INTERNATIONAL CARDIOVASCULAR RESEARCH JOURNAL
Year:2015 | Volume:9 | Issue:1|Papers Count:12

Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event.Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) and to identify the influencing clinical factors.Patients and Methods: This prospective, longitudinal study was performed on 300 cardiac surgery patients in a single university hospital. The patients were assessed regarding their preoperative anxiety level using VAS-A, APAIS, and a set of specific anxiety-related questions. Their demographic features as well as their anesthetic and surgical characteristics (ASA physical status, EuroSCORE, preoperative Length of Stay (LoS), and surgical history) were recorded, as well. Then, one-way ANOVA and t-test were applied along with odds ratio for risk assessment.Results: According to the results, 94% of the patients presented preoperative anxiety, with 37% developing high anxiety (VAS-A³7). Preoperative LoS>2 days was the only significant risk factor for preoperative anxiety (odds ratio=2.5, CI 95%, 1.3 - 5.1, P=0.009). Besides, a positive correlation was found between anxiety level (APAISa) and requirement of knowledge (APAISk). APAISa and APAISk scores were greater for surgery than for anesthesia. Moreover, the results showed that the most common anxieties resulted from the operation, waiting for surgery, not knowing what is happening, postoperative pain, awareness during anesthesia, and not awakening from anesthesia.Conclusions: APAIS and VAS-A provided a quantitative assessment of anxiety and a specific qualitative questionnaire for preoperative anxiety in cardiac surgery. According to the results, preoperative LoS>2 days and lack of information related to surgery were the risk factors for high anxiety levels.

Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR) is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population.Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR.Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims.Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not.Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

Background: There are differences in studies on the effect of non-pharmacological methods of anxiety reduction in patients undergoing coronary angiography.Objectives: The present study aimed to evaluate the effect of implementing a multi-modal preparation package on anxiety in patients undergoing coronary angiography.Patients and Methods: This single blind randomized clinical trial was conducted on 100 patients undergoing coronary angiography. The patients were equally assigned to an intervention and a control group. The preparation package was implemented about two hours prior to angiography. Spielberger's anxiety inventory was used for measuring anxiety. The patients’ anxiety level was measured the day before, immediately before, and after implementing the preparation package and 30 minutes before angiography. Then, the data were entered into the SPSS statistical software, version 11.5 (SPSS Inc., Chicago, IL, The USA) and analyzed using T-test and repeated measures ANOVA. Chi-square test was also used to compare the two groups’ demographic characteristics. P values<0.05 were considered as statistically significant.Results: The results revealed no significant difference between the control group (34.36±5.56) and the intervention group (34.64±4.71) regarding baseline anxiety mean scores (P=0.787). This score increased in the control group (38.14±7.36) as well as in the intervention group (38.94±5.36) 2 hours before angiography (P=0.536). However, the mean anxiety score decreased to 34.16±2.75 in the intervention group and to 40.38±8.16 in the control group immediately after applying the preparation package (P=0.001).Conclusions: The preparation package reduced anxiety before angiography. Considering the beneficial effects of this preparation package on reducing anxiety, this method is recommended for preparation of patients for coronary angiography.

Background: Diabetes mellitus is a chronic disease with many serious complications.Objectives: The present study aimed to assess the effect of educational interventions on glycemic control represented by changes in glycated hemoglobin (HbA1c) levels in the patients with type 2 diabetes.Patients and Methods: This study was performed on 100 adults with type 2 diabetes using computerized randomization based on registration numbers from June to November 2012. An educational course of diabetes together with exercise training and nutritional education was designed for the study population in order to increase the patients' knowledge and attitude toward diabetes and to increase their participation in self-monitoring of blood glucose.Results: All the 100 diabetic patients completed the educational course. The mean age of the participants was 57.76±10.03 years (range: 40-75 years). HbA1c changes three months after completion of the educational interventions were compared to baseline values using paired sample t-test. According to the results, the mean level of HbA1C was significantly lower at the 3-month follow-up compared to the baseline (8.09±0.31 versus 8.51±0.26, P<0.001).Conclusions: The educational interventions effectively improved the diabetic patients’ glycemic control and are, thus, highly recommended for diabetic patients.

Background: Cardiomyopathy is one of the major complications of diabetes. It has been indicated that regular Exercise Training (ET) and antioxidants could reduce cardiomyopathy and cardiovascular morbidity and mortality of diabetes.Objectives: The present study aimed to determine the effects of Grape Seed Extract (GSE) with and without ET on left ventricular function in Streptozotocin (STZ) -induced diabetic rats.Materials and Methods: In this study, 45 male Wistar rats weighing 200 - 232 grams were randomly assigned to five groups: sedentary control, sedentary diabetic, trained diabetic, GSE treated sedentary diabetic, and GSE treated trained diabetic. ET was conducted on a treadmill daily. After eight weeks, left ventricular function was determined by Langendorff system. Then, the data were statistically analyzed using one-way and repeated measures ANOVA followed by LSD test.Results: Systolic pressure gradient associated with diastolic pressure and maximum±dP/dT that was reduced by STZ was partially improved with GSE or ET, but was completely corrected by their combination. Moreover, heart rate and left ventricular developed pressure that were reduced by STZ did not change by GSE or ET alone, but improved by their combination.Conclusions: The results indicated that a combination of ET and GSE had more significant improving effects on left ventricular dysfunction compared to ET or GSE alone. Thus, it may constitute a convenient and inexpensive therapeutic approach to diabetic cardiomyopathy.

Background: Dyslipidemia is considered as one of the crucial contributors to cardio- cerebro-vascular diseases.Objectives: The present study aimed to compare the effects of Rice Barn Oil (RBO), Grape Seed Oil (GSO), and Canola Oil (CO) on dyslipidemia and oxidative stress in experimentally induced hyperlipidemic rats.Materials and Methods: In the present experimental study, forty hyperlipidemic male Wistar rats were randomly assigned to 4 groups to receive RBO, GSO, or CO or Soy Bean Oil (SBO), as controls, for 4 weeks following a 3-week period of Atherogenic Diet (AD) intake. Blood samples were collected at the beginning of the study, after inducing dyslipidemia, and at the end of the experimental period. Then, the data were entered into the SPSS statistical software (v.13.0) and analyzed using paired t-test, paired sample Wilcoxon signed rank test, and Kruskal-Wallis test.Results: AD elevated lipid and/or lipoprotein profile and decreased the paraoxonase activity in the hyperlipidemic rats. The results of paired t-test revealed that RBO led to a significant improvement in serum lipoprotein profile and paraoxonase activity. Besides, a significant difference was found in the GSO group regarding all the measured parameters, except for paraoxonase activity. Moreover, CO diet showed a significant hypolipidemic effect on serum Triglyceride (TG) and Total Cholesterol (TC) and led to a slight improvement in Low Density Lipoprotein-Cholesterol (LDL-C) and High Density Lipoprotein-Cholesterol (HDL-C).Conclusions: The results of the present study suggested that vegetable oils, including RBO, GSO, and CO, might improve dyslipidemia and oxidative stress in hyperlipidemic rats. Indeed, substituting saturated fatty acids with unsaturated fatty acids in rats’ diet had beneficial effects on serum lipid profile and oxidative stress. Comparison of the 3 edible oils showed that GSO had a more profound effect on decreasing hyperlipidemia.

Background: Some species of Allium family are known to have antihypertensive, anti-diabetic, and lipid lowering effects.Objectives: This study aimed to examine the possible mechanisms of antihypertensive, anti-diabetic, and anti-lipid activities of Allium eriophyllum which grows in Fars province, Iran in a rat model of simultaneous type 2 diabetes and renal hypertension.Materials and Methods: This study was conducted on six groups of male Spargue-Dawley rats each containing 8 - 10 animals, including a sham-control, a diabetic, a renal hypertensive, and three simultaneously hypertensive–diabetic groups receiving vehicle or 30 or 100 mg/kg/day hydroalcoholic extract of Allium eriophyllum. Four weeks after induction of diabetes, renal hypertension was induced and the animals started receiving the vehicle or extract for the subsequent four weeks. Afterwards, blood pressure, fasting blood sugar, serum cholesterol, triglyceride, and markers of oxidative stress were measured, and isolated studies were performed on aortic rings.Results: Systolic blood pressure, heart rate, fasting blood sugar, maximal response, and effective concentrations 50 (EC50) of phenylephrine and acetylcholine of the hypertensive-diabetic group receiving vehicle were significantly higher compared to those of the sham-control group, and treatment with the extract led to a significant reduction in these variables. Moreover, serum superoxide dismutase and glutathione reductase and maximal response of acetylcholine were significantly lower in the hypertensive-diabetic group receiving vehicle in comparison to the sham-control group, and treatment with the extract significantly reduced these variables.Conclusions: The present study findings indicated that antihypertensive, anti-diabetic, and anti-lipid effects of the extract might be partly due to its antioxidant mechanism. It was also revealed that its antihypertensive effects may be additionally mediated by improving the release of nitric oxide as well as by sympatholytic activities.

Background: The global prevalence of hypertension is one billion persons resulting in about 7.1 million deaths per year. In Iran, no statics of hypertension is available, but it has been reported that 40% of deaths are caused by cardiovascular diseases. Measuring blood pressure is one of the basic principles of medical examinations; however, the quality of the scientific standards of its technique is not highly observed.Objectives: The present study aimed to evaluate the frequency of errors of measuring blood pressure among B.Sc. nurses working at in government hospitals of Shiraz, Iran.Materials and Methods: This descriptive-analytical, cross-sectional study was conducted on 250 nurses selected from various wards. The study data were collected using the standard check list of blood pressure measurement, technique of American Heart Association (AHA guideline), and a questionnaire containing questions regarding knowledge about blood pressure measurement skills.Results: This study showed that 54.0% and 78.0% of the participants obtained moderate scores (50 - 74.99) in the theoretical and practical tests, respectively. The results of Pearson's correlation coefficient demonstrated no significant relationship between the scores of theory and practice (P>0.05). Most of the errors in measuring blood pressure in this research consisted of not measuring blood pressure at two stages, not observing its preparations and the proper time interval between the two stages, and not observing the measuring arrangements according to the checklist.Conclusions: Considering the participants' theory and practice scores, it was concluded that evaluation of blood pressure measurement, which is an important basis in diagnosis and treatment, should be considered as an educational priority of health teams.

Background: Subclinical hypothyroidism (Sch) is the most frequent thyroid disease. The relationship between overt hypothyroidism and cardiovascular diseases has been well documented, but conflicting data have remained regarding Sch.Objectives: The present study aimed to assess the effect of Sch on increasing the risk of cardiovascular involvement considering the autoimmune subset.Patients and Methods: This case-control study was conducted on thirty patients with Sch and 30 healthy controls. Serum levels of thyroperoxidase antibody (TPOab), lipids, hsCRP, homocysteine, and ferritin were measured. Besides, conventional echocardiographic study and tissue Doppler imaging (including strain rate indices) was done to evaluate Left Ventricular (LV) systolic function.Results: The results showed a significant difference between the Sch patients and the controls regarding the serum level of triglyceride (117.43±63.51 mg/dL vs.86.86±41.57, P=0.031), echocardiographic parameters (longitudinal systolic strain rate [SRs: -1.006±0.4 vs. -1.26±0.16, P=0.002; SRl: -1.43±0.27 vs. -1.68±0.29, P=0.001]), and Sm of septal mitral annulus (6.90±0.6 vs.7.43 ± 0.8, P=0.006)]. However, no significant difference was observed between the two groups regarding the serum levels of the inflammatory markers. Moreover, a significant correlation was found between TSH and Sm (r=-0.36, P=0.005) and longitudinal systolic strain rate (SRs: r=0.42, P<0.001; SRl: r=0.40, P=0.001). Systolic strain rate was significantly lower in the TPOab positive patients (-0.99±0.18 vs. -1.15±0.25, P=0.047).Conclusions: The clear association between Sch and subclinical LV systolic dysfunction which was more evident in the subgroup of patients with circulating anti-thyroid antibodies would remind a greater emphasis for considering the subgroup of TPOab positive patients for directing toward hormone replacement.

Background: Atrial Septal Defect (ASD) is one of the most common congenital heart diseases that may lead to pulmonary hypertension. Advantages of ASD closure by limited thoracotomy as a minimally invasive approach includes reduction of post-operative complications and improvement of post-operative recovery.Objectives: The present study aimed to assess the safety of right submammary minithoracotomy for repair of ASD in children and to evaluate the cosmetic and functional results of this approach.Patients and Methods: Between August 2010 and August 2013, 35 children underwent heart operations for ASD closure via right submammary thoracotomy. The standard anterolateral thoracotomy technique entailed a 4 - 5 cm right submammary incision. After establishment of cardiopulmonary bypass, the right atrium was opened and defect was closed by pericardial patch. The thoracotomy was closed in a routine fashion.Results: The study patients included 5 males (14.29%) and 30 females (85.71%) whose age ranged from 1 to 7 years. Among the patients, 30 had ASD and 5 had a sinus venosus type. There were no intraoperative complications regarding exposure, cannulation, or bleeding. There were also no deaths in the post-operative period. Postoperative complications included significant hemorrhage from the suture line in one case and sick sinus syndrome requiring pacemaker implantation in another case. The mean length of stay in the intensive care unit was 2 days and the mean length of hospital stay was 4.5 days.Conclusions: Our study findings indicated that use of right submammary thoracotomy technique to repair ASD could be accomplished safely and provided good short-term results in terms of cosmetics, especially in female patients.

The majority of scorpion stings are generally seen with a set of simple clinical findings, such as pain, oedema, numbness, and tenderness in the area of the sting. However, occasionally events, such as toxic myocarditis, acute heart failure, acute pulmonary oedema, and Acute Respiratory Distress Syndrome (ARDS), which occur in scorpion sting cases are a significant problem which determine mortality and morbidity. The case presented here was a 38-year-old man who developed acute toxic myocarditis, acute heart failure, and acute pulmonary oedema following a scorpion sting on the 3rd finger of his right hand.

Absence of pericardium is a rare type of pericardial disorders. Left sided pericardial absence is more common than the right one. This disorder may present with a variety of signs and symptoms or abnormalities in electrocardiography and echocardiography. In this report, we discussed diagnosis of partial absence of pericardium in a 52-year-old man presented with a dull left-sided chest pain from 4 months ago with special electrocardiographic features. The axis deviations in his serial electrocardiograms led us to further evaluations with possible diagnosis of pericardial absence. His echocardiography and Magnetic Resonance Imaging (MRI) confirmed the suspicion of pericardial absence. Suspicion of potentially life-threatening cardiac abnormalities should remain even while facing atypical chest pain or other non-specific symptoms. In this case, abnormal electrocardiographic and chest X-Ray findings together with echocardiography were all helpful in referring the patient for cardiac MRI as the imaging modality of choice in such cases.