[ quality of life after first acute myocardial infarction]

Improvement in the management of patients who are afflicted with acute myocardial infarction [AMI] has resulted in the increase of their survival after heart attacks. The purpose of this study was to determine the quality of life [QOL] after first AMI among patients who referred to teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences. This cross-sectional study was performed with the participation of 300 patients. The inclusion criteria were age between 32 to 79, first AMI, 6 to 30 months after AMI and consent for participation. These patients had been admitted in Shahid Modares, Loghmane Hakeem, Taleghanee and Shahid Labafeenejad hospitals, affiliated to Shahid Beheshti University of Medical Sciences, for AMI and they had written medical records in these hospitals. The participants were enrolled in the study when they referred for routine follow-up visits at outpatient clinics. Data was collected by interviewing the patients. For measuring QOL, The Short Form Health Survey [SF-36] was used. The mean age of patients was 56.6 +/- 9.6 years from which 57.5% were men and 42.3% women. The mean scores of QOL in various aspects were 67.2 for physical function, 52.9 for role limitation due to physical health problems, 71.1 for bodily pain, 48 for general health, 52.6 for vitality, 71.3 for social function, 59.2 for role limitation due to emotional problems and 57.2 for mental health. In comparison with the general population, QOL in this study was reduced in all scales but the amount of reduction was not the same. With increasing age, QOL of patients decreased in all aspects. QOL in women after AMI, 9% to 23% more than men was reduced. The study showed that QOL of patients 6 to 30 months after the first AMI. The QOL decreased in physical scales more than mental and emotional scales. Decrease in QOL was related to increasing age and in women was more than men

Changes of left ventricular mass index among end-stage renal disease patients after renal transplantation

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. 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. 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/m[2] following the operation [P = .002]. All of the patients survived during 1-year follow-up, and no death was reported. Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD

combined approach to severe multi-organ atherosclerosis

Severe coronary artery disease often coexists with peripheral vascular atherosclerosis. The assessment of the supra-aortic circulation is, therefore, of clinical relevance. We herein describe a case of coronary artery disease treated with surgical revascularization using the internal mammary artery and thereafter the progressive atherosclerotic disease of the native coronary arteries as well as the left subclavian and left renal arteries. We also describe and discuss the clinical presentation, the diagnostic procedures, and the therapeutic approach with respect to the percutaneous transluminal angioplasty of the subclavian, renal, and right coronary arteries

Potential role of thermal therapy as an adjunct treatment in congestive heart failure

The clinical and economic importance of heart failure is widely recognized. The incidence of heart failure is on the increase, particularly with the aging of the population around the world. It is time for a paradigm shift in heart failure management. Alternative non-pharmacological strategies to remodel the failing ventricle will shape a major portion of heart failure therapy in the decade ahead. Exposure to heat is widely used as a traditional therapy in many cultures. In this paper, we will review recent data that suggest thermal therapy may be helpful as an adjunctive non-pharmacological treatment for heart failure

Coronary artery perforation after guidewire removal

Coronary artery perforation is a rare, but potentially serious, complication of percutaneous coronary intervention and is associated with a high incidence of death, Q-wave myocardial infarction, and emergency coronary bypass surgery. Management is different but requires prompt recognition and treatment. We describe a case of coronary perforation only after guidewire removal and also review the management of vessel rupture and perforation

Prevention of atrioventricular block during radiofrequency ablation by pace mapping of Koch's triangle

Complete atrioventricular block [AV block] is a serious complication of slow pathway ablation therapy in the treatment of atrioventricular nodal re-entrant tachycardia [AVNRT]. The present study was aimed at determining whether the electroanatomical pace mapping of Koch's triangle could significantly improve the safety, efficiency, and efficacy of selective slow pathway ablation in the treatment of AVNRT. A total number of 124 patients were selected to be studied consecutively for radiofrequency [RF] ablation therapy in the treatment of AVNRT. The subjects were divided into two groups: one, designated Group 1, to serve as the control group, and the other, designated Group 2, to serve as the study group. Conventional fluoroscopic slow pathway ablation was performed on the Group 1 subjects [n=66], with the Group 2 subjects receiving slow pathway ablation therapy guided by pace mapping of Koch's triangle. The slow pathway ablation in Group 2 [n=58] was performed with regard to the pace mapping data obtained on the basis of the St-H interval in the anteroseptal [AS], midseptal [MS], and posteroseptal [PS] regions of Koch's triangle. The anterograde fast pathway [AFP] location was determined based on the shortest St-H interval obtained by stimulating the anteroseptal [AS], midseptal [MS], and posteroseptal [PS] aspects of Koch's triangle. In the Group 2 subjects, AFP location was AS in 50 [86.2%] of the cases, MS in 7 [12%] of the cases, and PS in 1 case [1.7%]. One patient with posteroseptal AFP was administered retrograde fast pathway ablation therapy. One patient in the control group [Group 1], representing 1.5% of the group, developed persistent AV block in the course of the treatment, but none of the subjects in the study group [Group 2] developed any complications. It was concluded that an atypical fast pathway location is conducive to the development of atrioventricular block in the ablation therapy in AVNRT, with pace mapping of Koch's triangle having the capacity to eliminate the risk of any such complication developing. It follows that it helps to identify the AFP location before ablation therapy is administered in AVNRT, thereby improving the safety of the treatment

Randomized, blinded trial comparing enoxparin with unfractionated heparin in patients undergoing contemporary percutaneous coronary intervention

This study was designed to examine a unique and low dose use of intravenous enoxaparin in elective percutaneous coronary intervention [PCI] that would be applicable to an unselected population regardless of age, weight, and renal function. There is limited experience in anticoagulation using intravenous low-molecular-weight heparin in PCI. A total of 100 consecutive patients undergoing elective PCI were treated with a single IV bolus of enoxaparin [0.5mg/kg] in group A of patients [n=50] or with unfractionated heparin in group B of patients [n=50]. Sheaths were removed immediately after the procedure in patients treated with enoxaparin and some hours later in those treated with unfractionated heparin. In group A, ACT was 124.6 +/- 9.3 before PCI and 149.2 +/- 17.1 after that [P<0.05]. In group B, one patient [2.9%] developed groin hematoma. No deaths, MI, or urgent target vessel revascularization were reported. Low- dose [0.5 mg/kg] IV enoxaparin allows a target level of anticoagulation in patients undergoing PCI, appears to be safe and effective, allows immediate sheath removal, and does not require dose adjustment