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Seyed Masoud Majidi Tehrani, Hamid Ghaderi , Mahnoosh Foroughi , Manouchehr Hekmat, Mahmoud Beheshti Monfared, Hassan Tatari , Seyed Mohsen Mirhosseini , Zargham Hossein Ahmadi, Zahra Ansari Aval, Seyedeh Adeleh Mirjafari,
Volume 72, Issue 2 (5-2014)
Volume 72, Issue 2 (5-2014)
Abstract
Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until dis-charge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago. Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Results: Eighteen patients included in the study, 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6±6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography (TTE), in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5.6%) was recurrent. In 16 patients (88.9%) tumor were found in the Left Atrium (L.A) and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases (38.9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77.8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5.6%). Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but ad-vances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.
Reza Shariat Moharari, Pejman Pourfakhr , Mohammad Reza Khajavi , Farhad Etezadi , Atabak Najafi ,
Volume 72, Issue 7 (10-2014)
Volume 72, Issue 7 (10-2014)
Abstract
Background: Today Anesthesiologists occasionally face with bradycardia during gastric surgery and recognized this phenomenon as a vagal reflex. The objective of this study is finding of anesthesia risk factors for bradycardia and prevention of its hazardous complications during gastric surgeries. Methods: In this retrospective study, fifty patients undergoing laparatomy and gastric surgery in Sina hospital between September 2009 to September 2013. They had been anesthetized with propofol or thiopental and their maintenance was kept by isoflurane or propofol were enrolled. The age, gender, underlying diseases, drug history, chemotherapy, kind of surgery, heart rate variability, onset time of bradycardia and its complication during a period of four years was noted. Results: Of Fifty patients, 31 males and 19 females was enrolled in this study. The mean age of patients was 48±8.3 yr all patients had laparatomy under general anesthesia. The kind of surgery were mainly gasterectomy and gastrojejunostomy. The mean onset of episode bradycardia was 24.5±3.5 min after initiation of surgery incision, and most of the bradycardia was mild to moderate (47 patients) that with injection of atropine it resolved. There was no relationships between anesthetic drugs and anesthetic maintenance, age, gender, and incidence of bradycardia event during the surgery. The risk factors of bradycardia were, diabetes mellitus in seven patients, use of beta blockers in 17 patients in perioperative period and gastric cancer and chemotherapy (neoadjuant therapy) in three patients that lead to asystole, they were not response to standard treatment during surgery and lead to death. Conclusion: The history of gastric cancer and previous chemotherapy might be the only common factors that cause to bradycardia and irresponsible asystole during gastric surgery in these patients. It seems that only close monitoring and vigilant anesthesiologist require for treatment and prevention from adverse effect of such a sever bradycardia event.
Seyed Mostafa Ghavami , Ramin Abedinzadeh , Fakhrosadat Sajjadian ,
Volume 74, Issue 4 (7-2016)
Volume 74, Issue 4 (7-2016)
Abstract
Background: The primary manifestation of cardiac tumors in embryonic period is a very rare condition. Cardiac rhabdomyomas most frequently arise in the ventricular myocardium, they may also occur in the atria and the epicardial surface. In spite of its benign nature, the critical location of the tumor inside the heart can lead to lethal arrhythmias and chamber obstruction. Multiple rhabdomyomas are strongly associated with tuberous sclerosis which is associated with mental retardation and epilepsy of variable severity. Ultrasonography as a part of routine prenatal screening, is the best method for the diagnosis of cardiac rhabdomyomas. In the review of articles published in Iran, fetal cardiac rhabdomyoma was not reported.
Case presentation: We report a case of cardiac rhabdomyoma on a 24-year-old gravid 1, referred to Day Medical Imaging Center for routine evaluation of fetal abnormalities at 31 weeks of her gestational age. Ultrasonographic examination displayed a homogenous echogenic mass (13×9mm), originating from the left ventricle of the fetal heart. It was a normal pregnancy without any specific complications. Other organs of the fetus were found normal and no cardiac abnormalities were appeared. No Pericardial fluid effusion was found. The parents did not have consanguineous marriage. They did not also have any specific disease such as tuberous sclerosis.
Conclusion: The clinical features of cardiac rhabdomyomas vary widely, depending on the location, size, and number of tumors in the heart. Although cardiac rhabdomyoma is a benign tumor in many affected fetuses, an early prenatal diagnosis of the tumor is of great significance in making efficient planning and providing adequate follow up visits of the patients and the complications such as, heart failure and outlet obstruction of cardiac chambers.
Khosro Barkhordari , Samaneh Yaghooti , Sepideh Nikkhah , Afsaneh Aein , Arash Jalali , Akbar Shafiee ,
Volume 74, Issue 9 (12-2016)
Volume 74, Issue 9 (12-2016)
Abstract
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Background: We retrospectively compared the clinical outcome of post-cardiac surgery tracheal extubation between patients extubated with a lower than normal pH and patients extubated according to our routine institutional protocol. Our main goal was to clarify that strict adherence to the current criteria is dispensable. Methods: In this retrospective cohort study, we recruited 256 patients who met our study criteria and divided them into the exposed group (n= 95) and the control group (n= 161). The inclusion criteria consisted of coronary artery bypass grafting alone and age> 18 years. The exclusion criteria comprised the use of corticosteroids in the preceding 2 weeks, Serum creatinine (SCr)> 2 mg/dL, uncontrolled diabetes, liver dysfunction, Glasgow coma scale <13, and acetazolamide and sodium bicarbonate use. The arterial blood gas (ABG) characteristics before and 6 hours after extubation, extubation failure rate, length of stay in the in ICU, length of stay in the hospital and mortality were compared between the two groups. Results: In the control group, the males outnumbered the females and the ejection fraction was higher relative to that in the exposure group (P= 0.01 and P= 0.02, respectively). There were more patients with chronic obstructive pulmonary disease in the exposure group (P< 0.005) and also the euroSCORE was higher (P< 0.002). There were no significant differences between the groups regarding the ABG values at the time of ICU admission. Significantly higher levels of FiO2 and PaCO2 (P< 0.001 for both) as well as lower HCO3 and pH (P< 0.001 for both) were observed in the exposure group immediately before extubation. Following extubation, there was a significant increase in pH and a significant reduction in FiO2 need in the exposure group (P< 0.001 for both). The extubation failure rate, length of stay in the in ICU, length of stay in the hospital, and mortality rate were not different between the 2 groups. |
Conclusion: The patients with a lower than normal pH, tracheal extubated at the discretion of the ICU anesthesiologist did not have a clinical outcome worse than that of the patients extubated in accordance with our routine institutional protocol.
Roya Sattarzadeh-Badkoubeh , Babak Geraiely , Mohsen Nassiri-Toosi , Ali Jafarian, Kazem Heydari ,
Volume 74, Issue 11 (2-2017)
Volume 74, Issue 11 (2-2017)
Abstract
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Background: We assessed different systolic cardiac indices to describe left and right ventricular dysfunction in cirrhotic patients before liver transplantation. Methods: In this case-control study, eighty-one consecutive individuals with the confirmed hepatic cirrhosis and candidate for liver transplantation in the Imam Khomeini Hospital between March 2008 and March 2010 were selected. Thirty-two age and gender cross-matched healthy volunteers were also selected as the control group. A detailed two-dimensional and Doppler echocardiography was obtained in all patients and controls performed by the same operator on the day of admission. Results: Dimensions of both left and right atriums as well as left ventricular end-diastolic volume and basal right ventricular dimension in the cirrhotic group were significantly higher than control group. Left ventricular end-systolic dimensions as well as aortic annulus diameter were not different between the two study groups. Left ventricular outflow tract velocity time integral, isovolumic pre-ejection time, isovolumic relaxation time, stroke volume, left ventricular ejection fraction, IVCT+IVRT+ET, systolic velocity of tricuspid annulus, systolic velocity of basal segment of RV free wall, systolic velocity of basal segment of septal wall, peak strain of septal margin (base), peak strain of septal margin (midpoint), peak strain of lateral margin (midpoint), strain rate of septal margin (base), strain rate of septal margin (midpoint), strain rate of lateral margin (base), strain rate of lateral margin (midpoint), Tei index (left and right ventricles), systolic time interval and tricuspid annular plane systolic excursion were higher in cirrhotic group, significantly, (P< 0.05). Left ventricular ejection time and systolic velocity of mid segment of lateral wall were lower in cirrhotic group, significantly, (P< 0.05). |
Conclusion: In this study, the effects of liver on heart were volume overload, hyperdynamic state and systolic dysfunction in cirrhotic patients. These effects were due to chamber enlargement and we cannot use the most of cardiac indices for evaluation systolic function in cirrhotic patients. So, we suggest that systolic time interval and Tei index are useful indices in evaluation of systolic function in cirrhotic patients.
Kamran Ebrahimi , Shaker Salarilak , Kamal Khadem Vatan ,
Volume 75, Issue 3 (6-2017)
Volume 75, Issue 3 (6-2017)
Abstract
Background: Cardiovascular disease (CVD) is the most common cause of death in the world that is mostly due to vascular disease. Myocardial infarction (MI) is the most lethal form of coronary heart disease Which is increasing in developing countries. This study was done to calculate and compare lost years of life due to death and disability for the most important cause of death (myocardial infarction) in the studied population.
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Methods: This cross-sectional study was carried out in Urmia university of Medical Sciences in Western Azerbaijan Province, Iran during 2012 to 2013. Confirmation of the occurrence of myocardial Infarction in hospitalized patients was based on clinical symptoms, changes in electrocardiogram and increases of cardiac enzymes (CK-M Band Troponin). The burden of health from Myocardial Infarction was calculated- using the disability adjusted life years index (DALY). The morbidity data of MI was collected from myocardial infarction Registration System Department of Health, and mortality data were extracted based on death registration ICD10 (I 20-25). Results: The total occurrence of MI was 7235 patients (60.6% men and 39.4% women) with the mean ages of 69±15 years. Number of disability adjusted life years (DALY) caused by MI was 53804 years (17.7 per thousand people) and the portion of early death Years of Life Lost (YLL) due to premature death was 52170 years (17.1 per thousand people), and Years of Life Lost (YLD) due to disability resulting from the disease was 1634 years (0.54 per thousand people). The disease burden in men was more than in women, and the greatest burden was in the age group of 80 and above in both sexes. Prevalence rate of the MI was estimated 376 (Per hundred thousand people) and the MI accounted for 18.8% of all causes of death. |
Conclusion: The high burden of myocardial infarction, especially in men, raises the incidence of Myocardial Infarction a health priority and the need for proper planning in order to take effective measures for the prevention and treatment.
Farzin Halabchi , Ahmad Shahidzadeh Mahani, Tohid Seifbarghi ,
Volume 75, Issue 9 (12-2017)
Volume 75, Issue 9 (12-2017)
Abstract
Sudden cardiac death in sport, although rare, but is a tragic event, attracting the media and public attention. Sport and exercise may act as a trigger for sudden cardiac death. Risk of sudden death in young athletes with cardiovascular disease is 2.5 times more frequent than non-athlete individuals. More than 90% of cases of sudden death occur during or immediately after training or competition. Incidence of sudden cardiac death in any population, including athletes, is related to multiple factors such as gender, age, race, nationality, diagnostic screening methods and preventive measures for sudden cardiac death. Otherwise, incidence rate of sudden cardiac death is linked to the used definition and method of diagnosis. Different cardiovascular disorders may result in death of young athletes and hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia and aortic rupture are among the most common causes. Marfan syndrome, dilated cardiomyopathy, viral myocarditis, Wolff-Parkinson-White (WPW) syndrome, congenital long QT syndrome, Brugada syndrome and commotio cordis are reported as other etiologies. In older athletes (more than 35 years), ischemic coronary heart disease is responsible for majority of the cases similar to the general population. Because the outcome of sudden cardiac arrest in sports is very poor except in few cases, proper national strategies are needed to diminish the burden of sudden death in young athletes. It seems that there are two main strategies to achieve this goal: A) Primary prevention with use of purposeful pre-participation evaluation programs. This evaluation should focuss on the proper history and physical examination. Nevertheless, there is significant debate between American and European countries regarding the use of paraclinical investigations (especially ECG). American heart association does not recommend ECG as an essential part of evaluation. In contrast, European society of cardiology and international olympic committee advocate ECG for all athletes younger than 35 years. However, all evaluations should be based on national, generally accepted standards and done by well-educated experts. B) Setting evidence-based and updated protocols for early and effective cardiopulmonary resuscitation (CPR), attendance of well equipped medical staff and early access to automated external defibrillator (AED) in all sport events and implementing CPR education in all coaching training courses.
Mehdi Nikseresht , Mahmoud Nikseresht , Valiolla Dabidy-Roshan ,
Volume 75, Issue 12 (3-2018)
Volume 75, Issue 12 (3-2018)
Abstract
Background: Cardiovascular diseases are the leading cause of human mortality worldwide. Myocardial ischemia is a type of cardiovascular disease that increases with age spread. Therefore, the purpose of this study was to compare non-invasive myocardial ischemia in patients with heart problems in different age groups.
Methods: This study is a causal-comparative study was conducted from July to October 2016 in the University of Mazandaran. One hundred and seventy-five (age=45-59 years) and 124 (age=60-77 years) men with heart problem participated in this study. The questionnaires of Rose angina pectoris (for assessing the risk of ischemic myocardium), lifestyle and physical activity level were completed by the participants. In addition, the anthropometric characteristics, blood pressure and peak oxygen uptake (VO2peak) of the participants were measured.
Results: The risk of myocardial ischemia in men aged 60-77 years was significantly higher than men aged 45-59 years (P=0.049). Men aged 60-77 years were significantly lower in good indices (physical activity level, VO2peak and more lifestyle indices) and higher in bad indicators (waist/hip ratio, body shape index, ankle systolic blood pressure, brachial systolic and diastolic blood pressure) than men aged 45-59 years (P<0.031, for all variables). Also, there was no significant difference in the risk of ischemia between groups, when they were similar in physical activity level.
Conclusion: It seems that the higher risk of myocardial ischemia in men aged 60-77 years, as compared to men aged 45-59 years, might be related to aging process and imbalance in the risk factors. Promoting physical activity can favorably affect the risk of myocardial ischemia in the middle-aged or elderly men. It is concluded that physical activity effectively decreased the risk of myocardial ischemia.
Methods: This study is a causal-comparative study was conducted from July to October 2016 in the University of Mazandaran. One hundred and seventy-five (age=45-59 years) and 124 (age=60-77 years) men with heart problem participated in this study. The questionnaires of Rose angina pectoris (for assessing the risk of ischemic myocardium), lifestyle and physical activity level were completed by the participants. In addition, the anthropometric characteristics, blood pressure and peak oxygen uptake (VO2peak) of the participants were measured.
Results: The risk of myocardial ischemia in men aged 60-77 years was significantly higher than men aged 45-59 years (P=0.049). Men aged 60-77 years were significantly lower in good indices (physical activity level, VO2peak and more lifestyle indices) and higher in bad indicators (waist/hip ratio, body shape index, ankle systolic blood pressure, brachial systolic and diastolic blood pressure) than men aged 45-59 years (P<0.031, for all variables). Also, there was no significant difference in the risk of ischemia between groups, when they were similar in physical activity level.
Conclusion: It seems that the higher risk of myocardial ischemia in men aged 60-77 years, as compared to men aged 45-59 years, might be related to aging process and imbalance in the risk factors. Promoting physical activity can favorably affect the risk of myocardial ischemia in the middle-aged or elderly men. It is concluded that physical activity effectively decreased the risk of myocardial ischemia.
Alireza Atashi , Shahram Amini , Erfan Ghasemi , Shima Sheybani , Saeid Eslami ,
Volume 76, Issue 4 (7-2018)
Volume 76, Issue 4 (7-2018)
Abstract
Background: Various prediction models have been developed aiming to estimate risk-adjusted mortality, morbidity and length of intensive care unit stay following cardiac surgeries. The European system for cardiac operative risk evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death. The objective of this study was to evaluate the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries.
Methods: A prospective cross-sectional study was conducted to collect required variables for all consecutive patients underwent heart surgeries in Emam Reza hospital, Mashhad, Iran, from March 2014 to March 2015. Once the patient was hospitalized a cardiologist or a general physician evaluated pre- peri- and post-operative state to fill out the pre-designed structural paper form. Comparing the observed and expected mortality, the sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and finally the discrimination power of the model for our patients were calculated and reported. The model value was calculated using the online tool.
Results: A total of 1337 patients (60% males) were included, the observed mortality rate was 3.2%. Although the overall performance was acceptable, the model showed poor discriminatory power (AUC=0.667, CI 95%: 0.648-0.685) and accuracy with sensitivity=61.88% and specificity=66.23%.
Conclusion: Our single-center study, based on consecutive patients who underwent cardiac surgery showed that EuroSCORE II demonstrated a moderate statistical overall performance with poor discrimination and calibration measures remain as concerning issues regarding 30-day post-operative mortality prediction after adult cardiac surgery. Poor performance measures for this system show the need for reformulating this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.
Methods: A prospective cross-sectional study was conducted to collect required variables for all consecutive patients underwent heart surgeries in Emam Reza hospital, Mashhad, Iran, from March 2014 to March 2015. Once the patient was hospitalized a cardiologist or a general physician evaluated pre- peri- and post-operative state to fill out the pre-designed structural paper form. Comparing the observed and expected mortality, the sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and finally the discrimination power of the model for our patients were calculated and reported. The model value was calculated using the online tool.
Results: A total of 1337 patients (60% males) were included, the observed mortality rate was 3.2%. Although the overall performance was acceptable, the model showed poor discriminatory power (AUC=0.667, CI 95%: 0.648-0.685) and accuracy with sensitivity=61.88% and specificity=66.23%.
Conclusion: Our single-center study, based on consecutive patients who underwent cardiac surgery showed that EuroSCORE II demonstrated a moderate statistical overall performance with poor discrimination and calibration measures remain as concerning issues regarding 30-day post-operative mortality prediction after adult cardiac surgery. Poor performance measures for this system show the need for reformulating this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.
Sogand Tourani , Salman Bashzar , Shekoufeh Nikfar , Hamid Ravaghi , Mehran Sadeghi ,
Volume 76, Issue 6 (9-2018)
Volume 76, Issue 6 (9-2018)
Abstract
Background: Thrombolytic therapy, an appropriate treatment option, if primary angioplasty is not available for the treatment of these patients in the early hours after the onset of the symptoms. The aim of this study was to evaluate the safety and effectiveness of new tenecteplase (TNKase) drug vs. streptokinase in the treatment of ST elevation myocardial infarction (STEMI) patients in Iran.
Methods: A systematic review and meta-analysis that was conducted in Iran University of Medical Sciences in September 2017. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE (1980 to March 2017) with number of strategies by the words “myocardial infarction, heart infarction, streptokinase, tenecteplase” in combination with other names of drugs and brands for clinical effectiveness. We hand searched US, European, and Iranian cardiovascular journals. Clinical trials and related observational studies in one of the Persian, English and Korean languages were included in this study. Two review authors independently assessed randomized controlled trials (RCTs) and non-RCT studies eligibility and quality, and extracted the data using data extraction form for interventions reviews. We cross-checked and resolved discrepancies by discussion to reach consensus. Finally, the data were entered to the Review Manager, Version 5.3 (The Nordic Cochrane Centre, Cochrane Collaboration, 2014, Copenhagen, Denmark), and then the Cochran-Mantel-Haenszel test (CMH) were used to analyzed the data. The I2 test has been used to calculate the Heterogeneity.
Results: We included 4 observational studies. Observational study assessment by strengthening the reporting of observational studies in epidemiology (STROBE) checklist and quality was high described. All studies entered the final analysis after the quality assessment. All studies reported mortality. In the meta-analysis of mortality, three studies with a sample of 812 people entered. No difference was observed between tenecteplase and streptokinase in the risk of mortality (RR=0.45, CI 95%: 0.20-1.03, P=0.40), hypotension (RR=1.86, CI 95%: 0.53-6.49, P=0.33), bleeding (RR=1.40, CI 95%: 0.49-3.99, P=0.53), and no difference was observed in the ST Segment resolution >50% (P=0.81).
Conclusion: The results of this study showed that the effectiveness and safety of streptokinase are similar to the tenecteplase drug.
Methods: A systematic review and meta-analysis that was conducted in Iran University of Medical Sciences in September 2017. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE (1980 to March 2017) with number of strategies by the words “myocardial infarction, heart infarction, streptokinase, tenecteplase” in combination with other names of drugs and brands for clinical effectiveness. We hand searched US, European, and Iranian cardiovascular journals. Clinical trials and related observational studies in one of the Persian, English and Korean languages were included in this study. Two review authors independently assessed randomized controlled trials (RCTs) and non-RCT studies eligibility and quality, and extracted the data using data extraction form for interventions reviews. We cross-checked and resolved discrepancies by discussion to reach consensus. Finally, the data were entered to the Review Manager, Version 5.3 (The Nordic Cochrane Centre, Cochrane Collaboration, 2014, Copenhagen, Denmark), and then the Cochran-Mantel-Haenszel test (CMH) were used to analyzed the data. The I2 test has been used to calculate the Heterogeneity.
Results: We included 4 observational studies. Observational study assessment by strengthening the reporting of observational studies in epidemiology (STROBE) checklist and quality was high described. All studies entered the final analysis after the quality assessment. All studies reported mortality. In the meta-analysis of mortality, three studies with a sample of 812 people entered. No difference was observed between tenecteplase and streptokinase in the risk of mortality (RR=0.45, CI 95%: 0.20-1.03, P=0.40), hypotension (RR=1.86, CI 95%: 0.53-6.49, P=0.33), bleeding (RR=1.40, CI 95%: 0.49-3.99, P=0.53), and no difference was observed in the ST Segment resolution >50% (P=0.81).
Conclusion: The results of this study showed that the effectiveness and safety of streptokinase are similar to the tenecteplase drug.
Alireza Mahoori, Nazli Karami , Seyedeh Zahra Karimi Sarabi ,
Volume 77, Issue 9 (12-2019)
Volume 77, Issue 9 (12-2019)
Abstract
Background: Emergence from general anesthesia and removing of tracheal tube can be associated with coughing, agitation, and hemodynamic disturbances. Dexmedetomidine is an alpha two adrenoceptor agonist that has effective sedation with less cardiovascular unstability and respiratory depression and may be useful for extubation and prevention of hemodynamic response during tracheal tube removing. The aim of this study was to evaluate the effect of dexmedetomidine on hemodynamic responses during endotracheal extubation and sedation level in recovery room.
Methods: In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.
Results: Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).
Conclusion: Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.
Methods: In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.
Results: Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).
Conclusion: Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.
Alireza Rai, Shirin Alord , Parisa Janjani , Siros Norozi ,
Volume 77, Issue 9 (12-2019)
Volume 77, Issue 9 (12-2019)
Abstract
Background: Nowadays, cardiovascular diseases (CVDs) are among the most common causes of mortalities worldwide. Parathyroid hormone (PTH) has an important role in the pathogenesis of CVDs. The aim of the current study was to compare serum PTH levels between patients with acute myocardial infarction (MI), unstable angina, and normal coronary function.
Methods: This descriptive and analytic study was performed on patients with acute MI, unstable angina, and normal coronary function visiting Imam Ali Hospital of Kermanshah city in Iran, during years 2016 to 2017. Data collection was done from December 2017 to March 2018. Of the patients who met inclusion criteria, 120 were selected by accessible sampling and were allocated into three groups. Serum level of PTH was determined in the three groups.
Results: Among the studied subjects, females and males comprised 43 (35.8%) and 77 (64.2%) respectively. Among those with normal coronary function, 22 (55%) and 18 (45%) were females and males respectively. In acute MI group, women and men comprised 8 (20%), and 32 (80%) respectively. Finally, males and females constituted 13 (32.5%) and 27 (67.5%) in unstable angina group. Based on this study, the overall mean serum PTH level was obtained 18.32 pg/ml. The highest PTH level was observed in individuals with normal coronary function, while the lowest level was recorded in patients with unstable angina. There was a significant difference in mean serum parathyroid hormone levels between the study groups in those with no history of smoking.
Conclusion: Our results indicated that parathyroid hormone serum level can be associated with cardiovascular diseases including unstable angina. There were significant differences in the means of parathyroid hormone level between the studied groups depending on the presence or absence of hyperlipidemia. In vitro evaluation of parathyroid hormone level in suspected subjects should be performed in the case of myocardial infarction, unstable angina and normal coronary, prevented from these diseases by testing.
Methods: This descriptive and analytic study was performed on patients with acute MI, unstable angina, and normal coronary function visiting Imam Ali Hospital of Kermanshah city in Iran, during years 2016 to 2017. Data collection was done from December 2017 to March 2018. Of the patients who met inclusion criteria, 120 were selected by accessible sampling and were allocated into three groups. Serum level of PTH was determined in the three groups.
Results: Among the studied subjects, females and males comprised 43 (35.8%) and 77 (64.2%) respectively. Among those with normal coronary function, 22 (55%) and 18 (45%) were females and males respectively. In acute MI group, women and men comprised 8 (20%), and 32 (80%) respectively. Finally, males and females constituted 13 (32.5%) and 27 (67.5%) in unstable angina group. Based on this study, the overall mean serum PTH level was obtained 18.32 pg/ml. The highest PTH level was observed in individuals with normal coronary function, while the lowest level was recorded in patients with unstable angina. There was a significant difference in mean serum parathyroid hormone levels between the study groups in those with no history of smoking.
Conclusion: Our results indicated that parathyroid hormone serum level can be associated with cardiovascular diseases including unstable angina. There were significant differences in the means of parathyroid hormone level between the studied groups depending on the presence or absence of hyperlipidemia. In vitro evaluation of parathyroid hormone level in suspected subjects should be performed in the case of myocardial infarction, unstable angina and normal coronary, prevented from these diseases by testing.
Ahmadreza Assareh, Maryam Jozaei, Hoda Mombeini , Nehzat Akiash ,
Volume 79, Issue 10 (1-2022)
Volume 79, Issue 10 (1-2022)
Abstract
Background: In patients with ST-segment elevation myocardial infarction (STEMI), Primary percutaneous coronary intervention (PCI) is the preferred reperfusion therapy. Timely primary PCI is essential in improving the clinical outcomes of these patients. The aim of this study was to evaluate the factors affecting balloon delay in STEMI treated patients by primary PCI and its relationship with major adverse cardiac events (MACE).
Methods: This prospective observational study was conducted on 143 cases of STEMI patients, who had the inclusion criteria and were treated by primary PCI, after obtaining written consent in Imam Khomeini hospital in Ahvaz, between May 2019 to May 2020. All-time components from symptom onset to PCI treatment include symptom-to-balloon time or ischemic time, symptom-to-door time and door-to-balloon time calculated. The incidence of major adverse cardiovascular events (MACE) including decompensated heart failure (DHF), acute coronary syndrome (ACS), sudden cardiac death (SCD) and cerebrovascular accident (CVA) was evaluated during 12 months follow up after primary PCI. left ventricular ejection fraction (LVEF) changes were evaluated 3 months after primary PCI.
| Results: The median symptom-to-door time was 200.5 minutes (IQR: 90-438.75 min), the median ischemic time was 406 minutes (IQR: 231-671 min), and most patients had an ischemic time ≥120 minutes (92.4%) and door-to-device time ≥90 minutes (64.3%). The most common delay for treatment was in the symptom-to-door time (76.9%) and then the decision for primary PCI to transfer to the cat lab (17.5%). Overall, 59 (41.3%) of the patients experienced MACE during 1-year of follow-up, including ACS (13.3%), DHF (22.4%), cardiac death (9.8%) and CVA (2.1%). The patients age (OR: 0.96, P=0.020), LVEF changes (OR: 1.123, P=0.005) and STEMI type (OR: 0.705; P=0.039) predicted in-hospital MACE, while the symptom-to-balloon time (P=0.607) and door-to-balloon time (P=0.347) were not associated with MACE. Conclusion: None of the time intervals were associated with the occurrence of MACE in one-year follow-up, and most STEMI patients were admitted to the hospital with a long delay. Therefore, efforts to shorten the time of hospitalization admission can help improve the MACE in STEMI patients under primary PCI in our medical centers. |
Mahmoud Saeidi, Zahra Eshaghian Dorcheh ,
Volume 79, Issue 10 (1-2022)
Volume 79, Issue 10 (1-2022)
Abstract
Background: Pericardial effusion is one of the most important complications of cardiac surgeries. Administration of a low-power suction to the mediastinal or pleural chest tube of patients helps better and constant drainage of pericardial or pleural secretions after surgeries. This technique might change the secretion and discharges of patients and might change the outcomes of surgeries.
Methods: This clinical trial was performed in 2017-2018 from April to March in Chamran Hospital of Isfahan on 91 patients who were candidates of cardiac surgeries. Patients are selected according to inclusion and exclusion criteria and finally, the study population is formed. In all patients after cardiac surgery, two Chest tubes were inserted, either in pericardial space or one in pericardia space and the other in left or right pleural space. After inserting chest tubes in patients and after sutures, patients were divided into two groups. In the first group, their chest tube was attached to the low power suctioning device, which resulted in active blood withdrawal or discharge of the site of surgery, the second group was also treated normally without binding to the suction device. The diagnosis of pericardial effusion or tamponade in patients who were hospitalized was made by clinical symptoms, portable chest graph as well as echocardiography, and in patients who had been discharged it was diagnosed by being referred to a specialist, clinical symptoms, chest radiography as well as echocardiography. Data regarding surgery duration, intubation duration, the prevalence of pericardial effusion, and cardiac tamponade were collected and analyzed.
Results: Administration of a low-pressure suction to the chest tube of patients was associated with decreased frequency of pericardial effusion (P=0.01). The frequency of tamponade was also significantly lower in patients with suction on chest tubes (P=0.04). Duration of intubation after ICU admission of patients was significantly lower in patients with suctions (P<0.001).
Methods: This clinical trial was performed in 2017-2018 from April to March in Chamran Hospital of Isfahan on 91 patients who were candidates of cardiac surgeries. Patients are selected according to inclusion and exclusion criteria and finally, the study population is formed. In all patients after cardiac surgery, two Chest tubes were inserted, either in pericardial space or one in pericardia space and the other in left or right pleural space. After inserting chest tubes in patients and after sutures, patients were divided into two groups. In the first group, their chest tube was attached to the low power suctioning device, which resulted in active blood withdrawal or discharge of the site of surgery, the second group was also treated normally without binding to the suction device. The diagnosis of pericardial effusion or tamponade in patients who were hospitalized was made by clinical symptoms, portable chest graph as well as echocardiography, and in patients who had been discharged it was diagnosed by being referred to a specialist, clinical symptoms, chest radiography as well as echocardiography. Data regarding surgery duration, intubation duration, the prevalence of pericardial effusion, and cardiac tamponade were collected and analyzed.
Results: Administration of a low-pressure suction to the chest tube of patients was associated with decreased frequency of pericardial effusion (P=0.01). The frequency of tamponade was also significantly lower in patients with suction on chest tubes (P=0.04). Duration of intubation after ICU admission of patients was significantly lower in patients with suctions (P<0.001).
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Conclusion: Generally, we indicated that the use of suction in cardiac surgeries is associated with decreased intubation time and of course decreased recovery time and decreased pericardial effusion. Therefore, this method could be used in cardiac surgeries.
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Ahmad Reza Assareh , Marzieh Jafarpor, Mohammad Hossein Haghighzadeh, Nehzat Akiash,
Volume 80, Issue 6 (9-2022)
Volume 80, Issue 6 (9-2022)
Abstract
Background: smoking enhances the risk of cardiac events in patients with coronary artery disease. So, it is necessary to evaluate the effects of exercise-based cardiac rehabilitation on endothelial function and functional capacity among smoker patients.
Methods: This randomized clinical trial study was conducted on 56 non-diabetic smokers with a history of percutaneous coronary intervention or coronary artery bypass graft surgery in Imam Khomeini Hospital from May to August 2015. Based on cardiac rehabilitation, patients were divided into intervention and control groups. Before rehabilitation, fasting blood sugar (FBS), lipid profile (LDL, HDL, triglyceride, and total cholesterol), and Ankle-Brachial Index (ABI) were measured for endothelial function. Besides, METs were measured based on the Duke activity status index. After 24 rehabilitation sessions (3 sessions of 1 hour each week for 2 months), all values were checked again and compared with the initial values.
Methods: This randomized clinical trial study was conducted on 56 non-diabetic smokers with a history of percutaneous coronary intervention or coronary artery bypass graft surgery in Imam Khomeini Hospital from May to August 2015. Based on cardiac rehabilitation, patients were divided into intervention and control groups. Before rehabilitation, fasting blood sugar (FBS), lipid profile (LDL, HDL, triglyceride, and total cholesterol), and Ankle-Brachial Index (ABI) were measured for endothelial function. Besides, METs were measured based on the Duke activity status index. After 24 rehabilitation sessions (3 sessions of 1 hour each week for 2 months), all values were checked again and compared with the initial values.
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Results: The mean age of the subjects in the cardiac rehabilitation and control groups were 61.18 and 52.32, respectively. Before the intervention, there were no significant differences between the two groups in terms of the ABI variables, BMI, systolic and diastolic blood pressure, LDL, triglyceride, total cholesterol and FBS; only HDL and METs showed significant differences. After exercise-based cardiac rehabilitation, the mean rate of ABI changes was +0.078 on the right side of the body and +0.084 on the left side of the body. In the control group, these values were 0.002 and 0.003, respectively (P=0.001). The amount of changes in increasing METs as well as decreasing body mass index (BMI), and systolic and diastolic blood pressure in the rehabilitation group were statistically significant compared to the control group. In addition, there were no significant differences in terms of FBS and lipid profiles either (P>0.05).
Conclusion: Two months of cardiac rehabilitation with regular exercise was associated with improved ABI as an indicator of endothelial function and prognosis of cardiovascular disease, as well as improved cardiac functional capacity among smoker patients. |
Mahbod Kaveh, Mohammad Kaji-Yazdi , Mohsen Jafari, Armen Malekiantaghi, Seyed Yousef Mojtehedi , Kambiz Eftekhari,
Volume 80, Issue 7 (10-2022)
Volume 80, Issue 7 (10-2022)
Abstract
Background: The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.
Methods: This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.
Methods: This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.
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Results: There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery.
Conclusion: If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital. |
Keihan Mostafavi, Fariba Ghorbani, Mojtaba Mokhber Dezfuli , Mahdieh Hazrati , Ehsan Alibeigi , Nafise Mohamadizade,
Volume 80, Issue 8 (11-2022)
Volume 80, Issue 8 (11-2022)
Abstract
Background: Considering the high death rate of patients on the transplant waiting list, one of the most important ethical challenges of organ transplantation is the lack of transplant organs and different approaches to cover it.
Methods: The ethical issues of organ transplantation have been frequently reviewed recently.
Results: Currently, there are 4 sources for organ transplants, which are: a) organ transplant from animal to human b) transplant from a living donor c) transplant from a brain-dead donor d) transplant from a cardiac-dead donor or donors without a heartbeat, and tissue engineering research continues to prepare a transplantable organ. Each of them has its own limitation and specific consideration. In Iran, organ procurement from brain-dead donors and living donors are the most important sources. Many approaches have been considered to increase the number of procured organs from brain-death cases in the world, but have not yet been able to reduce the gap between supply and demand. Therefore, since the 1980s, the program of organ transplantation from cardiac death (donors with irreversible cardiac arrest) in the world has been reviewed again. Based on the classification of cardiac arrest patients, they are placed in two general categories: uncontrolled and controlled. In a controlled condition, death is predictable, and organ removal is possible by eliminating planned medical interventions and patient support. But in the uncontrolled state, death occurs accidentally, which is more likely to prolong the duration of hot ischemia. Italy's organ donation group has recently introduced type 6 deaths in patients on ECMO, which is mentioned as a semi-controlled group. This group is called donors with abnormal blood flow versus brain-dead donors with normal blood flow. In this study, ethical considerations for organ donation from NHBD were discussed. Regarding the procurement of organs from non-heart beating donors, there are many ethical considerations that include both the donors and the recipients. Considering that the clinical conditions of the brain-dead donors are sometimes very unstable, cardiac arrest may occur before organ harvesting. In these cases, donation after cardiac death is an option.
Conclusion: It is necessary to regulate the ethical considerations for organ procurement from NHBD
Methods: The ethical issues of organ transplantation have been frequently reviewed recently.
Results: Currently, there are 4 sources for organ transplants, which are: a) organ transplant from animal to human b) transplant from a living donor c) transplant from a brain-dead donor d) transplant from a cardiac-dead donor or donors without a heartbeat, and tissue engineering research continues to prepare a transplantable organ. Each of them has its own limitation and specific consideration. In Iran, organ procurement from brain-dead donors and living donors are the most important sources. Many approaches have been considered to increase the number of procured organs from brain-death cases in the world, but have not yet been able to reduce the gap between supply and demand. Therefore, since the 1980s, the program of organ transplantation from cardiac death (donors with irreversible cardiac arrest) in the world has been reviewed again. Based on the classification of cardiac arrest patients, they are placed in two general categories: uncontrolled and controlled. In a controlled condition, death is predictable, and organ removal is possible by eliminating planned medical interventions and patient support. But in the uncontrolled state, death occurs accidentally, which is more likely to prolong the duration of hot ischemia. Italy's organ donation group has recently introduced type 6 deaths in patients on ECMO, which is mentioned as a semi-controlled group. This group is called donors with abnormal blood flow versus brain-dead donors with normal blood flow. In this study, ethical considerations for organ donation from NHBD were discussed. Regarding the procurement of organs from non-heart beating donors, there are many ethical considerations that include both the donors and the recipients. Considering that the clinical conditions of the brain-dead donors are sometimes very unstable, cardiac arrest may occur before organ harvesting. In these cases, donation after cardiac death is an option.
Conclusion: It is necessary to regulate the ethical considerations for organ procurement from NHBD
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Siros Norozi , Paniz Poursiabidi ,
Volume 80, Issue 12 (3-2023)
Volume 80, Issue 12 (3-2023)
Abstract
Background: Cardiopulmonary resuscitation is a quick and immediate intervention to prevent death in a person who has suddenly suffered cardiorespiratory arrest. This study aims to investigate the results of cardiopulmonary resuscitation and the factors affecting it with emphasis on the cause of cardiac arrest and 1-year prognosis of the saved patients.
Methods: Materials and methods: This research is a retrospective descriptive-analytical study that was conducted for 24 months, from April 1, 2017 to the end of March 2018, in Shahid Mostafa Khomeini Hospital in Ilam, from July 2022 to September 2022. The necessary information was collected based on the data available in the patients' files. Data analysis was done using SPSS24 software.
Methods: Materials and methods: This research is a retrospective descriptive-analytical study that was conducted for 24 months, from April 1, 2017 to the end of March 2018, in Shahid Mostafa Khomeini Hospital in Ilam, from July 2022 to September 2022. The necessary information was collected based on the data available in the patients' files. Data analysis was done using SPSS24 software.
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Results: Out of 152 patients, 64(42.1%) were men and 88(57.9%) were women. The average in the group that had a successful CPR was 60.75 years and in the group that had an unsuccessful CPR was 68.27 years. 13.7% of all CPRs occurred during shift change. The number of CPR was 11 cases (7.2%) in changing night shift to morning, six cases (3.9%) in changing evening shift to night, and four cases (2.6%) in changing evening to night shift. Most of the patients who underwent CPR were patients with internal diseases.
Conclusion: In this study, the final success rate of CPR was close to other studies. These results indicate that performing CPR is considered at any time. However, the reasons for the failure of the rehabilitation operation should be looked for in other factors. These factors can include updating nursing and medical team’s knowledge in the field of resuscitation, experience and skills of the resuscitation team, and periodic training of the resuscitation team, which should be considered regularly in order to reduce unsuccessful cases. |
Sara Hassanzadeh, Mahmonir Haghighi, Hojjat Shafipour, Maryam Faramarzpour,
Volume 81, Issue 1 (4-2023)
Volume 81, Issue 1 (4-2023)
Abstract
Background: Some negative psychological factors such as depression, anxiety, and stress have been identified as serious risk factors for the final adverse outcome of ischemic heart disease. Given the high prevalence of psychiatric disorders, in this study, we aimed to determine the relationship between the severity of depression, anxiety, and stress, with nuclear scan results in patients referred to Imam Khomeini Hospital in Urmia.
Methods: In this cross-sectional-analytical study, 163 patients with the possibility of ischemic heart disease from various clinics and medical centers referred to Imam Khomeini Hospital in Urmia for nuclear heart scanning from April to July 1400, were assessed by the DASS-21 questionnaire in terms of depression, anxiety, and stress scores. Finally, the data obtained from the DASS-21 questionnaire, nuclear scan, and demographic characteristics were analyzed with SPSS20 software.
Methods: In this cross-sectional-analytical study, 163 patients with the possibility of ischemic heart disease from various clinics and medical centers referred to Imam Khomeini Hospital in Urmia for nuclear heart scanning from April to July 1400, were assessed by the DASS-21 questionnaire in terms of depression, anxiety, and stress scores. Finally, the data obtained from the DASS-21 questionnaire, nuclear scan, and demographic characteristics were analyzed with SPSS20 software.
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Results: According to the results, the mean age of the patients was 54.78±11.54 years, 73% of whom were women. The prevalence of depression, anxiety, and stress was high (72.4, 80.3, and 59.5%, respectively). Although the prevalence of depression, anxiety, and stress in patients with a negative report of ischemia was higher and evaluated as 73.2, 78.7, and 58.3% respectively, there was not a significant difference with the subjects whose heart scan results were positive (P>0.05). Moreover, a weak positive correlation was observed between the severity of depression, anxiety, and stress with the severity of cardiac ischemia in study patients.
Conclusion: The results of this study revealed that the depressive, anxiety, and stress symptoms in patients before a cardiac nuclear scan are often moderate to mild. Likewise, among the different demographic characteristics of patients, only gender played an important role in these disorders. Regardless of the negative nuclear scan results in most patients (77.9%), the prevalence of these psychological symptoms in the studied patients was high. Therefore, considering the possibility of psychological disorders with clinical manifestations mimicking cardiovascular can prevent additional costs for diagnostic and therapeutic procedures in these patients. |
Maryam Mehrpooya, Zahra Sadeghi,
Volume 81, Issue 8 (11-2023)
Volume 81, Issue 8 (11-2023)
Abstract
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Left ventricular thrombosis (LVT) is a very serious condition and life-threatening complication that usually occurs after acute occlusion of the left anterior descending (LAD) coronary artery followed by acute myocardial infarction with ST-segment elevation (STEMI), which leads to significant regional wall motion abnormality (RWMA). It should be noted that its diagnosis, treatment, and management are challenging now and depend on various factors such as the type of thrombus, time of percutaneous coronary intervention (PCI), and underlying disease. The preferred diagnostic method is cardiovascular magnetic resonance imaging (CMR), but transthoracic echocardiography (TTE) is routinely used for diagnostic and screening purposes also follow-up of response to treatment. It is worth mentioning that when the diagnosis of left ventricular thrombus is not clear with conventional echocardiography, contrast echocardiography is used for more resolution and detailed information. Left ventricular thrombosis can appear in both acute and chronic forms and lead to significant complications, the most important of them are stroke and systemic arterial embolism (SE). According to previous studies, vitamin K antagonist (warfarin) by keeping INR within the therapeutic range currently used to treat left ventricular thrombosis. Although the use of direct oral anticoagulants (DOAC) has brought excellent outcomes, but due to the lack of large clinical trials, the routine use of these agents is controversial, and only in case of warfarin intolerance or contraindications, DOACs can be used as an alternative. Generally, the best way to prevent left ventricular thrombosis is primary percutaneous coronary angioplasty (primary PCI) which preserves left ventricular function. Depending on the sensitivity of the diagnostic method, thrombus will likely resolve in >50% of patients by six months after the MI. On the other hand, in rare cases, surgery is indicated if a thrombosis remains despite the medical treatment especially if it is accompanied by a left ventricular aneurysm. The purpose of this narrative review is to evaluate the latest evidence in the field of left ventricular thrombosis management and to adopt the best approach for these patients.
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