coronary intervention (PCI) and received drug-eluted stents (DES). CYP2C19 polymorphisms were assessed using real time PCR and frequency of CYP2C19*1 and CYP2C19*2 were determined, and then homo- or heterozygous state of genes was detected by Melt Curve Analysis method. Forty three patients (mean age = 58.8 ± 10.0 years, 79.1% male) participated in this study. CYP2C19*1/CYP2C19*1 genotype was observed in 31 (72.1%) of participates, CYP2C19*1/CYP2C19*2 genotype in 10 (23.3%), and CYP2C19*2/CYP2C19*2 genotype in 2 patients (4.7%). The frequency of CYP2C19*2 allele in the sample was 27.9%. This study demonstrated a high prevalence of CYP2C19*2 gene polymorphism in Iranian patients. Further studies with larger samples or longitudinal are required to determine the effects of this polymorphism on the prognosis of CAD patients in our population.

This study aimed to determine the role and effects of baroreflexes during acute increase in blood pressure (BP) after severe and long-term infusion of morphine. This experimental study was conducted on male desert rats. They were assigned into 4 groups and the rats of the case group received morphine in the short and long term periods, whereas the control rats received normal saline for the same duration. Then, the rats were anesthetized, and their femoral artery and vein were cannulated for the injection of phenylephrine and naloxone, respectively. The injection of phenylephrine was performed by the device after a period of recording BP, mean arterial pressure (MAP), heart rate (HR) and baroreflex sensitivity (BRS) in order to induce acute hypertension before and after injecting naloxone. The Student t-test and analysis of variance (ANOVA) were used for statistical analysis. The obtained results suggested that acute and chronic injections of morphine may cause significant reduction in systolic and diastolic arterial BP as well as the mean arterial pressure; moreover, it significantly increased the sensitivity of baroreflexes. Furthermore, the increased baroreflex sensitivity was observed after acute injection of morphine, whereas chronic morphine injection caused reduction in baroreflex sensitivity. It seems that the details of the opiate's effects on the body including cardiovascular system depend on the type of opioids and consequently, on the type of stimulated receptor.

Nowadays, coronary artery bypass graft (CABG) is a frequent surgery in treatment of coronary artery disease. According to high expense of this surgery and its important role in patients’ quality of life, high survival rate of patients and success of surgery are necessary. The aim of this study was the evaluation of fever incidence (febrile events) due to incidence of pneumonia, wound infection, bacteremia, urinary tract infection and inflammatory response without infection after CABG. In an intergrades descriptive-analytical study, 107 patients who underwent coronary artery bypass graft (CABG) were enrolled in the study.The patients then were examined by the febrile events and also their characteristics including age, sex, duration of surgery, underlying diseases, and frequency distribution of antibiotics consumptions in pre-surgical and postsurgical periods, and incidence of infectious syndromes. Frequency distribution of febrile events after CABG was 29.9 percent. The most common administered antibiotic before the surgery was cephalothin (Keflin) and then, cefazolin. The most common administered antibiotic after the surgery was cephalothin (Keflin) and cephalexin (47.7%) and then, cephalothin-gentamicin-cephalexin (31.8%). The average age of patients without febrile syndrome was 60.53 years and in those with febrile syndrome was 59.31 years. In terms of gender, 74.8% of the patients were males. So that 32.5% of males and 22.2% of females had fever. The incidence time of fever in most cases was in the postoperative fourth day. In terms of underlying diseases, 13 percent of them had hypertension and hyperlipidemia, 14 percent had only hypertension, 11.2 percent had only hyperlipidemia and 6.5 percent had diabetes. This study showed that the prevalence of fever in patients undergoing CABG was 29.9 percent and the most common cause of fever was sternal infections. There was a significant correlation between administered antibiotics in preoperative and postoperative periods and febrile syndrome.

About 2-5% of people experience deep-vein thrombosis (DVT) during their lives. Death, disease recurrence, post-thrombotic syndrome, and excessive bleeding due to coagulant medications are among the most important DVT complications. Recent research found a high incidence of DVT recurrence after the first attack. Disease recurrence has a multifactorial pathogenesis and its probability is related with the number and severity of risk factors. The present study aimed to investigate DVT recurrence and the associated risk factors. This retrospective cross-sectional study evaluated all DVT patients hospitalized in Alzahra Hospital, Isfahan, Iran, during April 2000 to April 2011. The risk factors were obtained from patient's records including smoking, intravenous drug abuse, having a history of surgery in last four weeks, immobility, obesity, history of cardiac disease, and cancer. A total number of 2550 DVT patients were hospitalized in Alzahra Hospital during the study period. It was only possible to extract the data from 385 patient records. A history of DVT was reported in 48 individuals (12.5%). The comparison between the risk factors in patients with a first time DVT and those experiencing a recurrent DVT revealed significant differences solely in the prevalence of blood disorders and immobility. Applying stepwise regression indicated immobility (OR: 4.57; 95% CI: 1.26-16.57; P < 0.021) and coagulopathy (OR: 0.33; 95% CI: 0.13-0.81; P < 0.016) with DVT recurrence. Based on our findings, DVT patients are suggested to be mobilized as soon as possible. In addition, they should be advised to increase their activity after discharge.

The patient is a 65 year old male,7 years earlier while the patient was in excellent medical condition without any risk factor for coronary artery disease except cigarette smoking the patient developed extensive ant MI. Coronary angiography at that time revealed severe(90%) stenosis of LAD mid portion, significant stenosis of LAD distal portion and significant stenosis of origin of diagonal branch. Plain balloon angioplasty of diagonal branch and predilation and stenting of LAD mid portion was planned in another session. two 0.014 guidewire were inserted in LAD and Diagonal branches. Plain balloon angioplasty of diagonal branch was done using 2.0-20 balloon. Then LAD distal lesion was opened by 3 15 balloon using nominal atmosphere pressure. LAD proximal lesion was primarily predilated with 3.0 14 balloon and then stented with 3.0 -15 stent at 16 atmosphere pressure. In final angiogram both LAD and diagonal branches were completely open. But at the end of procedure while pulling back the guide wires from the coronary arteries, Diagonal guide wire was trapped and it’s distal, radiopaque segment was separated and remained behind the LAD stent(fig 1). Since the patient hemodynamic condition was stable and the retained guidewire did not impair blood flow in LAD or Diagonal branch no further action was made and the patient was sent to post cath unit. The patient was discharged home the day after.