relationship between perceived life changes and mental health in family caregivers of patients with heart failure who referred to Rajaei cardiovascular medical and research center, Tehran

Caring for a patient with heart failure can be a challenging and stressful situation. However, researchers have paid less attention to caregiving outcomes in heart failure caregivers. This study was conducted to investigate the relationship between perceived life changes and mental health of family caregivers of heart failure patients. Through a correlational design, a convenience sample of 90 Iranian family caregivers of patients with heart failure was selected. Data were collected using demographic-clinical characteristics form, Bakas Caregiving Outcomes Scale and General Health Questionnaire-28. Data were analyzed in SPSS using independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression analysis. Half of the caregivers reported that their lives had changed for the worse and nearly three fourths were suspected cases of mental disorders. There was a strong negative correlation between perceived life changes and mental health [r=-0.607, P<0.001]. This finding remained consistent [B=-0.522, P<0.001] even when potential confounding factors including caregiver's age [B=-0.222, P=0.016], caregiver's marital status [B=-6.085, P=0.025], and patient's age [B=-0.153, P=0.030] were controlled. Being younger, unmarried caregiver and caring of younger patients were identified as other correlated factors of poor caregivers' mental health. The strong negative correlation between perceived life changes and mental health in caregivers of patients with heart failure suggests that the heart failure caregivers with poor mental health may benefit from nursing interventions that improve appropriate coping with life changes related to caregiving

Mental health in family caregivers of patients with heart failure

Family caregivers of patients with heart failure [HF] deal with a wide range of problems related to caregiving that influence their mental health. The aim of this study was to investigate the mental health status of the family caregivers of patients with HF. In this descriptive cross-sectional study, 90 family caregivers of patients with HF, who referred Shahid Rajaei Cardiovascular Center, were selected through convenience sampling method. The data were collected using General Health Questionnaire [GHQ-28] for measuring mental health and were also analyzed by SPSS 16, and then processed using descriptive statistics, independent t-test, one-way ANOVA and Pearson correlation test. The mean score of GHQ-28 was 33.06 +/- 14.34 [range: 9–72]. The majority of caregivers [74.4%] were suspected cases of mental health disorders. Regarding to instrument subscales, the prevalence of caregivers' problems were 65.6% in somatic symptoms, 82.2% in anxiety/insomnia, 83.3% in social dysfunction, and 25.6% in depression. The total GHQ-28 score of the caregivers gradually decreased with increasing patient's age as in the minimum age group of the patients [aged 40 years and lower], the highest mean score of GHQ-28 was observed [P < 0.05]. A considerable proportion of family caregivers of patients with HF were suspected cases of mental health disorders. A routine assessment of mental health in this group of caregivers should be considered to identify those at risk. Also, clinical team should design and implement effective programs aimed at improving the mental health, especially in caregiver who provide care for younger patients

Pregnancy outcome after mechanical mitral valve replacement: a prospective study

Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. In this prospective study, undertaken between 1999 and 2009, 53 pregnancies [47 women with mechanical mitral valves; 29.8 +/- 4.8 years old] were studied. Patients were divided into two groups: group I [n = 43] received Warfarin throughout the pregnancy, while group II [n = 10] received Heparin in the first trimester and then Warfarin until the 36th week. Thirty-two [60.4%] pregnancies resulted in live births, whereas 18 [34%] abortions, 2 [3.8%] stillbirths, and one [1.9%] maternal death occurred. In group I, there were 26 [60.5%] live births, one [2.3%] stillbirth, and 15 [34.9%] abortions. In group II, there were 6 [60%] live births, one [10%] stillbirth, and 3 [30%] abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine [90.7%] of the pregnancies in group I and 50% of those in group II [p value = 0.001] were without complications. There were no congenital malformations in the two groups. Fetal outcome was almost the same between the Warfarin and Heparin regimens. In maternal outcome, the Warfarin regimen is safer than Heparin

Percutaneous mitral balloon valvotomy; single center experience: a review of outcome

Percutaneous balloon mitral valvotomy [BMV] has been accepted as an alternative to surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Despite the worldwide use of the BMV technique, no studies have been hitherto designed to assess the outcome of the patients undergoing BMV in Iran. The present study reports the outcome of 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center during a 15-year time period. A total of 2531 patients underwent 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center between 1992 and 2006. Seventy-three percent [2278] of the cases were followed for 48 +/- 41 months. Recurrent stenosis in 802 [25.8%], mitral valve replacement [MVR] in 213 [6.9%], immediate good result in 3110 [99.1%], and successful outcome in 2000 [72.9%] cases were the outcome of the BMV procedures in the current study. Concordant to the similar studies, we concluded that BMV produces a good clinical outcome in a high percentage of patients. The recent study demonstrated that the successful outcome of BMV was multi factorial and the selection of patients with rheumatic mitral stenosis is recommended to be based on both anatomic and clinical characteristics of the individuals. The procedure-related variables must also be considered in order to predict the outcome

Malignant melanoma in the heart, with focus on the histopathological diagnosis: review of our two cases in a five-year period

Over a five-year period, we encountered two cases of malignant melanoma with metastasis to the heart and pericardium. Both patients had a relevant medical history, showing their previous involvement by this tumor. A high index of suspicion, simply provided by a precise clinical history, together with histopathological and cytological studies can be used to diagnose such patients in due course. The preliminary diagnosis is made by echocardiography, by which the tumoral masses are seen in different parts of the heart. Nevertheless, their primary or secondary origin as well as the histogenesis can only be ascertained by pathological studies. Routine staining methods are useftil in the demonstration of malignant cells in the tissue or pericardial fluid samples

Anti-coagulation during pregnancy in women with mechanical heart valves: a prospective study

Pregnancy is associated with a hypercoagulable state, therefore the optimal anticoagulants for potential use in pregnant women with prosthetic heart valves are controversial. The aim of this study is to investigate the effect of anticoagulants on pregnancy outcomes and their potential risks in pregnant women with mechanical heart valves. In this prospective cohort study, we followed 44 women with 49 pregnancies who had mechanical heart valves from September 2002 to September 2007. A total of 38 patients took warfarin throughout their pregnancies [group A]. In 11 patients, warfarin was changed to heparin during the first trimester and then again to warfarin during 12[th] to 36[th] weeks of gestational age [group B]. All women took warfarin from 36[th] weeks of gestational age until deliver. In group A, there were 22 live births [57.9%], 15 abortions [39.5%] and 1 maternal death [2.6%]. In group B, there were seven live births [63.6%], three spontaneous abortions [27.3%] and one intra-uterine fetal death [9.1%]. There was no significant difference in live birth rate between the two groups [p=0.24]. Thirty-three pregnancies [86.8%] in group A and five pregnancies [45.4%] in group B had no maternal complications [p=0.004]. The difference in pregnancy complications between both groups was significant [p<0.001]. The present study shows that low dose warfarin [5 mg/day or less] may be safe during the first trimester of pregnancy. Maternal adverse events are low when pregnant women with mechanical heart valves remain on a warfarin regimen. The risk of embryopathy doe not necessarily increase

Anterior leaflet augmentation: an effective method to repair tricuspid valve regurgitation

As an invaluable surgical tool, autologous pericardium has been successfully used to repair many cardiac lesions. The encouraging results from its use in repairing heart valves have been applied to repair tricuspid valve regurgitation [TR]. In the present study, we report our preliminary results using autologous pericardium as an alternative surgical technique in repairing tricuspid valve insufficiency. From June 2002 to November 2006, 22 patients [mean age 39.7 years] with heart valve disease underwent tricuspid valve repair by anterior leaflet augmentation with glutaraldehydetreated autologous pericardium. Nineteen patients [86.4%] had pure tricuspid valve regurgitation [TR], while the remaining three patients [13.6%] had significant associated tricuspid valve stenos is in whomcommissurotomy was carried out. TR was considered severe in 18 patients and moderate to severe in four cases. All had associated left-sided heart valve surgery, except two patients. Concomitant adjustable tricuspid annuloplasty by pericardial band was performed in 12 patients. The mean follow-up period was 10.39 months [range 1 to 42 months]. There was one in-hospital death due to postoperative multiorgan failure. One patient developed partial detachment of the pericardial patch, which was successfully repaired. Echocardiography data showed a significant decrease in the severity of TR: trivial to mild in 68.2% [n=15], mild to moderate in 22.7% [n=5], and moderate to severe in 9.1% [n=2] of the patients. Anterior tricuspid leaflet augmentation is a safe, effective and appealing surgical technique in dealing with patients with tricuspid valve regurgitation. Further studies are, however, mandatory to evaluate its long-term outcome

Echocardiographic Characteristics Including Tissue Doppler Imaging After Enhanced External Counterpulsation Therapy

The aim of this study was to echocardiographically assess the effects of EECP [Enhanced External Counterpulsation Therapy] therapy on systolic and diastolic cardiac function. LVEF [left ventricular ejection fraction], ESV [end-systolic volume], EDV [end-diastolic volume], Sm [myocardial systolic wave], Ea [myocardial early diastolic wave], Vp [propagation velocity], E/Ea [peak early diastolic transmitral flow velocity/Ea], E/Vp and diastolic function grade were studied in twenty-five patients before and after 35 hours of EECP. EECP reduced ESV and EDV and increased EF significantly [p=0.018, 0.013, 0.002, respectively] in patients with baseline LVEF 50%. Patients with E/Ea >/= 14 had a significant reduction in EDV and ESV [p=0.038 and 0.32, respectively] and an increase in LVEF [p=0.007] after EECP, whereas patients with baseline E/Ea<14 had no significant change in these parameters. Similarly, EECP significantly improved ESV, EDV and LVEF [p=0.014, 0.032, 0.027 respectively] in patients with grades II and III of diastolic dysfunction [decreased compliance] at baseline, but not in patients with normal diastolic function or grade I diastolic dysfunction [impaired relaxation]. Patients with Ea<7 cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after therapy [p=0.024, 0.015, 0.001], while patients with Ea >/= 7cm/sec showed no significant change. Similarly, patients with Sm<7cm/sec prior to EECP showed significant improvement in EDV, ESV and LVEF after EECP [p=0.016, 0.017, 0.006], while patients with Sm >/= 7 cm/sec did not. These results provide new insight into the hemodynamic effectiveness and potential clinical applications of EECP