Journal of Cardio -Thoracic Medicine
Volume:8 Issue: 2, Spring 2020

High blood pressure is one of the most important risk factors for cardiovascular diseases. Hypertension has different prevalence rates across the world. The aim of this study was to determine the prevalence of high blood pressure in the middle-aged and elderly population covered by the Mashhad University of Medical Sciences, Mashhad, Iran.

This analytical cross-sectional study was carried out on the secondary data of SINA (Integrated Health Information System) performed on 246,904 people, aged ≥ 30 years, registered in 2017. Diagnostic testing was performed according to the clinical guidelines of the Seventh Report of the Joint National Committee on Prevention, Detection, and Evaluation (JNC7). The data were analyzed using the SPSS software, version 22. Chi-square tests were used to analyze the relationships between the variables. A p-value less than 0.05 was considered statistically significant.

The overall prevalence of hypertension was estimated at 32.3%. With regard to gender distribution, the prevalence of this disorder among males and females was obtained as 32% and 32.5%, respectively. Additionally, this disorder had the prevalence rates of 25.3% and 38.8% in cities and villages, respectively.

It seems that the prevalence of high blood pressure is higher in the studied population than in those living in many parts of Iran and the world. Accordingly, it is required to plan serious interventions in this regard.

Post-dilatation is associated with a simultaneous expansion of the stents that enhances the angioplasty outcomes. However, increased risk of mortality and morbidity has been reported in patients with acute myocardial infarction (AMI) which has provoked considerable controversies concerning its efficiency. During a two-year period, all patients underwent angioplasty with or without post-dilatation procedure, due to clinical features of the acute coronary syndrome (ACS), including unstable angina, non-ST-elevated myocardial infarction, and AMI, were included. The patients underwent 12 months of follow-ups after the angioplasty with or without post-dilatation. The primary endpoint was the TIMI flow of coronary artery after intervention. However, mortality, readmission due to ACS, need for revascularization, and incidence of AMI during 12 months, were secondary endpoints. No significant difference was observed in terms of demographic data between the groups with and without post-dilatation. Comparing mortality rate, the prevalence of AMI, intervention for revascularization and incidence of major adverse cardiac events (MACE) during the follow-up period showed no significant difference between the study groups. Based on the findings of the present study, balloon post-dilation was not associated with a reduction in MACE incidence. However, post-dilation may improve the TIMI flow in these patients.

The use of two arterial conduits for CABG is rapidly increasing. The second arterial conduit to LITA is usually RITA or radial artery. We sought to compare outcomes when either RITA or radial artery is exclusively used as a Y composite graft to LITA for total arterial revascularization.   We retrospectively analyzed 231 patients who underwent CABG in the period from 2010 to 2014. RITA was used in 178 patients (RITA group) and radial artery was used in 53 patients (radial group). Radial was used more frequently in female patients and in diabetic patients. Radial group had comparable number of distal anastomoses and lesser operative time to RTIA group. Early postoperative outcomes (low cardiac output syndrome, post-operative myocardial infarction, use of intra-aortic balloon pump, post-operative stroke, re-explorations, incidence of deep sternal wound infection and death) were all comparable in both the groups. Late deaths and need for repeat revascularization were also similar in both the groups for up to 4 years after surgery. Only the incidence of major acute cardiac and cerebrovascular events (MACCE) was more in the radial group. Radial artery has comparable short- and mid-term outcomes to RITA when used as a second arterial conduit in CABG. Its use should be especially considered in diabetic patients when DSWI is a concern.

Pleural effusion may develop during various acute or chronic medical conditions. Despite different diagnostic workups, some cases of pleural effusion may remain undiagnosed. Pleuroscopy and closed biopsy are common diagnostic approaches used for the diagnosis of undiagnosed cases. The present research aimed to evaluate the diagnostic yield of medical pleuroscopy and closed biopsy in Iran. The present cross-sectional study was performed within 2016-2018, in the North-East of Iran. Patients who had undiagnosed lymphocytic predominance exudative pleural effusion were included in the present research. Every patient underwent medical pleuroscopy or closed pleural biopsy by an Abrams needle. The collected data were analyzed in SPSS software (version 12).Ap-valuelessthan0.05 was considered statistically significant. A total of 108 patients with the mean age of 58.73±18.13 years enrolled in the present study. Around 50 patients underwent needle biopsy,while the other 58 patients went through medical pleuroscopy. Chronic pleuritis, malignant pleural effusion, negative results, and tuberculosis were the common results. When pleuritis is regarded as negative results and malignant and tuberculosis pleural effusion as positive results, medical thoracoscopy provides more significant positive results and fewer negative results (P=0.024). No patient developed complications after the procedures. In contrast to other studies, both of these techniques had low diagnostic yield for the diagnosis of undiagnosed pleural effusion. Therefore, performing other diagnostic workups (e.g., imaging techniques) may decrease the rate of undiagnosed pleural effusion.

Coronary artery disease (CAD) is recognized as the major cause of mortality and morbidity worldwide. Coronary artery interventions are considered the best therapeutic choice for most patients. Similar to other invasive procedures, these interventions whether performed from femoral or upper extremities have their own complications. There is a paucity of studies regarding access site pain and its related factors as a common complication of coronary intervention. With this background in mind, the present study aimed to determine the prevalence and the risk factors associated withthe development of upper extremity pain following coronary artery interventions. The present cross sectional studywas conductedin Ghaem and Imam-Reza hospitals (Mashhad, Iran) from July to December 2019. Every patient who underwent coronary intervention using radial and ulnar arterieswere enrolled in the present study, and the development of pain on the first day of intervention was evaluated. The relationship between upper extremity pain after the procedure and the study variables was assessed using Chi-square and Fisher’s exact tests. A p-value less than 0.05 was considered statistically significant. Most of 370 patients who underwent coronary artery angiography were male (n=202; 54.6%), and the cardiovascular risk factors were not significantly different betweenthe patients who developed upper extremity pain and those who did not. Upper extremity pain was detectedin 43.8% of patients within their first day after the procedure. Most of the patients reported pain at the puncture site(n=80). The female gender and the development of hematoma were significantly related to experiencing upper extremity pain (P There is a paucity of studies regarding the upper extremity pain following coronary intervention. The present study demonstrated that approximately 44% of patients who undergo coronary intervention on their upper extremities will experience upper extremity pain mostly at the puncture site within their first day after the surgery. Planning specific pre-procedure management program for female patients who are most likely to develop pain may be of great help in reducing the limb pain following the procedure.

The present study aimed to correlate renal oximetry near-infrared spectroscopy (NIRS) values with conventional non-invasive biomarkers for the early detection of acute kidney injury (AKI) in adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Accordingly, renal NIRS can be employed as a trending device for the prevention of AKI development. After institutional ethical committee approval, a number of 132 adult patients undergoing cardiac surgery with CPB were selected by consecutive consenting sampling method. Emergency surgery and patients with preexistent renal insufficiency were excluded. NIRS sensor was applied on either the right or the left side of the spine at the lower border of L-1 before starting the induction. A renal regional oxygen saturation (rSO2) score was calculated after recording the renal oximetry values intra- and postoperatively. Urine output and serum creatinine were measured at 24, 48, and 72 hours postoperatively. Out of 132 patients, 22 cases (16.66 %) developed AKI according to Acute Kidney Injury Network (Akin) criteria± Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification. Among these AKI patients, three cases required dialysis, and one of these three patients died on the 21st day postsurgery. Renal rSO2 scores in the AKI group were measured at 535 and 912 minutes %, in comparison to 162 and 184 minutes % reported in the non-AKI group which was statistically significant (P< 0.05). As evidenced by the obtained results, there is a correlation between intraoperatively measured renal NIRS readings and the occurrence of AKI following adult cardiac surgery using CPB.

  The use of carbon dioxide blower has been recognized as the standard of care in patients undergoing beating coronary artery bypass grafting (CABG) due to higher solubility and lower risk of embolization. On the other hand, the compressed air blower has gone out of use since air can be easily trapped and is less soluble which can cause coronary embolism. The present study aimed to compare the outcomes of patients undergoing on-pump beating CABG using CO2, as opposed to an air blower. A total number of 125 patients requiring coronary revascularization underwent on-pump beating CABG within February 2017-February 2018. In the current cross sectional study, 45 patients underwent CABG with CO2 blower and other patients were operated using air blower. The reported postoperative outcomes included mortality, low cardiac output state, malignant arrhythmia, postoperative myocardial infarction, blood transfusion, transient ischemic attack or stroke, intra-aortic balloon pump (IABP), as well as intensive care unit and hospital length of stay. Demographic characteristics of patients in two groups in terms of age, sex, risk factors, echocardiographic and angiography data were similar and demonstrated no significant difference. Patients' outcomes, such as cardiac arrhythmias, myocardial infarction, ICU and hospital stays, were also similar in both groups. In addition, the overall morbidity and hospital mortality showed no significant difference between the two groups. Although the use of CO2 during beating CABG has been advocated with its theoretical advantages, no significant difference was observed between the two groups in terms of mortality and morbidity using CO2, as opposed to air blower.

The acute occlusion of a coronary artery without the evidence of myocardial infarction might immediately affect both the diagnosis and treatment of coronary artery disease. We present the case with a sudden occlusion of the left main coronary artery without typical chest pain following an exercise tolerance test and rapid spontaneous reperfusion of the left main coronary artery.