فهرست مطالب

Iranian Heart Journal - Volume:19 Issue: 2, 2018
  • Volume:19 Issue: 2, 2018
  • تاریخ انتشار: 1397/05/03
  • تعداد عناوین: 11
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  • Ali-Asghar Farsavian, Seifollah Abdi, Mohsen Maadani *, Hosein Farsavian, Meisam Mojri Pages 6-12
    Background
    Bleeding during or after primary percutaneous coronary intervention (PCI) is the most common noncardiac complication in patients treated for cardiac ischemic events. The present study aimed to compare bleeding complications between primary and rescue PCI procedures.
    Methods
    In a prospective study, the recorded files of 95 consecutive patients who underwent one of the 2 procedures of primary PCI (n=90) or rescue PCI (n=5) were evaluated. The consequences of bleeding were assessed through the measurement of serum hemoglobin levels before, immediately after, and 24 hours after the procedures. Within the hospitalization period and before discharge, any occurrence of bleeding was recorded.
    Results
    Regarding postoperative events, hematoma was revealed in 3.3% in the primary PCI group and 20% in the rescue PCI group, with no significant difference (P=0.224). Additionally, gastrointestinal bleeding was reported in 2.2% of the patients who underwent primary PCI and none of those in the other group, without any difference (P=0.999). In total, postoperative morbidity was seen in 5.6% in the primary PCI group and in 20% in the rescue PCI group, with no difference (P=0.314). The mean of the decreased level of serum hemoglobin in the primary PCI group and the rescue PCI group was 1.22±1.31 and 1.33±0.90, respectively, with no difference (P=0.849). A multivariate linear regression model, after adjustments for the baseline parameters, showed no difference between the 2 procedures regarding the decreased level of serum hemoglobin. Advanced age was the only variable able to predict higher morbidity.
    Conclusions
    There were no significant differences in postprocedural complications regarding major bleeding between the 2 procedures of rescue PCI and primary PCI. The main predictor for bleeding after PCI was advanced age.
    Keywords: Primary PCI, Rescue PCI, Bleeding
  • Mohsen Ziyaeifard, Rasoul Azarfarin, Khadijeh Zamani *, Azin Alizadehasl, Yasaman Khalili, Maryam Moradian, Zahrasadat Koleini, Hamidreza Pouraliakbar Pages 13-19
    Background
    Management and evaluation of pain in children can be challenging due to difficulties in expression and verbalization. The imperative role of nurses in the assessment and management of pain should be considered. The aim of this study was to evaluate the role of the education of ICU nurses in pain assessment and measurement in order to reduce postoperative pain in children.
    Methods
    In this clinical trial, 146 children aged 3 to 15 years who underwent cardiac surgery were allocated to 2 groups. The control group (n=73) was managed routinely in that analgesics were administered as needed at the discretion of each anesthesiologist. In the trained nurses group (n=73), the ICU nurses received an education program including a pain assessment and treatment protocol. In both groups, pain scores were evaluated and recorded according to the Wong–Baker FACES Pain Rating Scale on the first and second postoperative day. Analgesics were administered to alleviate moderate and severe pain, and the nurse was asked to record all pain scores and analgesic drug doses.
    Results
    Pain scores on the second day decreased in both groups (P
    Conclusions
    Implementation of our pain management protocol by ICU nurses led to an increase in analgesic use and a decrease in sedative drug administration and better pain control in pediatric patients undergoing cardiac surgery.
    Keywords: Nursing, Education, Pediatric, Pain management, Cardiac surgery
  • Akram Shahbazi, Nahid Rahmani, Milad Abbasi, Reza Nabi Amjad, Hossein Marioryad, Alireza Khammar, Monir Alimohammadi, Mohsen Poursadeghiyan* Pages 20-26
    Background
    Occupational stress is the leading cause of many disorders in employees. Drivers are a high-risk group for work-related stress. The purpose of this study was to determine the association between cardiovascular risk factors and occupational stress among locomotive operators.
    Methods
    This cross-sectional study recruited 350 locomotive operators. The Osipow questionnaire was used to measure stress. After 10 hours of fasting, systolic and diastolic blood pressures were recorded. Intravenous blood samples were also taken. Two groups of job stress were included as “trivial and trivial-to-average stress” and “average-to-acute and acute stress”. The Mann–Whitney U test was utilized to compare the risk factors of cardiovascular disease between the 2 groups. The association between education level and job experience was assessed using the χ2 test.
    Results
    Of the 350 participants, 250 (71.43%) individuals reported average-to-acute stress, 30 (8.57%) reported acute stress, and 70 (20%) reported average stress. There was a significant relationship between education level and job experience (P=0.000). There were no significant differences between the 2 groups in the smoking rate (P=0.92), triglyceride level (P=0.55), and diastolic blood pressure (P=0.21), while the trivial and trivial-to-average stress group had significantly higher blood glucose levels (P=0.024) and systolic blood pressures (P=0.000) than the other group. Finally, the blood cholesterol level in the average-to-acute and acute stress group was significantly higher than that of the other group (P=0.000).
    Conclusions
    High rates of occupational stress were reported in the studied locomotive operators. Stress may have effects on blood glucose, triglyceride, and cholesterol levels in this job group.
    Keywords: Risk factors, Cardiovascular disease, Occupational stress, Osipow, Locomotive operators, Cardiovascular risk factors
  • Hakimeh Sadeghian, Ebrahim Nematipour, Ali Kazemi Saeid *, Masomeh Lotfi-Tokaldany, Neda Ghaffari-Marandi, Elham Hakki Kazazi, Mehran Mahmoodian, Seyed Hesameddin Abbasi Pages 27-35
    Background
    The evaluation of the left ventricular ejection fraction (LVEF) is important for predicting mortality and identifying high-risk patients. We aimed to identify factors affecting the variation in the LVEF measurement via echocardiography and contrast left ventriculography (CVG).
    Methods
    A total of 4422 patients (mean age=59.0±10.52 y, range=22–88) who underwent echocardiography and CVG within the same hospitalization period (0- to 14-day intervals) were included. Data were obtained the Echocardiography Data Bank and the Coronary Angiography Data Bank in Tehran Heart Center.
    Results
    The correlation between the estimation of the EF by echocardiography and CVG was good (r=0.716); however, there was no point-by-point agreement. In 21.5% of the patients, echocardiography and CVG estimated the EF equally, and a difference greater than 20% was found in 1.8% of the patients. The differences between the 2 measurements were remarkable either in the patients with EFs greater than 50% or in those with EFs of 50% or less by CVG (59.71±3.72 by CVG vs 55.96±7.57% by echocardiography in EFs>50% and 40.69±8.96 by CVG vs 43.90±10.71% by echocardiography in EFs≤50%). By linear regression analysis, the presence of pathologic Q wave, atrial fibrillation and left bundle branch block, moderate and severe mitral regurgitation, increased LV size, and increased interventricular septal diameter resulted in a higher EF value via CVG, as in those with EFs of 50% or less, the EF by echocardiography was higher. No effect of time gap between the measurements was found.
    Conclusions
    According to our study, the EF measurements obtained by echocardiography and CVG varied on an individual basis. The level of the EF was the most important factor correlating with the difference between the measurements by the methods.
    Keywords: Echocardiography, Contrast ventriculography, Ejection fraction
  • Ata Firouzi, Ronak Ahmadi, Nargeuss Abbaszade Marzbali, Anita Sadeghpour, Zeinab Norouzi, Hamidreza Pasha, Reza Golpira, Yousef Moghaddam, Nasim Naderi * Pages 36-43
    Background
    The presence of pericardial effusion (PE) in the setting of infective endocarditis (IE) may be a sign of more severe IE. In this study, we aimed to determine the prevalence and prognostic significance of PE in patients with native valve IE.
    Methods
    The Iranian Registry of Infective Endocarditis (IRIE) is a single-center observational hospital-based study of patients with IE. Between 2002 and 2015, all patients with a diagnosis of IE who had been enrolled in the IRIE were evaluated.
    Results
    A total of 445 patients (68.3% male) were enrolled in this registry, and 221 (49.7%) patients had PE. PE was more prevalent in the patients with native valve IE and those with right-heart involvement (65% in right-heart IE vs 50% in left-heart IE; P=0.002). The rate of in-hospital mortality was 20% and 19.2% in the patients with and without PE, respectively, and the presence of PE was not a predictor of in-hospital death in our multivariate analyses. Additionally, there was no relationship between the rates of IE-related complications and the severity of PE. However, the prevalence of PE was higher in the patients with right-sided IE as well as in those with aortic root abscess and systemic emboli at presentation.
    Conclusions
    The prevalence of PE in the setting of IE was relatively high in the present study. Most cases of PE had mild effusion, and there was no relationship between the severity of PE and IE- related complications as well as in-hospital mortality.
    Keywords: Infective endocarditis, Pericardial effusion
  • Azin Alizadehasl, Anita Sadeghpour, Nehzat Akiash* Pages 44-49
    Background
    Hypertrophic cardiomyopathy (HCM) is clinically characterized by the presence of left ventricular hypertrophy in the absence of hypertension and valvular heart disease. Diastolic dysfunction is an important pathology in patients with HCM, and it is characterized by abnormal relaxation, increased left ventricular filling pressure, pulmonary congestion, and ultimately cardiac symptoms. The present study aimed to assess the isovolumic relaxation time (IVRT) in patients with HCM as an important indicator of diastolic dysfunction.
    Methods
    Nineteen control subjects and 35 patients with HCM were included in the present study. Diagnosis was based on the confirmation of unexplained myocardial hypertrophy in the left ventricle by conventional echocardiography. The peak velocity of early (E) and late (A) filling, E-wave deceleration time (DT), and the E/A ratio were assessed using pulsed-wave Doppler (PWD) echocardiography at the tip of the mitral valve leaflets in the apical 4-chamber view. The IVRT was measured in the 4-chamber view via the PWD method. To that end, the filtering gain of the images was adjusted and the IVRT was estimated.
    Results
    The mean age of the patients was 31±16 years. The IVRT more significantly increased in the patients with HCM than in the control group (P
    Conclusions
    The diastolic function was impaired in our patients with HCM. Moreover, the IVRT as a noninvasive index of the diastolic function was prolonged in those with HCM.
    Keywords: Hypertrophic cardiomyopathy, Isovolumic relaxation time, Diastolic dysfunction
  • Ahmad Mirdamadi, Mansoureh Safdari, Mojgan Gharipour*, Mohammad Garakyaraghi, Ali Pourmoghadas Pages 50-56
    Background
    This study attempted to evaluate functional and structural cardiac states using echocardiography in patients with white-coat hypertension in comparison with true hypertension and normotensive conditions.
    Methods
    The study population consisted of 72 individuals, aged 25 to 75 years. The subjects were assigned to 4 groups: white-coat hypertensives (n=20), controlled true hypertensives (n=20), uncontrolled true hypertensives (n=12), and a normotensive group (n=20). Whilst the 4 sub- groups in the study exhibited a similar gender distribution, the normotensive subjects were significantly younger; however, there was no discrepancy in the mean age between the white- coat hypertensive group and the other hypertensive subgroups. Univariate comparisons between the functional and structural cardiac parameters of the white-coat hypertensives and the other study groups revealed low deceleration time and E’-wave velocity and high E-wave velocity and left ventricular internal dimension indices compared with the other 2 hypertensive groups.
    Results
    After adjustment for sex and age, the white-coat hypertensive group revealed differing results in 2 indices of E’ wave velocity and interventricular septal thickness (IVST) when compared with the other three. A number of features were identified as the hallmarks of white-coat hypertensives: specific functional and structural cardiac changes such as low IVST in comparison with the uncontrolled hypertensives; presence of diastolic dysfunction, which was not found in the normotensives; and greater cardiac mass than that in the normotensives, less than that in the uncontrolled hypertensives, but closer to that in the controlled hypertensives.
    Conclusions
    Although the prognosis for patients with white-coat hypertension is not as grave as that for those with true hypertension, it is considerably worse than the prognosis among the normal population.
    Keywords: Function, Structure, Heart, White-coat hypertension
  • Nima Akbarian, Mohammad Masoomi*, Maryam Sedaghat, Maryam Askari Pages 57-64
    Background
    The present study aimed to assess the relationship between vitamin D deficiency and the severity of coronary artery disease (CAD) in a sample of Iranian diabetic patients.
    Methods
    This cross-sectional study was performed on 169 consecutive diabetic patients suspected of CAD. The severity of CAD was defined based the number of involved coronary vessels. The serum vitamin D level was measured via immunoassay, and its serum level was categorized as normal (>30 ng/mL), insufficient (20–30 ng/mL), mildly-to-moderately deficient (10–20 ng/mL), and severely deficient (
    Results
    There was no significant relationship between vitamin D deficiency and the number of involved coronary vessels (P=0.423), and nor was there any difference in the serum level of vitamin D in the individuals with CAD (24.84±18.53 ng/dL) and those without CAD (22.37±16.88 ng/mL) (P=0.409). Our multivariate logistic regression model showed that vitamin D deficiency could not predict the presence of CAD (OR=0.963, 95% CI: 0.666 to 1.392; P=0.842). Analysis of the area under the ROC curve indicated a low value for the measurement of the vitamin D level in discriminating CAD the normal coronary status (AUC=0.533, 95% CI: 0.437 to 0.629; P=0.496).
    Conclusions
    Our study could not demonstrate a predictive role for vitamin D deficiency concerning the severity of CAD in type 2 diabetes. Among the different CAD risk factors, smoking and opium use were significantly correlated with vitamin D deficiency.
    Keywords: Coronary artery disease, Vitamin D, Diabetes, Risk factor
  • Rasoul Azarfarin, Ziae Totonchi, Mahtab Babaei *, Azin Alizadehasl, Behshid Ghadrdoost, Mohamadali Najafikhah, Amirreza Ehsani Pages 65-70
    Background
    Family members of patients undergoing surgical or interventional procedures are prone to anxiety while awaiting the outcome. What can even increase such anxiety is receiving inadequate information about the patient’s status the nursing staff. Educating nurses about the means and ways to alleviate anxiety among the family members of patients can be time- consuming and at times impractical in large hospitals. Accordingly, seeking to improve communication with patients’ family members, we designed an information card containing estimated procedure times, related telephone numbers, and other useful information regarding cardiac surgery and angiographic procedures. The aim of this survey was to assess anxiety status among the family members of patients undergoing surgery or angiographic procedures after receiving the information card during the cardiac procedure.
    Methods
    The present quasi-experimental study was conducted in a university heart hospital in Tehran (Iran) in 2016. The participants were ed among the family members of patients undergoing cardiac surgery or angiographic intervention. The study population was divided into a control group (n=59) and an intervention group (n=59). An information card was given only to the intervention group in the waiting room. The data collected included demographic variables and the Spielberger State Anxiety Inventory questionnaire.
    Results
    The informational card diminished the family members’ anxiety level (P=0.016). The mean score of anxiety was 51.7±13.4 in the control group and 45.9±12.2 in the intervention group.
    Conclusions
    Our results showed that the implementation of an information card decreased the level of anxiety among the family members in the waiting room while awaiting the outcome of their patients’ surgical or angiographic procedures.
    Keywords: Family members, Waiting room, Anxiety, Informational support
  • Mohammad Abassi Tashnizi, Atefeh Ghorbanzadeh, Nahid Zirak, Hamid Hoseinikhah, Aliasghar Moeinipour * Pages 71-74
    A right-sided aortic arch with an aberrant left subclavian artery and a Kommerell diverticulum is a very rare finding, and it can cause tracheoesophageal compression. We describe a 45-year-old female patient with a right-sided aortic arch in tandem with an aberrant left subclavian artery and a Kommerell diverticulum. She had an 8-month history of mild dysphagia and nausea. Reconstruction of the aberrant left subclavian artery was not possible because of its deep position and exposure limitation; the artery was, therefore, simply ligated between 2 clamps. Ligation of an aberrant left subclavian artery is acceptable when it is difficult to access the artery or when the artery has a narrow orifice.
    Keywords: Aberrant left subclavian artery, Kommerell diverticulum, Right-sided aortic arch, Ligation
  • Shabnam Madadi, Zahra Emkanjoo*, Mehrana Sharifi, Hadi Ahmadpour Pages 75-78
    Several algorithms have been proposed for the localization of an accessory pathway the pre-excited 12-lead ECG. Some of these algorithms are based on the polarity of the QRS complex, 1-2 as others are based on a combination of QRS and delta-wave polarities. 3–5 However, none of these algorithms is 100% sensitive or specific. Furthermore, there may be considerable variations between algorithms in the predicted site of the accessory pathway, particularly in cases with minimal pre-excitation or pre-excitation in more unusual locations. This brief case report describes a patient with frequent episodes of palpitations and electrocardiographic abnormalities consistent with pre-excitation and multiple episodes of tachyarrhythmia such as atrioventricular reciprocating tachycardia and pre-excited atrial fibrillation, with an unusual location of the accessory pathway. The patient was a 42-year-old female. Her 12-lead ECG showed evidence of pre-excitation with a positive delta wave in V1, and II, III, aVF and a negative delta wave in I, aVL, and aVR. During electrophysiologic study, an orthodromic atrioventricular reciprocating tachycardia was induced and the earliest site of retrograde atrial depolarization was recorded at the proximal site of the coronary sinus. Meticulous mapping via septostomy and during tachycardia showed the local ventriculoatrial fusion in the anteromedial mitral annulus, and radiofrequency application in this area resulted in the termination of the tachycardia and elimination of the accessory pathway.
    Keywords: Accessory pathway, Aortomitral continuity, Catheter ablation, Pre-excitation