Abstract

Background: Vasoconstriction in the salivary glands, changes in the sympathetic nervous system, fluid restriction, nursing care services, together with pharmacotherapy in heart failure (HF) patients cause thirst as a painful complication. Against this background, the present study aimed to reflect on thirst dimensions based on the theory of unpleasant symptoms (ToUS) in HF patients.

Methods: This descriptive cross-sectional study was fulfilled on 217 HF patients, admitted to the teaching hospitals in the city of Tehran, Iran, from May to November, 2020, who were selected based on purposive sampling and upon meeting some inclusion criteria. The data collection tools consisted of the demographic survey form (DSF), the Thirst Intensity Visual Analogue Scale (TI-VAS), the Thirst Frequency Scale (TFS), and the Thirst Distress Scale (TDS). The data were then analyzed by descriptive and analytical statistics using the SPSS (ver. 20) software package.

Results: The standard deviation (SD) scores of thirst intensity in the HF patients were 47.53±26.37 (viz. at the moderate level) and such values for thirst distress were equal to 25.92±8.13 (i.e., at the high level). Most patients (35.9%) also had high degrees of thirst distress. In addition, the majority had felt thirsty over the last month, almost every day (61%), which had occurred all day long. The level of education, HF class, living conditions, fluid restriction, taking angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, aldosterone antagonists or diuretics, as well as suffering from diabetes were ultimately identified as the main predictors of thirst intensity and distress.

Conclusion: With regard to the high prevalence rate of thirst in HF patients and the bothersomeness of this condition, nurses are suggested to consider thirst sensation while they deliver care services to these individuals, and then shed light on the effective factors and predict thirst intensity during history-taking.

The Fractals are a fascinating mathematical tool for modeling the roughness of nature and understanding the structure of such complex objects. They are considered a tool for understanding the world. In general, fractal objects are characterized by the fractal dimension. In this work, and in order to exploit the fractal dimension to analyze fractal signals, we have defined the notion of the fractal dimension by presenting the methods for calculating this dimension. In this paper; we have shown that the electrocardiogram (ECG) is a fractal signal. This allows us to classify heartbeats based on the fractal concept. The aim is to develop a digital technique to analyze ECG signals in order to make an accurate diagnosis of cardiovascular diseases

Background: Complete heart block (CHB) is a known complication following congenital heart disease (CHD) corrections in children, yet data on its prevalence and short-term outcomes is limited. This study investigates the prevalence and short-term outcomes of post-procedural CHB in pediatric patients undergoing surgical or transcatheter procedures for CHD.

Method: A retrospective cohort study was conducted on pediatric patients who underwent CHD corrections between 2019 and 2020 at a tertiary cardiac center in Isfahan, Iran. Patients with a history of arrhythmia or heart block before surgery were excluded. The medical records were reviewed to identify cases of post-procedural CHB. The prevalence, risk factors and short-term outcome of post-procedural CHB were analyzed.

Result: A total of 840 patients were included in the study, with a mean age of 3.41±4.30 years and 47.8% being male. CHB was identified in 22 patients (2.6%) during the post-procedural period, with a prevalence of 0.6% in the transcatheter group and 4.7% in the surgical group. Patients with post-procedural CHB were younger than non-CHB patients. Regression analyses indicated that the type of procedure and type of CHD were associated with post-procedural CHB. Patients who developed post-procedural CHB had a longer mean stay in the pediatric cardiac critical care unit than non-CHB patients. The in-hospital mortality rate was 5.2%, with no correlation to CHB occurrence.

Conclusion: The findings highlight the importance of attentive monitoring for post-procedural CHB, particularly in younger patients, to facilitate timely intervention and improve the patient’s outcome.

Background: Noninvasive estimation of elevated left ventricular end-diastolic pressure (LVEDP) is a necessary step in evaluating left ventricular diastolic dysfunction (LVDD). Most echocardiographic parameters used for this purpose have limitations. Left atrial (LA) strain was recently found useful for noninvasive estimation of LVEDP. Therefore, this study aimed to investigate the correlations between LA deformation parameters assessed by speckle-tracking echocardiography (STE) and invasively obtained LVEDP.

Methods: This study was prospectively performed on 82 patients in sinus rhythm who underwent left heart catheterization at our center. All the patients underwent complete transthoracic echocardiography and peak atrial longitudinal strain (PALS) evaluation by STE within 12 hours before catheterization.

Results: LVEDP was elevated in 45 patients (54.9%) and normal in 37 (45.1%). PALS, LA ejection fraction, and septal E’ had moderate inverse correlations with LVEDP (r= −0.590, P=0.001, r= −0.463, P=0.001, and r= −0.449, P=0.001, respectively). The E/E` ratio also had a moderate correlation with LVEDP (r= 0.567, P=0.001). Lateral E’ and the E/A ratio demonstrated a rather weak inverse correlation with LVEDP (r= −0.231, P=0.037 and r= −0.229, P=0.038, respectively). In multivariate logistic regression, age (OR, 1.14; 95% CI, 1.02 to 1.27), PALS (OR, 0.77; 95% CI, 0.65 to 0.91), and the E/E` ratio (OR, 1.36; 95% CI, 1.11 to 1.89) were independent predictors of an LVEDP≥12 mm Hg. PALS demonstrated the highest diagnostic accuracy 0.849 (0.764–0.935, P<0.001) to predict an LVEDP≥12 mm Hg. A cutoff of 35% had sensitivity =81.1%, and specificity =81.4% for prediction of increased LVEDP.

Conclusions: PALS proved to be a suitable noninvasive parameter to predict elevated LVEDP. It can potentially be used as a measure for earlier identification of LVDD.

Background and Objective: Myocardial infarction (MI) presents one of the most common cardiovascular disorders and a progressive debilitating condition. Patients with MI experience low quality of life (QoL) mainly due to the devastating complications of this condition, and it is necessary to upgrade QoL and self-care among these patients. Self-care training is one of the ways to improve QoL in these patients. Therefore, the present study aimed to investigate the effects of implementing Orem’s self-care model on the QoL of patients experiencing MI hospitalized in the intensive care unit (ICU).

Methods: The present research employed a quasi-experimental randomized pre-post design conducted from February 2021 to August 2022. The research population included 70 patients with MI hospitalized in the ICU of the Shahid Mostafa Khomeini Hospital of Ilam City, Eligible patients according to entry and exit criteria were divided into the intervention and control groups. Data were gathered using a questionnaire consisting of three parts: 1-demographic information, 2- needs assessment based on the Orem model, and 3- the MacNew Heart Disease Health-related Quality of Life. The intervention group received 4 sessions of self-care training (30-45 minutes each session) via in-person, virtual, and phone-based methods and handed a self-care training booklet. Participants in both groups filled out the QoL and self-care questionnaires before and two weeks and two months after the intervention by face-to-face visits or phone/virtual interviews. The data collected were analyzed using SPSS v.26 software by calculating frequencies, means, and standard deviations. The repeated-measure analysis of covariance was utilized to compare the two study groups before and after the intervention.

Results: The results showed no significant difference in the mean QoL score between the intervention and control groups before the intervention (P-value = 0.05); however, after the intervention, the two groups showed a significant difference in terms of the mean score of QoL (P-value = 0.001).

Conclusion: The results of the present study showed that Orem self-care training could effectively improve the QoL of patients with MI, suggesting this approach as an effective non-pharmaceutical approach to upgrade QoL in these patients.

Background: Icosapent Ethyl (IPE) is effective and safe in reducing the risk of ischemic cardiovascular disease (CVD). The present study aimed to systematically collect and synthesize available cost-effectiveness studies of IPE in combination with statin therapy for cardiovascular risk reduction in primary and secondary prevention.

Methods: Electronic searches on PubMed/MEDLINE, Scopus, Web of Science Core Collection Embase, Cochrane Central Register of Controlled Trials (CENTRAL), NHS Economic Evaluation Database (NHS EED) and the Health Technology Assessment (HTA) database were searched for relevant literature (updated to May 2024). Out of 580 initial studies, 11 studies had the inclusion criteria.

Results: The results show that IPE reduced hospitalization and mortality rates versus standard drugs. The current study showed that IPE has higher QALYs and LYQs than statins. IPE is more expensive than conventional drugs such as statins, for example, the one-year cost of IPE in Australia is $ 3,768 and in the United States is $ 3,497 per patient. The results also show that the threshold for evaluating the effectiveness of IPE varies from $ 50,000 to $ 150,000 in the United States and AUD 50,000 ($ 39,000) in Australia.

Conclusion: According to the current study, IPE is cost-effective and the probability of cost-effectiveness of IPE in patients with secondary prevention is higher than in primary prevention.

Ewing's sarcoma, a highly aggressive, round-cell neoplasm of unknown origin, rarely manifests as a primary occurrence in the heart. In this intriguing case, we present a report of primary Ewing sarcoma in the right ventricle of an adult patient.

The patient was a 27-year-old man who presented with epigastric pain, fever, tachycardia, nausea, vomiting, shortness of breath, and dry cough. CT scan and echocardiogram showed an anterior mediastinal mass originating from the free wall of the right ventricle and located in the pericardium. It was causing pressure on the right ventricular outflow tract (RVOT) and pulmonary artery.

Based on the clinical conditions and paraclinical findings, a decision was made for surgical treatment. The mass was carefully separated from the heart tissue, and the RVOT was resected along with the pulmonary valve and the main pulmonary artery. This was repaired with a Dacron composite graft and anastomized to the bifurcation of the main pulmonary artery. The mass near the superior vena cava and the area of the pulmonary vein was also meticulously removed.

The patient was successfully removed from the cardiopulmonary pump in a stable condition and transferred to the intensive care unit. Histopathology results confirmed the presence of small round cell sarcoma and Ewing sarcoma in the patient. The patient was discharged and scheduled for regular follow-up visits.

Following discharge, the patient was referred to the radiotherapy center and underwent radiotherapy. In a re-examination after one year, the absence of any signs of disease recurrence or re-engagement provided a beacon of hope and optimism. This case suggests that timely referral and treatment of Ewing's sarcoma in the heart can lead to a better prognosis.

Myocarditis is a rare manifestation of tuberculosis, often associated with high morbidity and mortality. Cardiac magnetic resonance imaging (MRI) is a critical imaging tool for assessing infiltrative myocardial conditions. We describe the case of an adult patient from a tuberculosis-endemic region who presented with sudden-onset symptomatic arrhythmias. Cardiac MRI findings included heterogeneous signal intensity in the left ventricular myocardium, altered myocardial nulling time, and a patchy “zebroid-like” pattern of late gadolinium enhancement. Additionally, necrotic supraclavicular and retroperitoneal lymphadenopathy were observed. Fine-needle aspiration cytology of the affected lymph node revealed epithelioid inflammatory granulomas. The patient was diagnosed with disseminated tuberculosis and tubercular myocarditis. Following the initiation of a standard anti-tubercular regimen, significant clinical improvement was noted at the 2-month follow-up.

Background: Post Infarction Ventricular Septal Rupture (PIVSR) is a rare condition of mechanical complication of myocardial infarction (MI) with a high mortality rate. Deterioration of hemodynamics is inevitable during both its progression while waiting for a timely surgery and after the surgery itself. Continuous vigilance of hemodynamic may improve hemodynamic status observation, enable timely interventions that target specific problems, and ultimately improve patient prognosis.

Case Illustration: 65-year-old man with dyspnea, following 19 days after onset of MI. He was referred to our hospital with a presentation of acute heart failure, with pansystolic murmur grade IV/VI heard at the apex area. Echocardiogram showed a 14 mm IVS gap at the apex area, with left to right shunt. The patient was then stabilized in the CVCU and planned to undergo VSR closure and CABG. Procedure was done at 16^th day of hospitalization. Post operative period, he developed shock due to bleeding and cardiac tamponade that required him to underwent 2x redo surgery. After tremendous efforts for stabilizing the patient, he ultimately survived.

Conclusions: Hemodynamic monitoring and stabilization play a pivotal role in determining the prognosis in the case of PIVSR. Prompt diagnosis of post-operative complications that deteriorate hemodynamics, along with an interdisciplinary team approach, can improve treatment strategy and significantly reduce fatal complications and morbidity, which ultimately will improve the patient’s chances of survival.

Keywords: Myocardial Infarction, Ventricular Septal Rupture, Hemodynamic

HbD is a variant of hemoglobin mainly found in north-western parts of India like Punjab and Gujarat, Pakistan, Iran and other countries. HbD arises due to genetic mutation at 121^st aminoacid residue glutamic acid which is replaced with glutamine. HbD may exist in homozygous or heterozygous forms. Patients with HbD usually remain asymptomatic during their life time. However, HbD may sometimes coexist with sickle cell disease which exhibits clinical manifestations. However, coinheritance of HbD with thalassemia is a rare possibility and is believed to have clinical presentation which is not much reported in literature. In this article we have reported a case found in Bathinda district of Punjab with coexisting HbD and thalassemia trait showing severe cardiac presentation which could be late sequelae of hemoglobinopathy owing to underlying chronic anemia. We have also proposed an algorithm which might help the clinicians and diagnostic lab experts for easy work up of hemoglobinopathies considering that availability and affordability of genetic allele testing is a major limitation in majority of clinical settings.