عدالت حسینیان

Coronary artery disease (CAD) increased due to lifestyle changes. Awareness of health status and distribution of disease have major role in the health planning. This study aimed to determine hospitalization rate due to coronary artery disease in Ardabil Province by GIS.
This cross-sectional study was performed by using the data belonging to 60156 patients with history of admission in the hospital due to CAD in Ardabil Province over the years 2010-2015. Hospitalization Rate (HR) was calculated after classification of the data in terms of location and date of hospitalization. Data were analyzed by descriptive statistics, ANOVA and repeated measure in SPSS v23. Then centralization of disease in the province was studied by Spatial Autocorrelation Analysis.
The pattern of disease distribution was indicated the random distribution in Ardabil province. In cluster and outlier analysis was observed outlier in Khalkhal and Kosar city, that was indicated the hospitalization rate in the Khalkhal city was higher than the surrounding cities and in the city of Kosar was lower than the surrounding cities.
In Hot Spots analysis was observed cold spot in the cities of Ardebil and Nir that was showed a low distribution of disease in comparison with other cities of the province.
The results of this study showed that in spite of the randomized distribution of coronary artery disease in Ardabil province, this disease is more prevalent in Khalkhal city. Identification of high risk areas, spatial clustering and determination of hot and cold spots will help to clarify the spatial aspects of internal and external correlations of cardiovascular disease and to assess and control the risk factors of space and screening. This is effective in planning health policies and implementing health services and identifying priority areas for disease prevention.

Coronary artery disease (CAD) is the most common cause of mortality and disability around the world. Determination of the health status and spatial and temporal patterns of the disease prevalence has a major role in health planning. This study aimed to investigate the spatiotemporal pattern of CAD in Ardabil Province.
This descriptive and cross-sectional study was performed using the data belonging to 60156 patients with history of hospital admission due to CAD in Ardabil Province during 2010-2015. Hospitalization Rate (HR) was calculated after classification of the data in terms of location and date of hospitalization. The spatiotemporal and demographic variables, including age, gender, type of CAD, periods and duration of hospitalization were analyzed by descriptive statistics, ANOVA and repeated measures in SPSS v23 statistical software. Spatial distribution maps were drawn for each month and year in ArcGIS 10.2.
Of 60156 hospitalized patients with CAD diagnosis, men (58%) were more in number than women (42%). The majority of hospitalized patients fell in the age range 60-69 years (25.3%), and 92.40% of patients were hospitalized for less than 7 days. An ascending pattern was observed in temporal hospitalization trend in Khalkhal and a descending trend in Ardabil. The lowest hospitalization rate, however, was observed in Kosar city despite the ascending trend. During the research period, the greatest decline in hospitalization rate was observed in temporal trend in Bilasuvar, Meshkinshahrand Namin cities, and the largest increase was observed in Germi, Pars-Abad and Kosar cities.
By using the comprehensive technology, GIS, spatiotemporal distribution and CAD trend during 2011-2015 were modeled in Ardabil province. Spatiotemporal trend of CAD in Ardabil province and allied cities indicated the necessity of paying more attention and studying community for further prevention of the disease. Community-based interventions should be implemented for prevention of risk factors of CAD during childhood and adolescence especially in the districts with high risk.

Most of coronary angiography patients have not enough information about undergoing procedure . This lack of knowledge makes anxiety in patients and thereby changes their vital signs. There is no study regarding the effective education of patients based on their native language. This study was done to investigate the effect of video education in native language on vital signs caused by anxiety of patients undergoing coronary angiography.
This quasi experimental study was done in 2013 on 160 patients undergoing angiography in Imam Khomeini Hospital in Ardabil. Participants were divided into two groups randomly (80 in each group): case (native video education) and control groups. The sheets of hemodynamic variables were completed in determined time intervals for data collection. ANOVA with repeated measures and Chi square were used to analyze the data in SPSS13 software. P-value The results of repeated measures ANOVA showed significant improvement in vital sign variables except for temperature in both groups over the time (p Video education in native language decreases the vital signs in coronary angiography patients. Therefore the video education especially in native language is recommended for improving vital signs before invasive procedures.

Myocardial infarction (MI) isone of the most commonly heart diseases in all countries with the mortality rate of about 30%. Reperfusion of blocked coronary arteries plays an important role in reducing mortality and enhancing the quality of life of patients after acute MI. This clinical trial is to compare the efficacy of streptokinase administered intravenously in a two slow and accelerated groups: control group (slow intravenous infusion during 1 hour) and case group (half-hour accelerated intravenous infusion of streptokinase) with the sample size of 100 patients (divided randomly to 50 patients in each group). The data tool was a questionnaire, included the collected ECG changes before and after echocardiography and laboratory tests of patients. Data analyzed with SPSS software using chi-square test. After reperfusion of the coronary artery, in the both case and control groups, elevation of ST segment has decreased statistically in two groups (60% and 84%, respectively). The complications rate following injection of SK in both case and control groups were 46% and 56%, respectively. The fraction in which 30% and 38% belong to cardiac complications, 32% and 22% to allergic symptoms and hematologic effects were 32% and 22%, in two groups, respectively and there was no statistically significant difference between two groups. According to the results of this study the accelerated (30 minutes) SK infusion can be fruitful for improving coronary reperfusion in patients with MI.

Nowadays, coronary artery disease is the most common cause of death in developed countries and in the whole world. According to the WHO reports, it will be the main cause of death in 2020. Myocardial infarction is the most common diagnosis among hospitalized patients in industrialized countries. This disease causes more mortality and morbidity than others. Coronary artery bypass grafting surgery (CABGS) is one of the common treatments for ischemic heart disease but it may have some complications. In this study we wanted to evaluate the incidence of CABGS complications in Imam Khomeini Hospital of Ardabil in the first month after CABG. This study was a cross sectional analytic descriptive type and performed on all of the patients underwent CABGS in Imam Khomeini Hospital during 2011-2012. All of the data from patients (like demographic, past medical history, physical exam findings, paraclinical findings and CABGS complications) were inserted in special forms after gathering, and analyzed by SPSS v.16. In this study, 211 patients were studied. About 145 (68.72%) of them were male and 66 (31.28%) were female. Seventy patient (33.17%) were more than 70 years old. About 33.22% of patients had a history of cigarette smoking and 9.95% were opioid abused. The 34.12% of patients had hypertension (HTN) history, 40.28% diabetes mellitus (DM), 17.06% history of hyperlipidemia and 63.98% had a history of the previous MI. Chest pain was the most common complication among the patients (93.36%). According to our study the prevalence rate of post CABGS complications were: bleeding after surgery 13.27%, postoperative myocardial infection 8.05%, neurological disorders 12.32%, renal complications 2.36%, respiratory symptoms 11.37% and 34.59% for cardiovascular complications. Also the total mortality was 5 (2.36%) persons. The data analysis showed that there was a significant relationship between sex with survival status, local infection and neurological disorders, and also there was a significant relationship between age with post CABGS survival, bleeding after surgery and renal complications. There was also a significant relationship between DM and post CABGS survival, local infections and respiratory complications and between HTN and local infections. According to the results of this study, the most common post CABGS complications were cardiovascular complications, especially arrhythmias.

Coronary bifurcation lesions are important، complex lesions with different therapeutic strategies. In this study، patients with Coronary bifurcation lesions were treated and clinical results in these patients were followed during the nine-month period. This descriptive analytical study was performed between January 2007 to December 2008 at Tabriz Shahid Madani Cardiovascular Center. We have studied 96 patients (83 male and 13 female). Patients on the basis of one or two stents were placed in one group and the other groups were divided based on the use of Drug Eluting Stent and Bare Metal Stent. After diagnostic angiography if coronary bifurcation lesions were present based on Medina classification، appropriate angioplasty treatment was carried out. In a situations including chest pain، electrocardiographic changes or the objective evidence of ischemia and indication of angiography، appropriate diagnostic tests during follow up period were done. Clinical outcomes including acute coronary events were recorded. And result analyzed using SPSS version 16. Chi-square، Fisher and T tests were used to compare the relationship between variables. In this study 86. 5% was male and 13. 5% female. The mean age of these patients was 56±9. 9 years old. The most prevalent risk factor was HTN with 41. 7% incidence and 55. 2% of patient had chronic stable angina and 26% of them had history of acute myocardial infarction، 7. 2% with history of PCI and 5. 2% with history Of CABGS. Most prevalent site of bifurcation was ALD/diagonal with 65. 5% incidence. The most prevalent complication was mild bleeding from puncture site with 10. 4% and 5. 2% of patients had mild hematoma. Among patients with two stents versus one stent presence of AMI presentation with CSA، ST Elevation in ECG was statistically significant. Also involvement of SB (side branch) lesions lengths at SB، kissing ballooning after implantation of two stents were statistically significant. Among patients with DES versus BMS usage of stent in RCA، LAD، lesion lengths at PMB (proximal main branch)، DMP (distal main branch) and SB، procedure time، radiation dose، fluoroscopy time were statistically significant. Among two groups MACE (major acute coronary event) in two stents patient between 1-3 month and total MACE at first 6 month were statistically significant The age of patients treated with CBL was low، also more usage of BMS and stenting of BFLs with two BMS had weak results in this study but surprisingly total results of BMS and DES did not have significant difference after 9 months follow up between two groups.

Low dose aspirin has been widely used in the prevention and treatment of cardiovascular disease. The bimodel action of aspirin on serum uric acid showed that aspirin at a high dosage promoted uricusuria; while intermediate doses were (1-2gr/day) caused uric acid retention. The main goal of this study was to survey the effect of low dose aspirin on serum level of uric acid in patients with ischemic heart disease. The study design was cross-sectional and analytical type. In this study we selected 60 patients who used low dose aspirin among the patients of Imam Khomeini hospital's heart clinic (2008-9) and their information was registered in special questionnaires including serum level of uric acid and creatinine before and after prescription of aspirin. Data was then statistically analyzed using Paired t test and Willcoxon. Of 60 patients 11 (18.3%) were under 50 years and 49 (81.7%) were above 50 years. The male to female ratio was 1.72 (38: 63.3% versus 22: 36.7%). 53.3% of patients showed an increase in serum uric acid, but 46.7% did not. No significant differences in uric acid levels was found in patients under 50 years before and after administration of aspirin. Serum uric acid levels were increased after administration of 0.1unit of aspirin. Low-dose aspirin (80 mg/ day) caused a slight but significant increase in serum uric acid and creatinine levels in patients over 50 years of age.

Myocardial infarction is one of the most common causes of mortality throughout the world. Utilization of thrombolytic drugs at the first hours upon MI leads to decrease in the rate of mortality. Streptokinase (SK) is commonly used because of its cost and availability. The golden time for maximum effect of SK appeared to be first hours after MI. The drug efficiency diminishes after 3 hours and it will be ineffective after 12 hours. This study was aimed to investigate interval between onset of the clinical symptoms and streptokinase receiving in patients with acute myocardial infarction admitted for drug reception. This cross-sectional study was conducted in 150 patients with STEMI (ST elevation Myocardial Infarction) who were attended to emergency room of Imam Khomeini hospital and fulfilled a questionnaire containing the data about age, sex, educational level, onset of symptoms, referring time to emergency room, SK utilization, past medical history of cardiac diseases, type and location of AMI, contraindications and side effects of SK. In 111 men (74%) and 39 women (26%), the mean for interval between onset of symptoms and drug injection was 8 hour and 27 minutes ± 8 hour and 18 minutes. Only 41% of patients received streptokinase in less than 3 hours after chest pain. The main reasons for delaying in drug consumption were delayed decision to come to hospital in 61% of persons, long distance to hospital for 22% of individuals, delayed admission tor CCU for 13% of cases and delay in physician diagnosis for 0.043% of patients. To have a male sex and residency in city where the hospital was establilished were associated with less-delayed treatment start. However, the educational level, age and history of MI were not correlated with onset of treatment. Our results clearly show that the majority of patients receipt streptokinase more than 3 hours after chest pain. With considering the factors associated with delay to receive SK, teaching the patients with ischemic heart disease and giving information about golden time for thrombolytic therapy and its effect in prognosis as well as extending cardiac disease treatment centers in suburbs are recommended.

Coronary artery disease is the main cause of mortality in developing and industrial countries. Recently the involvement of infectious agents as a risk factor for Acute Coronary syndrome is drafted. So this study was designed to investigate the probable association between Acute Coronary syndrome and Helicobacter pylori infection. This case-control study was carried out on 300 hospitalized patients with the diagnosis of Acute Coronary syndrome (UA and MI) and 300 hospitalized patients without the history of coronary heart disease. Anti Helicobacter pylori Antibody level was determined by as an indicator of infection history. Using chi-square and t- test the results were analyzed in SPSS software. Results showed that 79 patients (26.3%) in control group and 122 patients (40.6%) in case group were seropositive and the difference was significant. Relationship between cronory diseases risk factors and levels of IgG was not significant. Also the results showed that the rate of hypertension in seropositive patients in case group was significantly upper than control group. Regarding the findings of this study we can conclude that Helicobacter pylori infection probably is a risk factor for Acute Coronary Syndrome. Thus, further studies are needed to elucidate the association between Helicobacter pylori infection and Acute Coronary Syndrome.

Visit is an essential issue in hospitals and of patient's basic needs in coronary care units (CCUs). However, there is no evidence regarding its physiologic effects on them. The aim of this was to determine the physiologic indexes of patients before, during and after visit at CCU of Imam Khomeini Hospital in Ardebil.In this descriptive study, 50 patients with acute myocardial infarction were selected through convenience sampling method. A questionnaire and a cardiac monitoring device were used for data collection. Content method and calibration the device were used for validity and reliability of the tools respectively. ANOVA with repeated measurements was used for data analysis. %72 of patients was male and %28 was female. Their mean age was 59.8. Significant differences were found between systolic, diastolic and mean arterial pressures; heart as well as respiratory rates; temperature; and oxygen saturation before, during and after the visits. Accordingly, the indexes increased significantly by the start of visits and turned back to the previous state after them with no significant difference in before-after amounts.It seems that the physiologic indices of patients change in normal range during visits and return to their primary state after 30 minutes from the end of visits with no clinical importance.

Cardiovascular disease is the most important cause of death in the world. Statistics shows that mortality and morbidity from cardiovascular disease in Iran is going up, so quality of management and treatment of these patients need to be better. For these reasons, determination of survival rates and factors affecting it is important and is also the aim of this study. This is a survival analytic prospective study, done on 800 patients, admitted in Ardabil Bouali Hospital CCU. All of the patients were followed up one year and a questionnaire about them was obtained. Statistical analysis was done with SPSS. For survival analysis Kaplan Maier, life table, logReng test and Cox regressions model were used. Mean age of patients was 60.6±12.4 years. Total number of mortality in one year was 84 persons (10.5%). 582 patients were men and 218 were women. 47.4% were smokers, 33.4% had hypertension, 18.1% had diabetes mellitus, 15.3% had hyperlipidemia and 30% had arrhythmia. Survival rate in the first 10 days, 28 days and one year were 94%, 93% and 90% respectively. Factors that affected survival in Cox regress ional model were: diabetes mellitus, age, use of streptokinase, left ventricular ejection fraction, heart rate and heart block. Knowledge from survival rates and relative risks can help health managers in better health service preparation.

Today, heart diseases are the most common mortality causes in many of the world countries. According to current statistics, mortality rate from MI have been increased in Iran. The aim of this study was to determine survival rate and its effective cause in MI patients. This analytical-descriptive study was performed on 800 MI patients in Ardabil Bouali hospital. One year follow-up was carried out for all patiens and data collected through a questionnaire. The reliability and validity of questionnaire had been earlier evaluated using Cronbach's alpha in 30 samples pilot study. Data analysis was caried out by statistical methods such as: Kaplan-Maier for survival rate and log-rank test for comparison survival mean in two groups using SPSS software. Cox regression model and survival graph was used for predictive effective causes on survival rate. Age mean of patients was. For one-year follow-up, mortality rate was 10.5% for all patients. 72.8% of patients were male and 27.2% female. 47.4% of patient was smoker, 33.4% have a HTN history, 18.1% were diabetic and 15.3% had high lipid. Survival rate in first ten days, first month and a year following MI was 0.95, 0.93 and 0.91, respectively. Effective causes in patient’s survival rate were DM, HTN, SK and EF. knowing survival rate and effective causes in MI patients, we can provide a better service as well as spatially works to control MI and decrease mortality rate from MI and also increase survival time in patients.

Mitral valve prolapse (MVP) syndrome is one of the most prevalent abnormalities of mitral valve that arises from pathologic changes of the various parts of mitral valve. MVP may lead to ECG changes, like T wave inversion in inferior leads and atrial and ventricular arrhythmias, in some people that may be misdiagnosed as myocardial ischemia. This was an analytical (case-control) study in 50 cases with MVP with age below 30 years who had referred to the Ardabil Bouali Hospital and some private cardiology clinics. The diagnosis of MVP was based on clinical and echocardiographic findings, and after taking history and physical examination, an ECG and an echocardiogram were taken from each person in case and control groups and the acquired information was analyzed via statistical methods of SPSS software. From 50 studied cases with MVP, 60% (30 cases) were female and 40% (20 cases) were male, and the most common age range was 21 – 25 years. From these cases, 68% (34 persons) had changes in their ECGs while %32 (16 subjects) did not. In control group, from 50 persons, 44% (22 persons) had ECG changes and 56% (28 persons) did not. In general this study showed that increase in ECG changes in MVP group in comparison with control group (p=0.01). In cases with MVP, there was not significant relationship between gender and ECG changes. In comparing case and control groups, there was not significant difference in ECG changes in females, while there was a significant difference in males (14 of 20 versus 6 of 20) with considering that ECG changes in persons with MVP may be misdiagnosed as ischemic heart disease,it is recommended that cases (especially men) with MVP always keep a record of their ECGs.

Arthrosclerosis is the major cause of cerberovascular disorders and major problems of industrial countries. Mortality from chronic diseases such as arthrosclerosis and mortality from infectious diseases have a reverse, relationship with economic and educational levels of people. For this reason, investigating the relationship of MI with other risk factors such as infections has been of great interest. This was a case- control study. 60 patients with MI and 60 matched cases were selected from other wards of Boali Hospital. All of the patients who had been admitted with myocardial infarction diagnosis in the time of study were selected and information about them was recorded in a researcher made questionnaire. Serum sample from patients and control case were sent to determinations of IgG Anti Chlamydia antibodies with enzyme immune assay. Control case were selected from other wards of hospital who matched in age, sex and same test in serum sample was done. In this study in each group 48 persons (80%) were male and 12 persons (20%) were female. The range of age group was 35-80. Mean age group was 58.83±12.6 (SD) and mean age of control tools was 59.08±11.59.All of the patients in each group had anti Chlamydia antibodies (IgG) (titer more than 5U/ml). The mean range IgG in both groups were compared through t-test and there was no significant difference between them (p=0.85). In this study all of the cases and controls had anti Chlamydia antibodies. (IgG) high prevalence due to cold climate and high crowd of people in this area may be related to Chlamydia infection.

Coronary artery diseases are the leading causes of mortality and morbidity in industrial countries and in Iran. Myocardial infarction and unstable angina are essential clinical syndromes of coronary artery diseases, with the difference that the mortality and morbidity of NonST-elevated myocardial infractions is more than U/A and requires more intensive care. Rapid differentiation and diagnosis of NSTEMI from U/A plays a major role in effective treatment of patients and improvement of their prognosis. This study was designed to determine the incidence of nonST-elevated MI among patients hospitalized with initial diagnosis of U/A. This is a descriptive and analytical study performed on patients hospitalized with U/A diagnosis between 2001 and 2002 in Ardabil Buali hospital. The data (including demographic characteristics, patients’ clinical findings, ECG changes, laboratory findings) were collected using a questionnaire and analyzed by SPSS software using descriptive and analytical statistics. mean patient age was 61 and prevalence of nonST-elevated MI among patients with U/A was 23 patients (22.1%). Mean age of patients with NSTEMI was 60.5 and its prevalence was greater in male (69.9%) than in female (30.4%). The most prevalent ECG change in patients was T wave inversion and ST depression (78.3%) and in U/A patients it was T wave inversion (60.5%). The difference was statistically significant (p<0.001). 64.7% of the NSTEMI patients and 27.4% of the patients with U/A had severe chest pain (p<0.004). Prevalence of NSTEMI was about 1/5 of patients hospitalized with diagnosis of U/A and ECG changes among these patients (as T wave inverison and ST depression along with negative T wave) is more prevalent compared to those with U/A. Clinical manifestation and complications were more severe in these patients than U/A group.

Hypertension and diabetes mellitus coexist more commonly than predicted by chance and the synergistic effect of these two diseases is the cause of early disability and high rate of mortality in these patients. Controlling the blood pressure has a critical role in decreasing cardiovascular mortality in diabetic hypertensive cases. The goal of this study is to determine the rate of recognition and treatment of hypertension in type II diabetic subjects referring to diabetes clinic of Bou-ali hospital, Ardabil.

In this cross-sectional study 300 type II diabetic patients were examined in terms of blood pressure control.

The patients who participated in this study ranged between 28 to 80 years of age (mean: 55.5 ± 11.4). About 61.6% of diabetic patients had hypertension (BP>140/ 90 mmHg) 76.7% of these patients were aware of their hypertension. Only 8.8% of these patients with hypertension had a well-controlled blood pressure and the rest of them (91.2%) had a poorly- controlled blood pressure (BP>130/80 mmHg). About 21.8% of hypertensive diabetics although aware of their hypertension were not on any anti- hypertensive agents.

This study indicates poor control of hypertension in diabetic patients. It seems that reconsidering CME programs for the physicians, emphasizing the control of risk factors especially in high-risk groups and educating the diabetic patients will improve the control of hypertension in these patients.

Despite all improvements in diagnosis and treatment, one third of patients with Myocardial infarction lose their life. Different studies have shown that cardiac arrhythmia are the most common cause of death in MI, and cardiac blocks are one of the important groups of these arrhythmia, which are effective in prognosis, duration of hospitalization and hospital mortality of the patients. In this study, 630 patients with AMI, who were admitted in CCU of Bou-Ali hospital in Ardabil from January 1998 to January 2001 were studied and the data were callected with the help of questionnaires and secondary data analysis method. The data were analyzed with statistical methods. 9.4% of cases in this study had AV block and 30.2% had bundle branch block. 40.5% of men and 37.6% of women had at least one kind of block(in AV node or bundle branch), but no significant relation was found between sex and these blocks. Also, 62% of in-hospital mortalities of patients with AMI were in association with blocks (AV or bundle branch) and only 38% of mortalities were without blocks. This showed a meaningful relation between hospital mortality and these kinds of blocks (p <0.05). The total frequency of AV and bundle branch blocks due to AMI, was 39.6% which is similar to other studies, but what is remarkable in this study, is the higher prevalence of bundle branch blocks due to AMI.

Today, with changes in health care systems, most of the patients, receive occupational and special cares at home after being discharged from hospital. The aim of this study was to assess the effects of follow up on physical and emotional status of the patients with recent myocardial Infarction. This experimental study was done on 60 patients with acute myocardial infarction, who referred to Boali Hospital during 2000-2001.The patients were chosen randomly and were set in two different groups with 30 subjects in each group. Then, a home care program was designed for case group. but there was no intervention for control group. This home care program was completed and one week later the physical and emotional status of the patients in two groups were analyzed by Spilbergar and Beck tests and finally the results were compared in two groups using X2 test. The X2 test showed that there is a significant difference between resting heart rate of two groups with P<0.05 but the difference among systolic and diastolic blood pressure, body weight, anxiety and depression was not statistically significant in two groups. Regarding the effects of follow-up on the physical and emotional status of the patients, nurses can improve the quality of the patienys life through active home - care and rehabilitation programs along with social supports.