Clinical image; Management of Coronary Artery Thrombosis

Background: Acute myocardial infarction is an increasing cause of morbidity and mortality in the world. This condition sometimes happens as a result of coronary arteries blockage due to clot formation, spasm or plaque rupture. Cases Report: A 31-year-old man referred to our hospital with severe exertional chest pain. Electrocardiogram revealed ST- segment elevation in precordial leads. Coronary arteries angiography revealed a visible clot at  proximal part of left anterior descending artery. As the thrombolysis in myocardial infarction (TIMI)  flow of the artery was  normal and the patient became  asymptomatic , conservative management was considered. The patient was commenced on anticoagulant, glycoprotein  2b/3a  inhibitor,  aspirin, and  clopidogrel. Follow-up  angiography  showed normal flow with no clot existence. Conclusion: Coronary thrombus is an etiology of acute coronary syndrome. Patients often have varying levels of concurrent atherosclerosis. It’s management is anticoagulation, thrombolysis, and occasionally invasive strategies . Some cases can be managed conservatively, so decision-making is an import part of these patients management

Adherence to Antihypertensives in Patients With Comorbid Condition.

BackgroundComorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications.ObjectivesWe decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen.Patients and methodsTwo hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews.ResultsThe most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions.ConclusionsWith increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time

Comparison of Face to Face vs. Group Training on Self-pulse Rate taking Ability of Patients

Introduction: Determining the rate and regularity of peripheral arterial pulses has a major role in assessing the clinical status of patients with cardiovascular disorders. We compared two training methods on the ability of patients to take their radial pulse rate accurately.Methods: Three-hundred patients were randomly divided into two arms. One arm received individual face-to-face training and the other arm received group training via displaying an animation movie. Immediately after the training and then after 48 hours, the patients were tested by a nurse to find out whether they have learned the correct technique of taking radial pulse rate or not.Results: Immediately after the intervention, 84.9% in face-to-face arm and 81.8% in group training arm were able to correctly count their radial pulse rate (P = 0.536). After 48 hours, 71.7% in face-to-face and 60.8% in group training arm were able to correctly count their radial pulse rate (P = 0.051).Conclusions: Both methods were effective to improve the ability of the patients to count their radial pulse rate correctly though face-to-face method was marginally superior to group training

Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units

Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs). This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27%) were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation) hospitalization duration was 3.04 (±0.71) days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602). The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205). Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699). Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization costs, and the lack of cardiovascular complications in patients observed at 1-month follow-up after discharge, it is recommended that appropriate evaluations be performed in emergency units to prevent unnecessary admissions. Keywords: bed occupancy, hospitalization expenses, low-risk patients, chest pain, exploitation of resource

Is It Time to Review our Educational Program for the Electrocardiography Operators?

No abstract available

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days.Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis.Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05).Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients’ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy

Type I anaphylactic reaction due to contrast induced angioedema causing neck swelling: the role of sitting fiberoptic bronchoscopy in emergent intubation

Contrast induced angioedema is a rapidly progressive state involving a number of organ systems including the upper airway tract; which is usually a type I anaphylactic reaction also known as immediate hypersensitivity reaction. Prompt preservation of the respiratory tract is the cornerstone of this situation. The use of fiberoptic bronchoscope for tracheal intubation though very helpful, has some special considerations due to the anatomic distortions created by edema.This manuscript describes a patient with contrast induced angioedema managed successfully. Serum levels of IgE were highly increased during the first hours after the event; while serum levels of complement were normal. However, rapid airway management and prophylactic intubation saved the patient and prevented the possible aftermath of airway obstruction.Keywords: airway management; type I anaphylactic reaction, angioedema; fiberoptic bronchoscope.Conflict of interest: none of the authors has any conflict of interest

Changes of Left Ventricular Mass Index Among End-Stage Renal Disease Patients After Renal Transplantation

Purpose: The aim of this study was to determine left ventricular (LV) mass index via echocardiography in end-stage renal disease patients (ESRD) before and after renal transplantation, and its association with one-year survival. Materials and Methods: Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction (EF), LV mass, and LV mass index were determined. All of the patients were followed up for 1 year.Results: Mean LVEF was 51.6% which increased to 53.7% after renal transplantation (P = .001). Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation (P = .001). Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m2 following the operation (P = .002). All of the patients survived during 1-year follow-up, and no death was reported.Conclusion: Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD

Adherence to Antihypertensives in Patients With Comorbid Condition.

BackgroundComorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications.ObjectivesWe decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen.Patients and methodsTwo hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews.ResultsThe most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions.ConclusionsWith increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time