Arya Atherosclerosis
Volume:7 Issue: 5, Winter 2012

Despite more accurate methods of cardiac imaging, plain chest X-ray (CXR) still is the first imaging method in people with suspected heart diseases. The most important application of CXR in cardiac patients is the estimation of cardiac size. There are two main methods for cardiac estimation in CXR; transverse diameter (TD) and calculation of cardiac width ratio to thoracic cage or cardiothoracic ratio (CTR). Echocardiography is a standard and more accurate method for cardiac size measurement; however, it requires more time and is costly,and is not as accessibleas CXR. This study aimed to determine the sensitivity and specificity of CXR to diagnose enlarged heart (cardiomegaly) in comparison with echocardiography. In this study, 327 adults that referred for echocardiography to Hajar Hospital(Shahrekord, Iran) during summer 2001 were recruited. Their CXR findings were compared to echocardiography. Mean age of the patients was 53.6 years and 46% were male. Considering the CTR ≤ 50% of thoracic cage widthand TD ≤ 16 cm as normal,CTR resulted in 28.2% false-positiveand 9.2% false-negative classification for cardiomegaly.The corresponding figures for TD were 8.8%and 58.5%, respectively. In order to determine cardiomegaly, CTR had a higher sensitivity in comparison with TD; however, the specificity of TD was higher than CXR.

Early diagnosis of coronary artery diseases (CADs) may lead to more efficient treatments. Coronary artery calcification is considered as a valuable index in detecting CAD using a noninvasive technique. This study was conducted to determine the correlation between coronary artery calcification and coronary artery stenosis in patients with typical chest pain. This cross-sectional study was conducted on 760 patients suffering from typical chest pain, in Chamran Hospital, Isfahan, Iran. The patients were all candidates for coronary angiography and were studied for the calcification of coronary artery by fluoroscopy. All patients signed a consent form after the whole procedures were fully explained to them. A fluoroscopic movie was taken from patients (after exposing, and before inserting the angiographic catheter), then the angiography was conducted using Judkins technique. The results of fluoroscopy and angiography were recorded by two cardiologists separately. The presence of any significant stenosis greater than 75% was considered as a sign of severe CAD. The data was analyzed by chi-square test. Abnormal angiogram was found in 402 patients (59.2%). Positive and negative predictive values for calcification were 81.8% and 26%, respectively. Positive and negative predictive values were respectively 87.1% and 63.4% in females, and 79.7% and 47.3% in males. The highest predictive value (100%) was seen in patients under 40 years old. Coronary calcification in patients with abnormal coronary angiogram was found to be 5.4 times greater than those with normal angiogram. Considering the high predictive value of coronary artery calcification in fluoroscopy, it can be used as a replacement for screening coronary involvement.

Ischemic heart disease is the leading cause of mortality and morbidity in the world. Vascular inflammation is the noticeable risk factor of ischemic heart disease. In this study, the relation between the intracellular adhesion molecule (ICAM) and vascular adhesion molecule (VCAM) were evaluated as the inflammation indicators of the coronary involvement extent. In this cross-sectional study, 82 patients with stable angina were studied. Patients were all candidates for angiography. Individuals with acute coronary syndrome, recent surgery, inflammatory disease, drug consumption, kidney and liver disease, phlebitis and pulmonary thromboembolism (PTE) were excluded. Blood sampling was performed for biochemical analysis of VCAM and ICAM. Coronary angiography was then conducted via standard method. Mean age of the patients was 58.4 ± 10.1 years and males constituted 72% of the studied population. Mean values of ICAM and VCAM were 183.9 ± 78 and 150.3 ± 136 ng/dl, respectively. There was not any correlation between VCAM and ICAM and the severity of coronary artery disease. In linear regression analysis, even with considering hypertension, hyperlipidemia, and diabetes as cofounders, there was not any relation between these factors and cardiovascular disease. According to our findings, inflammatory markers (VCAM and ICAM) did not add any further information about the extent of cardiovascular disease.

We aimed to evaluate subepicardial and subendocardial left ventricular (LV) functions in patients with single coronary artery lesion at an early stage after percutaneous coronary intervention (PCI). Patients with left anterior descending (LAD) lesion (n = 40) were evaluated.Subjects underwent PCI and at least one coronary stent was placed. Before and one month after PCI, patients underwent echocardiography. The ordinary Doppler indicators including E wave deceleration time, A velocity and E velocity as well as the pulsed-wave tissue Doppler imaging (PW-TDI) parameters (Aa, Ea and Sa velocity) were measured. The findings before and after intervention were compared. E wave deceleration time was the only factor that significantly improved in rdinary Doppler and other parameters such as A velocity and E velocity did not show any changes.Among TDI parameters, Aa velocity and Ea velocity in septum area improved significantly but despite an increase in Sa velocity in septum, it was not statistically significant. Ea velocity significantly improved in lateral area but Aa and Sa velocity insignificantly increased. In patients with coronary artery disease, the systolic and diastolic unction is impaired. It is simply diagnosable by TDI. Although the systolic function impairment is remained after PCI, the diastolic function considerable improved after angioplasty. Our study showed that diastolic function of left ventricle improved over time. In contrast with other studies, in this study, Aa velocity significantly improved one month after revascularization.

The barriers to participation in cardiac rehabilitation programs are individual and economic problemsas well aslimited availability of rehabilitation services. Because of the important role of rehabilitation, home-basedexercise rehabilitation is a new approach to participate in such programs. The purpose of this study was to evaluate theeffect of home-basedrehabilitation on quality of life (QoL) in patients with coronary artery disease after coronaryartery bypass graft (CABG) and percutaneous coronary intervention (PCI). Participants included 18 CABG (3 women, 15 men) and 40 PCI (12 omen, 28 men) low tomoderate risk patients. Finally, 17 patients in the exercise group and 16 patients inthe control group remained. The SF-36 was used to evaluate changes in QoL before and after the program. forty-three percent was dropped out from the program. Before and after program,the exercise group was betterin all domains of QoL (P <0.05). After 8 weeks of cardiacrehabilitation, significant improvements were observed inquality of life in both groups (P<0.05) but the exercise group showed more improvements in three domains. Home-based exercise rehabilitation after CABG and PCI may improve QoL and provide an efficient low-costapproach to cardiac rehabilitation. It may be helpful due to limited availability and resources in Iran. Nevertheless,there is a need for more trainingto increaseparticipation and decrease drop out.

Depression is very common amongst post-Myocardial Infarction patients and has been associated with adverse clinical events in these Patients. The purpose of this study is to consider the relationship between personal control in baseline and onset of post-MI depression. 176 patients between 32 to 84 years old whom followed MI admitted to CCU wards inIsfahan were selected based on the inclusive and exclusive criteria. Baseline data collection wasadministrated by Demographic and Medical Questionnaire, Personal Control scale, Beck Depression Inventory and Echocardiography. Three months after discharge, the Beck Depression Inventory for Primary Care (BDI-PC) was completed by the subjects. Covariance model was used to analyze the data. The findings indicate that 45% suffered from post-MI depression. The results of Covariance analysis show significant difference between two groups of patients with and without post-MI depression in Personal Control Scale (F = 6.16, P < 0.05). Generally, the findings indicate the relationship between patients’ beliefs about controlling of disease after MI and onset of post MI depression. Thus, this finding can be considered in rehabilitation in order to prevention of post-MI depression.

Myocardial infarction is a common and lethal disease, especially in the first hours. Rapid and correct decision is essential to prioritize advanced therapies. This study followed the accuracy of a scoring system for this triage. The aim was to assess the correlation between thrombolysis in myocardial infarction risk scores and angiographic scores in patients with ST elevation myocardial infarctio. In this cross-sectional, correlation study, 240 patients with ST elevation myocardial infarction from coronary care units (CCUs) of 3 academic hospitals in Isfahan, Iran,were evaluated. Thrombolysis in myocardial infarction risk score was calculated. All subjects underwent angiography and were followed up for 2 months. Mean age of patients was 60.02 ± 11.95 years old and 79 patients were female. The correlation between thrombolysis in myocardial infarction risk and angiographic scores was significant (P < 0.001). In addition, the correlations between ejection fraction and thrombolysis in myocardial infarction risk score (P < 0.001), as well as angiographic score and age (P < 0.001)were significant. There was no significant correlation between angiographic score and recurrent angina (P = 0.143), rehospitalization (P = 0.524), and death (P = 0.179). Pearson's correlation showed a significant relation between thrombolysis in myocardial infarction risk score and angiographic score (P < 0.001; r = 0.556). This study showed that thrombolysis in myocardial infarction risk score could probably be used for evaluating the angiographic extent of coronary artery disease. If onfirmed by a prospective cohort study, simple clinical use of this score at bedside would make it a method to stratify patients in high and low risk groups. Diagnostic and therapeutic strategies would accordingly be catgorized.

Antistreptokinase antibody in serum of people who had been exposed to streptococcal infections may interfere with thrombolytic effects of streptokinase. Streptokinase is the only thrombolytic medication in Iran, and is the first line treatment in myocardial infection. Considering the high prevalence of streptococcal infections in Iran as compared to developed countries, the high levels of serum antibody might neutralize streptokinase. Serum levels of antistreptokinase antibody of 126 people with myocardial infarction who went to Noor Hospital in Isfahan, Iran were measured before administrating streptokinase. The effects of the drug were then evaluated and compared by considering the consequent echocardiographic (ECG) changes during hospitalization. In 17 out of 126 patients (13.5%), the antibody levels were high and the drug did not have any effects. This number is 2.5 times more than the values in references. In 25 patients, among whom 3 had high levels of antistreptokinase antibody, the drug was effective. Considering the lack of relationship between high levels of antistreptokinase antibody and the efficacy of streptokinase in patients with myocardial infarction in this study, studies with larger sample size and more objective criteria, such as serum fibrinogen as the indicator of streptokinase efficacy, are recommended.

Despite conventional treatment methods of acute myocardial infarction, its complications and mortality rates are still very high. Finding new cost-effective treatments like regulation of ischemic muscle metabolism at the time of thrombolytic therapy can meet this requirement to some extent. This study investigated the efficacy of the pharmaceutical combination of glucose, insulin, potassium (GIK) and magnesium along with thrombolytic therapy. In a double-blind, controlled clinical trial, 200 patients with acute myocardial infarction who had the indication for thrombolytic treatment were selected and divided to 6 groups of almost 30 people. A specific treatment protocol was designed for each group. The patients in the first 5 groups were compared with the ones in the sixth group as the control group in terms of frequency of complications and in-hospital mortality and also mortality during 3 and 6 months after the treatment. Mean age of the patients was 58.77 ± 2.6 years. Males constituted 77% of the study population. Heart failure, in-hospital arrhythmia and ejection fraction (EF) at discharge showed favorable results in the five groups which received metabolic regulations as compared to the control group. In-hospital mortality of no groups was different from that of the control group (P > 0.05). Three months after the treatment, mortality of the group that received GIK and magnesium was lower than that of the control group (P < 0.05). After 6 months, none of the patients who received high-dose GIK and magnesium along with thrombolytic therapy died while the mortality rate of the control group was 44.4% (P < 0.05). The infusion of GIK and magnesium solution along with thrombolytic therapy can lead to a decrease in the long-term mortality and complications in patients with acute myocardial infarction.

Hypertension is a major cause of cardiovascular diseases whose prevalence increases by 10% for every 10 years after 50 years of age. This study aimed to investigate the causes of failure to control blood pressure in people aged over 65 years old. This descriptive case-control study was conducted on 200 participants aged over 65 years old who were diagnosed with hypertension through a routine travel check-up for pilgrimage to Mecca in Amin Hospital, Isfahan, Iran during 2003. Following the medical examinations and blood pressure measurements according to the World Health Organization (WHO) standards, the participants were divided into two groups of controlled blood pressure (case) and uncontrolled blood pressure (control). A questionnaire was filled in for each participant and the data was analyzed using chi-square and student-t tests. The mean age was 70.7 ± 5.2 and 69 ± 4.9 in case and control groups, respectively. Less than half of the participants in the case group took anti-hypertensive medicine, out of which 87.5% were treated by a physician and 12.5% practiced self-therapy. In addition, 25% took their medicine regularly and 55% expressed a lack of motivation as the cause of discontinuing their medication. Furthermore, patients with controlled blood pressure had significantly better knowledge and performance than the case group (P < 0.05). The most common causes of failure to control blood pressure were poor knowledge, inappropriate practice in diet, stress, smoking, and irregular intake of medication.

Investigating association of obesity indexes with other risk factors of cardiovascular diseases can help finding the best index in clinic for each sex. In this study, relationship of obesity based on body mass index (BMI), waist circumference, and waist-to-hip ratio with cardiovascular disease risk factors was investigated. Participants of the first phase of Isfahan Healthy Heart Program (IHHP)in 2000-2001, including 12800 healthy people aged over 19 years from Isfahan, Najafabad and Arak (Iran), were studied. Anthropometric indexes and cardiovascular risk factors were collected using conventional definitions and standard questionnaires. Kappa coefficient of agreement between calculated risk factors with definition of obesity based on anthropometric indexes was calculated using SPSS software. Waist circumference showed the highest correlation with cardiovascular risk factors in men and women. Obesity based on BMI and waist-to-hip ratio in both sexes showed the same correlation with cardiovascular risk factors. In the correlation study matched for age, it was shown that the highest correlation was seen between waist circumference and two other indexes. Correlation coefficient over 60% showed the strongest agreement between obesity indexes and metabolic syndrome. In Iranian population, waist circumference as a simple measure with a higher agreement with cardiovascular risk factors can be used in clinical settings and epidemiological studies. Keywords: Obesity Indexes, Obesity, Cardiovascular Risk Factors, Isfahan.

One of the causes of pulmonary artery hypertension (PAH) is mustard gas poisoning, which is a destructive factor in chemical bombs that contaminated Iranian soldiers during Iraq-Iran war. This study was designed to evaluate the effect of sildenafil, an effective drug for PAH, on symptoms of PAH caused by mustard gas. In a quasi-experimental study on 20 patients with a history of mustard gas poisoning and PAH symptoms, pulmonary artery pressure was measured with a transthoracic echocardiography (TTE). Patients took a 6-minute walking test (6-MWT), and then, they were treated for 12 weeks with 50 mg dailysildenafil. Finally, echocardiography and 6-MWT were repeated. All patients were men with a mean age of 42.8±3.9 years. Mean pressure of pulmonary artery at the beginning of the study was 37.7±8.2 mmHg, and the walked distance at 6-MWT was 263.3±2.2 meters. After 12 weeks, these values were 29.1±6.5 mmHg, and 291.3±82.3 meters, respectively, which were significantly higher. This studyshowedthat sildenafil improves mustard gas PAH. On the basis of our findings, even a single daily dose of sildenafil can have a good effect on these patients.

This study was conducted to evaluate the effect of an educational intervention on depression and quality of life (QoL) of patients with coronary artery bypass grafting (CABG) surgery. This was a quasi-experimental study on 54 patients after CABG who were randomly divided into the test and control groups. To evaluate depression, Cardiac Depression Scale was used. Then a researcher-made questionnaire of Predisposing, Reinforcing, Enabling Causes in Educational Diagnosis and Evaluation (PROCEED) was used and finally the 36-item Short-Form Health Survey (SF-36) was employed. The intervention was done through 9 educational sessions, once a week, lasting 60-90 minutes based on PRECEDE model and it was followed-up for two months. After the educational intervention, the mean score of predisposing causes, enabling causes, reinforcing causes and self-care behaviors significantly increased in the test group compared to the control group (P < 0.001). There was a significant difference in mean score of depression between the two groups after the educational intervention (P < 0.001). In addition, there was a significant difference after the intervention in physical functioning (P = 0.04), mental problems related to QoL (P < 0.001) and generally, in psychological health (P = 0.04). The findings of this study confirmed the efficacy of PRECEDE educational model and its components (predisposing, enabling and reinforcing causes) and behavioral factors of it on improvement of psychological status and depression of the patients which finally increased QoL of patients after CABG.

Although cardiovascular diseases get top position in burden of disease list, the role of risk factors in extent and severity of atherosclerosis in coronary artery disease (CAD) remain controversial. To study the determinants of severity and extent of coronary artery disease in consecutive patients with major risk factors of CAD undergoing clinically indicated coronary angiography. In this cross sectional study, coronary angiograms of 325 men and 235 women patients were analyzed quantitatively. Then systolic and diastolic blood pressure, body weight, height, fasting blood sugar, serum lipids and smoking habit were collected in a questionnaire. Relationship of angiographic scores, reflecting severity and extent of CAD were comparing with potential risk factors using logistic and multiple linear regression analysis. We found significant differences between age and fasting blood glucose in patients with positive coronary angiogram versus patients with negative coronary angiogram (P<0.05). Diabetic patients have higher score compare to non diabetics in both sexes and same difference were found in obese men. Fasting Blood Sugar in both sexes (males 0.017, females 0.016), diastolic blood pressure (0.044) in males and body mass index (BMI) (0.005) and HDL cholesterol (- 0.081) in females were significantly predictive factors for severity and extent of CAD (regression coefficient). This findings show that in patients with positive coronary angiogram, fasting blood sugar in both sexes, high diastolic blood pressure in males and HDL-C and BMI in females may be stronger predictors of extent of CAD. Prevention of these risk factors may be effective in controlling the progress of CAD.

Lipoprotein (a) (LP (a)) has been identified as one of the independent risk factors for coronary artery diseases. Various studies on the amount of serum LP (a) with relation to intensity and extent of observed lesions on coronary angiography have yielded in different results. Therefore, this study aimed to examine the importance of LP (a) levels and its relationship with the findings of coronary artery angiography. The present research was conducted by considering clinical symptoms, level of serum lipids and amount of LP (a) in 92 patients who were under angiography because of chronic stable angina. The angiography was performed in a standard way with conventional views and was interpreted by at least two cardiologists. The levels of LP (a) were considerably higher in the group with two-vessel coronary artery lesions (55 ± 45 mg/dl) as compared with the patients with one-vessel (30.3 ± 27 mg/dl) or three-vessel diseases (26.9 ± 15 mg/dl). The statistical analysis of the results in these three groups demonstrated that there was no relationship between the levels of serum LP (a) and intensity of observed lesions on the coronary angiography. Although a few studies have reported a statistical relationship between the serum levels of LP (a) and intensity of observed lesions on coronary angiography, similar to numerous other researches, such a relationship was not observed in the present study. However, the findings of this study confirm that LP (a) should be considered as a risk factor for early coronary artery diseases.

The complications of cardiovascular diseases (CVDs) include psychological stresses such as anxiety, depression, and hostility. They cause disease exacerbation and prolongation and delayed improvement. Some studies have reported rehabilitation and stress management interventions to be helpful in reducing such stresses. Due to the high prevalence of CVDs in Isfahan, Iran, the present study evaluated the effects of a cardiac rehabilitation course on psychological stresses in an Iranian population. A total number of 190 patients (40 females and 150 males), who have been introduced by cardiologists to Isfahan Cardiovascular Research Center for rehabilitation following the myocardial infarction and open heart surgery, participated in this study. Patients all took part in an exercise program including 24 one-hour sessions (three sessions per week). Each session consisted of warm-up (20 minutes), aerobic exercise and relaxation (40 minutes). Cognitive-therapeutic group therapy sessions, supervised by a psychiatrist, were also held for 1-2 hours weekly. Furthermore, patient's nutritional pattern was controlled by a nutritionist. All the individuals underwent exercise test at the beginning and the end of the exercise. In addition, anxiety, depression, and hostility were assessed by symptom checklist-90 (SCL-90) before and after the course. The data was analyzed by paired-t and independent-t tests in SPSS. The exercise volume in all the patients (42.7 ± 81.56 in males and 39.88 ± 33.36 in females) significantly increased at the end of the course. Moreover, scores of anxiety (-17.86 ± 68.49 in males and -32.33 ± 49.53 in females), depression (-12.80 ± 67.4 in males and -16.50 ± 57.84 in females), and hostility (-19.26 ± 71.86 in males and -12.80 ± 123.60 in females) showed a significant reduction at the end of the course (P < 0.001). Similar results were seen in both sexes. According to the changes found after rehabilitation, it can be concluded that the conducted rehabilitation program was helpful in reducing stresses among the studied population. Such programs can thus be an effective approach to reduce stress and its outcomes. In addition, there were no significant differences in the effectiveness of the program on psychological factors between males and females.

The incidence of atherosclerosis and cardiovascular diseases increases in diabetes mellitus patients. Therefore, the effects of a two-month oral administration of Marrubium vulgare (MV) on contractile reactivity of isolated aorta in an experimental model of diabetic rats were evaluated in the present study. Male Wistar rats (n = 44) were randomly divided into control, MV-treated control, diabetic, and MV-treated diabetic groups. For induction of diabetes, streptozotocin (STZ) was intraperitoneally administered (60 mg/kg). MV-treated groups received MV mixed with standard pelleted food at a weight ratio of 1/15. After 2 months, contractile reactivity of aortic rings to potassium chloride (KCl) and noradrenaline was determined using isolated tissue setup. Serum glucose levels showed significant increases in the diabetic group at 4th and 8th weeks (P < 0.001), while this increase was not observed in MV-treated diabetic group at the 8th week. In addition, the latter group showed a lower contraction to KCl (P < 0.05) and noradrenaline (P < 0.05) as compared to the diabetic group. Meanwhile, there was no significant difference between the control and MV-treated control groups regarding contractile reactivity. It can be concluded that oral administration of MV for 2 months could attenuate the contractile responsiveness of the vascular system which may prevent the development of hypertension in diabetic rats.

Cardiovascular disease (CVD) is known as a health threat worldwide. In Iran, similar to other countries, CVD is the first leading cause of death. Higher prevalence of cardiovascular risk factor leads to the higher prevalence of CVD. Previous studies revealed that CVD prevention depends on healthy lifestyle and people’s behavior. This study was conducted to determine the prevalence of cardiovascular risk factors among occupational population of the Isfahan Electricity Production and Distribution Company and to plan a strategy for CVD prevention in this population. This cross-sectional study was conducted on all 585 occupational populations of Isfahan Electricity Production and Distribution Company in 1999. Data collection was based on questionnaire including demographic characteristics, medical history, and physical examination. Information on sex, age, education, occupation, marital status, smoking, physical activity, and sleeping hours were obtained as demographic characteristics, CVD risk factor and non-communicable disease history as medical history. Height, weight, waist circumstance, hip circumstance, and blood pressure were measured. Fasting blood sugar (FBS), total cholesterol, LDL-C, HDL-C, triglyceride (TG) were tested for each person. Finding of this study showed that out of total population, 4.2% had high FBS, 33.3% high LDL-C, 48.2% high total cholesterol, 26.4% low HDL-C, and 51% had high TG. Obesity was seen in 13.6%, overweight in 46.7%, abdominal obesity in 42.8%, and sedentary lifestyle in 75%. In addition, 16.4% were current smoker and 5.8% of them were ex-smoker. Furthermore, those with hypertension and diabetes were 16% and 7.2%, respectively. Considering high prevalence of CVD risk factors in occupational population of Isfahan Electricity Production and Distribution Company, recognition of CVD risk factors could provide ground for interventional programs to prevent CVD in this company and maybe in other similar companies.

Albuminuria is one of the abnormalities which occur in diabetics.Different studies have shown its relationship with cardiovascular diseases but few studies have been performed to show the relationship between albuminoria level and coronary artery disease (CAD) severity. This study was designed to asses the relationship between albuminuria and coronary artery disease severity. In this cross-sectional study, the 164 Non-Insulin Dependent Diabetes Mellitus patients with angina pectoris who hospitalized for diagnostic or therapeutic angiography in Isfahan Chamran hospital were included. Urine Pr/Cr ratio has been calculated in all patients, using the first sample of morning urine. The standard angiography video has been assessed by three cardiologists through Seldinger method. CAD score has been given from 0 to 21 based on Extent method. The relationship between CAD severity and urine Pr/Cr ratio has been assessed with bivariate correlation methods and multivariate analysis. In 164 patients (males = 80 & females = 84) morning urine protein mean was 22.77 ± 30.99 and morning urine creatinin mean was 0.07 ± 0.04. Urine Pr/Cr ratio was 760.94 ± 401.56 mg/g and its median was 181.02. The CAD score was equal to 13.34 ± 6.24. There was no correlation between urine Pr/Cr ratio and CAD severity (P = 0.778, r = 0.022). In multivariate analysis, increased urine Pr/Cr ratio led to increased CAD severity by control of the age, FBS, gender, Captopril use, history of HTN and hyperlipidemia variables (P = 0.021). The amount of albuminuria which measured based on morning urine sample Pr/Cr ratio may be an independent risk factor for severity of CAD and can predict it. These findings signify the importance of albuminuria diagnosis and treatment.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Various studies show meaningful relation between ECG change in the rest and CVD mortality. Present study was performed to consider the relation between ECG and CVD risk factors in Iranian community. This cross-sectional study was performed on 3343 subjects aged ≥ 35 years from three provincial cities of Isfahan, Arak, and Najafabad. Questionnaire including questions on demographic and lifestyle information, as well as weight, height, blood pressure, hip and waist circumference measurement was completed. Laboratory tests including total cholesterol (TC), LDL, HDL, triglycerides (TG) and fasting serum glucose were measured as well. Ischemic criteria of ECG included minor and major changes in ST segment, T wave, conductive disorders, blocks and arrhythmia. Collected data were analysed using SPSS15 software. Ischemic changes in women were 1.5 times more than men (P < 0.05). Mean age of Ischemic group was 5 years more than non-Ischemic group. Comparison of lifestyle variables indicated that physical activity reverse to nutrient index, was significantly more in non-ischemic individuals compare to ischemic individuals. Smoking show a significant difference between two groups too (P < 0.05). Anthropometric variables including body mass index (BMI), hip and waist circumference and diabetic and systolic blood pressure in Ischemic group were significantly higher (P < 0.05). Biochemical factors including TC, HDL-C, LDL-C in ischemic group were significantly higher than non-ischemic group (P < 0.05). Considering of ischemic change in healthy individual with unhealthy life style or with risk factors, these points should be considered in evaluating of these individuals.

Depression is very prevalent amongst myocardial infarction (MI) patients. It has been reported to be associated with adverse clinical events in these patients. The purpose of this study was to consider the relationship between personal control at baseline and the onset of post-MI depression. A total number of 176 MI patients aged 32-84 years old who were admitted to coronary care units (CCUs) in Isfahan, Iran were selected. Baseline data was collected by a demographic and medical questionnaire, personal control scale, Beck Depression Inventory and echocardiography. Beck Depression Inventory for Primary Care was completed by the subjects 3 months after discharge. Covariance model was used to analyze the data. The findings indicated that 45% of the participants suffered from post-MI depression. Analysis of covariance showed a significant difference between patients with and without post-MI depression in personal control scores (F = 6.16; P < 0.05). Generally, our findings suggested relationship between patient's beliefs about having control over the disease and the onset of post-MI depression. This finding can be considered in rehabilitation courses to prevent post-MI depression.

One of the ways to modify education is to design clinical education courses based on advanced learning models with systemic collaboration of programmed spheres of practice variables. Nurses and academic members in nursing and medical schools play a key role in professional and personal promotion of nursing students. This study adopted synergy model to determine and assess patients’ and nurses’ characteristics. This is an action research. Synergy model was performed for 12 MSc nursing students (term two in CCU and Cardiac surgery ICU) selected by convenient sampling. The study was carried out in CCU of Nour and Cardiac surgery ICU and Cardiac surgery ward of Shahid Chamran hospitals of Isfahan University of Medical Sciences in the second semesters of 2008-2009 and 2009-2010. The data were collected by patients’ nurses’ characteristics questionnaire and levelizing them using synergy model with confirmed validity and reliability. The judgement in this study was based on mean score. Mean score of levelizing of nursing students’ characteritstics made by instructors and nurses showed that mean score in students’ function scale in clinical judgement was 3 (average), in advocacy and moral agcncy 1 (the lowest), in caring practices 3(average) in interdisciplinary collaboration 3, in systematic thinking 3 (average), in response to diversity 1 (the lowest), in facilitation of learning 3 (average) and in clinical inquiry 1 (the lowest)respectively. The findings of this study showed the need to promote mutual cooperation between nursing and medical schools and hospitals in education of nursing students and to promote care for clients and their families in a systematic planning framework. Synergy model is a functional approach for planned education and its development so that the students can aquire the ability to response to patients’ and their families’ needs in form of a learning system.

Reperfusion therapy is the standard treatment of acute myocardial infarction (AMI). If the percutaneous coronary intervention (PCI), as a preferred reperfusion strategy, is not available, thrombolytic therapy would be chosen as an alternative treatment. However, the effect of thrombolytic therapy on old patients is still controversial especially due to its effects on increasing the incidence of intracranial hemorrhage (ICH). In this study, we evaluated the incidence of neurological symptoms and ICH after thrombolytic therapy in AMI patients over 65 years of age. A total number of 300 AMI patients over 65 years of age who referred to the hospital within 12 hours of their symptom onset and had no contraindications for receiving thrombolytic therapy were selected. The patients were admitted in Noor Hospital, Isfahan, Iran, between 2004 and 2006. All of them received streptokinase (SK) in the same way. Their information was extracted from their files and collected by a questionnaire.. Among 300 patients in our study, there were 124 women (41.33%) and 176men (58.66%). Their mean age was 74 ± 9 years (range: 65-92 years). Moreover, 78% were discharged after one week of hospitalization and 22% (66 patients) died. Arrhythmias or myocardial reinfarction were the leading cause of death in 56.06% of all deaths. No death due to ICH and no evidence of ICH, such as hemiparesis or loss of consciousness, were observed. We suggest that thrombolytic therapy in old patients with AMI is a good alternative treatment when there is no access to an equipped PCI facility. In our study, the increase in mortality rate due to ICH was not high enough to prevent us from prescribing SK for AMI patients over 65 years of age.

Lack of information about clinical symptoms and risk factors of coronary artery tortuosity prompted us to perform this study to compare patients with and without coronary artery tortuosity. Among patients with chronic stable angina who underwent coronary angiography, we selected 98 patients with coronary tortuosity. They were retrospectively compared with 98 chronic stable angina patients without tortuosity to determine clinical symptom, risk factors, and angiography findings via Gensini score. In this study, 68.4% of patients with coronary tortuosity were female (P = 0.001). The mean age in this group was 59.2 years compared to 53.9 years in patients without tortuosity (P = 0.001). More than 7 clinical symptoms despite less coronary stenosis were found in tortuous coronary group. Among cardiovascular risk factors, only diabetes was significantly more common in the non-tortuous coronary group. This study concluded that coronary tortuosity is more common in the elderly and among female gender. Diabetic patients may have less prevalence of tortuosity. Further studies may provide more data about the cause and better management of the higher number of clinical symptoms in these patients despite their less epicardial artery stenosis.

The present study describes the methods of developing and validating two questionnaires that will be used to investigate the knowledge, attitude and practice of adults, children and adolescents regarding obesity. To design the questionnaires, we used the components of the Health Belief Model. The questionnaire for adults consisted of 6 sections with 50 questions. The questionnaire for children and adolescents included 7 sections and 52 questions. The questionnaires were assessed for face validity, content validity, and clarity of the items. To determine the internal consistency reliability of the questionnaires, Cronbach's alpha coefficient was measured for 100 questionnaires. Using the correlation coefficient, we determined the equivalent reliability of the study tools. The Cronbach's alpha coefficient ranged between 0.60 and 0.80 for the whole questionnaires. The Cronbach's alpha coefficient of the questionnaires for adults, children and adolescents were respectively 0.72 and 0.60 for awareness. The corresponding values for attitude were 0.70 and 0.75. Using Pearson's correlation coefficient, the interobserver reliability was determined to be significant (r ≥ 0.80; P < 0.001). Our study tools had adequate reliability and validity. They are thus suitable for assessing the knowledge, attitude, and practices of Iranian adults, and children and adolescents in toward obesity. Keywords: Validation Questionnaire, Obesity, Knowledge, Attitude, Behaviors.

Depressive symptoms are common among post myocardial infarction (MI) patients and may cause negative impacts on cardiac prognosis. Depression is observed in 35-45% of MI patients. While depression is an independent risk factor for MI, post-MI depression has been shown to be a risk factor for mortality, morbidity, and decreased quality of life in patients. The link between depression and MI is bidirectional in which behavioral and biological mechanisms have been proposed to be involved. The combination of these mechanisms is likely to involve in increasing the risk of mortality. Epidemiological studies have shown the link between depression and increased risk for development of cardiovascular disease, MI, and cardiac mortality. The adverse impact of depression on prognosis of heart disease is preventable with the right treatment. A number of therapeutic approaches including cardiac rehabilitation, social support, cognitive behavioral therapy, and antidepressants have been suggested for post-MI depression. However, due to their adverse effects, tricyclic antidepressants are recommended to be avoided for treating post-MI depression. On the other hand, administering selective serotonin reuptake inhibitors (SSRIs) shortly after MI would lessen their major side effects.