[Early mortality among patients with supraventircular tachyarrhythmia after acute myocardail infarction]

In this study the frequency of early term mortality [1 months] was evaluated among patients with early supraventricular tachyarrhythmia [<72 hours] during the first acute myocardial infarction [AMI]. In this prospective descriptive study, we studied 315 patients with the first S-T elevation AMI. Various factors including age, gender, risk factors and types of supraventricular tachyarrhythmias [within first 72 hours of CCU admission] were assessed based on medical records. Early cardiovascular mortality [30 days sudden cardiac death or acute coronary syndrome complicated with death] was probed through out-patient clinic. Among 300 patients, 208 individuals [69.3%] had one tachyarrhythmia with 8.1% mortality, 78 patients [26%] had two tachyarrhythmia with 12.8% mortality and the rest 11[3.7%] had three tachyarrhythmia with 45% mortality. Mortality among patients with and without atrial tachycardia [AT] was 36% and 9.4%, respectively [p<0.05], but in patients with and without atrial fibrillation [AF] was 20% and 9%, respectively [p>0.05]. Mortality among patients with and without atrial premature contraction [APCs] was 8% and 14%, respectively, [p>0.05] while among patients with and without sinus tachycardia [ST] was 15% and 5%, respectively. [p<0.05]. Early mortality [within 30 days] was more frequent among patients with S-T elevation myocardial infarction complicated with sinus tachycardia, atrial tachycardia and multiple simultaneously supraventricular tachyarrhythmia

[Comparative study of effects of fast release sublingual versus chewing-swallowing nifedipine on blood pressure decline in hypertension emergencies]

Hypertensive emergency is one of the most important conditions in the emergency department with high mortality and morbidity if not treated effectively. Hypertensive emergency is commonly treated with sublingual nifedipine. This drug is very short acting and it may decrease blood pressure suddenly, resulting in dangerous side effects such as myocardial ischemia and sudden cardiac death. We intended to find of a safer route of administration. Therefore, we compared the rate of blood pressure decline following sublingual and chewing-swallowing routes of administration. A quasi-experimental clinical study was performed on 160 patients with hypertensive emergency. All patients with blood pressure >/= 210/125 mmHg and without sign of end organ damage were selected randomly into those receiving sublingual or chewing-swallowing 10 mg nifedipine capsules. The data collection tools consisted of an information sheet and a semi-automatic sphygmomanometer. Information sheet had two parts, the first was related to demographic data and the second part was the check list of blood pressure [systolic, diastolic, mean] and heart rate at 5, 10, 20, 30, 60 and 120 minutes after administration. All data include quantitative and qualitative were analyzed with paired comparison, t-test and Chi-square. The results of this study showed that there was significantly greater fall in the rate of blood pressure in the sublingually-treated group compared with chewing-swallowing group at 5, 10 and 20 minutes after taking 10 mg nifedipine [P = 0.04, 0.01, 0.06 respectively]. There was no significant difference in diastolic blood pressure between both groups during the time of study. After 30 minutes the fall in systolic and diastolic blood pressures in both groups was similar. There was no significant difference in heart rate among both groups but there is some trend to the increase the rate. There was 23% decrease in mean basic blood pressure among the patients before and after treatment in sublingual and chewing-swallowing groups [P=0.0001]. There was no significant correlation of blood pressure abatement rate in both groups as dependent variables of age, sex, positive history of risk factors and current drugs as independent variable. The chewing-swallowing route may be safer than sublingual route since it reduces pressure less rapidly during the first 20 minutes of administration

Regression of left ventricular hypertrophy after successful renal transplantation among uremic patients

Recognition of the natural history and responsible leading factors for regression of left ventricular hypertrophy after successful renal transplantation are very important. The aim of this study was to assess the regression of left ventricular hypertrophy after successful renal transplantation among uremic patients. In this study 27 uremic patients [18 males and 9 females] with an average age of 38.5 years were randomly selected. Left ventricular mass index [LVMI] was calculated before and after renal transplantation at the beginning, and at 4, 6 and 8 months. The means of LVMI before and after transplantation were 180 +/- 19.3 g/m[2] and 133.8 +/- 16.8 g/m [2] respectively [p<0.001]. The means of regression after transplantation at 0, 4, 6 and 8 months of follow up were 191g/m[2], 157.3 g/m[2], 147.8 g/m[2] and 138.8 g/m[2] respectively. There was a significant difference between the means of hemoglobin concentration and blood pressure before and after transplantation [p<0.001]. For instance the means of hemoglobin concentration and blood pressure was 7.2 +/- 0.4 and 13.1 +/- 0.7 g/dL, 154 +/- 6 / 97 +/- 4.4, and 135 +/- 6.3/ 89 +/- 3.8 mmHg respectively. This study showed that maximum left ventricular hypertrophy regression occurred 4 months after transplantation, then decreased to a minimum level of 147.8 and 135.8 g/m[2] at 6 and 8 months after transplantation respectively. Restoration of hemoglobin concentration and blood pressure to normal levels may be recognized as a main cause of left ventricular hypertrophy regression