INTRODUCTION: Chest pain in unstable angina is associated with EKG changes in T-wave and ST-segment, which may help diagnose the disease. Based on certain references EKG changes prolonged for more than 12 hours may be suggestive of non-Q myocardial infarction. This study was conducted to assess the mean duration of EKG changes in patients with unstable angina. METHODS: This cross-sectional study was conducted on 34 patients in 2001. The subjects were randomly selected among patients hospitalized in the critical care unit of Isfahan Nour Hospital. New ST-segment T-wave changes and ruling out of acute myocardial infarction by enzymatic tests (Total CPK, CPK-MB, LDH) constituted criteria of inclusion in the study. Subjects with Wolf-Parkinson-White syndrome (WFW), salivary diseases, those taking anti-arrhythmic, anti-angina, or digital medications, patients with left bundle branch block, and those who had recently undergone surgery (all of which may cause T-wave and ST-segment changes) were excluded from the study. The patients were followed up for three months after discharges. RESULTS: EKG changes persisted for 28.65±7 days. Changes of ST-segment and T-wave lasted for 14.7±24 and 30.1±38 days, respectively. The minimum and maximum durations of EKG changes in patients were 1 day and 90 days, respectively. Eight patients underwent angiography; seven displayed abnormal findings. Statistical analysis did not show a significant relationship between the duration of EKG changes and severity of coronary involvement or incidence of future complications. DISCUSSION: EKG changes in patients with unstable angina who have recently developed these changes may persist for an average duration of one month and may complicate diagnosis. Hence greater importance should be attached to clinical symptoms and further laboratory diagnostic methods should be used.      

INTRODUCTION: Ischemic Heart Diseases (IHD) is the major cause of mortality and morbidity worldwide. Diabetes Mellitus (DM) is known as one of the main risk factors of IHD. Silent ischemia is seen in diabetic patients more that in others. Identification of these cases is of great value in clinical practice. In this study, ECG changes and their relationship with clinical symptoms of ischemia were evaluated in diabetes type II patients. METHODS: In a cross-sectional study at Isfahan Endocrinology and Metabolism Research Center on diabetes type II patients (2004), 500 consecutive records out of nearly 5000 active records were selected via a simple sampling method. 12-lead resting ECG was taken from all patients. Minnesota codes were used to study ECG changes. Patients with electrocardiograms suggestive of ischemia or MI but no chest pain were considered as having silent ischemia. RESULTS: A total of 500 subjects (44.4% men and 55.6% women) were studied. EKG changes favoring MI, probable MI, and ischemia were seen in 2%, 12.4%, and 13.6% of patients. Silent ischemia had a prevalence of 85.6%. Of this number, 6.3% had suffered definitive MI based on EKG changes. DISCUSSION: Silent ischemia is very common in diabetic patients. Alertness to silent ischemia, especially in the elderly can greatly contribute to early detection of CVD and adoption of timely therapeutic measures in these patients. However, as this study was merely based on resting-state EKG changes, the findings may be questionable. Hence, further studies using more accurate ischemia detection methods are warranted. 

Background and Objective: Lead toxicity remains a significant public health problem, since blood levels as low as 10 μg/ml have been shown to cause significant impairment of cardiovascular, cognitive and behavioral functions in human. The objective of this study was to evaluate the effect of lead pollution on cardiovascular function in people living around a lead mine in Ravar.Materials and Methods: First the lead concentration in water and plant samples in adiacent areas was measured. Thirty men aged 26±5yr who were living in contaminated areas were selected by a questionnaire (case group), and their blood samples were collected. EKG was performed and records were compared with those of the unexposed control individuals. Results: The results showed a high concentration of lead in water, plants and blood samples. The systolic and diastolic blood pressure as well as the heart rate were significantly higher than those of the control group (p<0.05). Conclusion: This study indicates that lead compounds in Feyz-Abad area can enter the biological cycle and human body. The high lead levels in exposed subjects can affect the cardiovascular system and alter BP and CR.    

Introduction: Acute pulmonary embolism (PE) is an emergency and life-threatening disease that despite its relatively high prevalence in ICU patients, is still difficult to diagnose due to non-specific signs and symptoms. Symptoms such as shortness of breath and chest discomfort are completely non-specific and overlap with the diagnosis of acute coronary syndrome (ACS). Materials and methods: EKG changes associated with acute pulmonary embolism are highly variable and can resemble acute coronary syndromes. Recently, changes in precordial leads in the form of inverted T wave have been described as a diagnostic clue of PE, although these changes are also seen in acute coronary syndrome. Results: In this article, we report a 92-year-old man with dyspnea and progressive hypotension. Which was initially wrongly diagnosed as acute coronary syndrome due to diffuse inverted T in precordial leads V1 to V6, and pulmonary embolism was confirmed after cardiac ultrasound evaluation at the bedside. Conclusion: In this article, we will talk about the diagnosis of this case and the review of related texts, emphasizing the limitations of EKG and the importance of using cardiopulmonary ultrasound at the bedside.

BACKGROUND: Considering that determining the effect of both contrast dye injection and balloon inflation on electrophysiological parameters would help us to predict the ischemic event during PTCA, the aim of this study was to determine the effects of these factors on QTc and QTc dispersion during PTCA in Isfahan.METHODS: In this cross-sectional study, consecutive patients undergoing elective PTCA in Chamran hospital in Isfahan enrolled. All patients were in sinus rhythm. A 12-lead electrocardiogram was continuously recorded before (baseline) and during PTCA after dye injection and balloon inflation. QTc and QT dispersion was calculated in all 12 leads of electrocardiogram during the mentioned times and compared with each other.RESULTS: 33 patients with mean age of 49.1±16.2 years were studied. Anatomic distribution of the coronary artery stenosis was as follows: left anterior descending artery (LAD) in 76.7% patients, left circumflex (Cx) in 16.6% and right coronary (RCA) in 6.66%. Mean of QTc at baseline, after contrast dye injection and after balloon inflation was 423.9±28.5, 437±29 and 437±22 msec, respectively (P<0.05). Mean of QTc dispersion at baseline, after contrast dye injection and after balloon inflation was 92.3±7.2, 95.4±8.3 and 93.75±7.5, respectively (P>0.05).CONCLUSION: The findings of this research supports the fact that during PTCA a transient myocardial ischemia occurs but further studies is recommended to accurately determine the stages at which ischemia occurred and the extent of its effect of it on cardiac depolarization and repolarization periods.

To determine the relationship between hypertension and ischemic heart disease in 30-64 years old population in Bushehr Port, 1036 person was studied. Ischemic heart disease end points defined electrocardiograms (EKG) according to the Minnesota code and angina pectoris was defined by Rose questionnaire. Hypertension was defined as systolic blood pressure ≥ = 140 mmHg and for diastolic blood pressure ≥ =90 mmHg and for current use of antihypertensive medication. This study was cross-sectional. The crude prevalence of hypertension was 19.4% (with age - adjusted prevalence of 18.3 for women and 14.5 for men). The age – adjusted prevalence of coronary heart disease was 2.5% in men and 1.3% in women by (P< 0.05). Possible myocardial infarction was significantly associated with hypertension in men [in men (odds ratio: 3.63 {95% CI: 1.59-6.76} P<0.001), in women (odds ratio: 1.87 {95%CI:1.22-2.87} P<0.001)]. The results introduced hypertension as a major risk factor for myocardial infarction in Bushehr Port, and considering high prevalence of hypertension in this port, prevention for decreasing hypertension should be a priority in health programs of this area.

Background: Methadone is one of the most useful opioids that can be used to achieve many therapeutic goals, and also it may be abused as an illicit drug. Methadone can cause different gastrointestinal, neurological, and cardiac complications. This study was performed to obtain a better understanding of the cardiac side effects of methadone in patients with methadone poisoning. Methods: This cross-sectional study was performed on 210 samples in Sina Hospital of Hamadan in a one-year period from March 2019 to March 2020. After assessing patients who had methadone poisoning and completing their demographic information and evaluation of changes in patients' EKGs, the data was collected and analyzed by SPSS 16 software. Results: Out of 210 participants, 178 (84. 8%) were males and the rest were females. The average age of the studied patients was 39. 56 years old. The study found that 6. 1% of methadone-poisoned patients were illiterate. It was found in this study that the most common cardiac complications of methadone intoxication were sinus tachycardia (20%), QT interval prolongation (6. 64%), and sinus bradycardia (4. 3%), respectively,nevertheless, 66. 2% of patients did not have any EKG abnormalities. Conclusion: According to the findings, it is necessary to have continuous cardiac monitoring for patients with methadone intoxication and by transferring such findings to medical centers, steps can be taken to use methadone more intelligently.

Background: The aim of the current study was to assess the value of simultaneous EKG with EEG to diagnose cardiac disorders in patients with seizure- like attacks and to investigate the extent of misdiagnosis of epilepsy.Materials and Methods: 210 patients presenting with transient loss of consciousness (TLoC) and paroxysmal events suspicious to seizure were studied. All patients had undergone EEG simultaneous with an EKG. Besides reporting the EEG, a cardiologist analyzed the EKG in an attempt to recognize abnormal EKG as a potential cause of TLoC. Moreover, in all patients it was ascertained if any cardiac disorders in patients and their first degree relatives had been diagnosed.Results: Sixteen out of two hundred ten (7.6%) patients had abnormal EKG which was significantly potential cause of symptom of whom 6 patients were found to have bradycardia and 10 patients had dysrhythmias. Moreover, in patients with previous cardiovascular disorder, 30.4% had abnormal EKG where as in patients without cardiac disease only 4.8% had EKG abnormalities. Besides in patients with positive family history for cardiac disease 20.3% had abnormal EKG while in patients without family history of cardiac disease, abnormal EKG was revealed in only 2.05% patients.Conclusion: Simultaneous EKG with EEG is valuable in declining rate of misdiagnosis of epilepsy. Besides, EKG abnormalities in these patients have a significant association with any previous cardiovascular disorders in the patients and in their first degree relatives.