محمود امامی میبدی

Several studies have evaluated the association of admission blood glucose levels and short and long term mortality after myocardial infarction and have had different results. The aim of this study was evaluation of association between admission blood glucose levels and in-hospital and one year mortality in non-diabetic patients with AMI.

In this study, demographic, clinical and Para clinical data of 120 non-diabetic patients with AMI on admission was collected and analyzed. The patients were followed for one year. Blood glucose level ≥ 140 mg/dl was defined as hyperglycemia.

78% of patients were men. The mean age and admission blood glucose level was 63+13 years and 146+76mg/dl, respectively. Death due to cardio vascular causes was seen in 20% of patients in hospital and 9.8% during the one year follow up. The mean admission blood glucose level in patients who died in hospital was significantly more than live patients and also had an influence on the in-hospital outcome. Every 100mg/dl increase in blood glucose level was associated with 11% increase in in-hospital mortality risk in non-diabetic patients.

Our results demonstrate that admission blood glucose level is a good marker for diagnosing patients with worse prognosis after AMI. We suggest that later studies should focus on optimal control of hyperglycemia with insulin in patients with AMI.

Previous studies have shown that various factors such as emotional stress can trigger of MI in susceptible persons. More studies are needed to evaluate the characteristics of patients regarding to emotional stress, heavy work, routine activity, infection or rest before occurrence of MI.

We studied 608 consecutive hospitalized in CCUs from May 2000 to October 2001. For patients, questionnaires including demographic, clinical and paraclinical characteristics were completed and data analyzed.

In this study rest (33.4%) and ordinary activity (32.4%) were more prevalent among the MI situations and infection had the lowest prevalence (0.7%). In patients higher than 45 years we had similar results, but in age group younger than 45 year ordinary activity (30.6%) and after heavy work (20.8%) had the highest prevalence before occurring of MI. In Diabetic patients, MI developed in sleep situation more frequently.(17.8%),(P=0.03) 52.5% of MI mortality occurred in rest situation.(P=0.009)

Rest had the highest prevalence of MI compared to other situations but in age group younger than 45 years MI after heavy work had the highest prevalence. Autonomic neuropathy may be one of the reason of higher prevalence of MI in sleep situation.

Coronary artery bypass graft can Improve myocardial contractility and functional class in Ischemic heart disease. 

Materials & Methods:

This study was done on 200 patient’s with CABG operation during 6 months. 142 patients were men and 56 patients were women with mean age 57.7  9.2 years (36-83). EF was measured by echocardiography before & 1 week after CABG, CCSFC evaluated before and 3 months after surgery by questioner. Data was analyzed statistically SPSS software.

Mean EF was 48.1  5.9 before surgery, and 48.3  8.5 after surgery. CCSFC was 2.9 0.9 before surgery and 1.10.3 after surgery (P Value = 0.0001).

CABG can improve EF and reduce CCSFC in ischemic heart disease especially in patient’s with EF<35% and history of myocardial infarction.

Everyday, millions of people around the world go through phlebotomy, either to donate blood or for therapeutic intention. The most important worrisome adverse effects are hemodynamic alterations. In this study, hemodynamic changes following blood donation were assessed. Methods & Materials: Three hundred laborers who donated blood voluntarily were enrolled in this study. Blood pressure (BP) and pulse rate were measured before the procedure, ten minutes afterwards, and one week following phlebotomy. Hemoglobin (Hgb) and hematocrit (Hct) were also determined prior to and one week after phlebotomy. Finally, results before and after donation were compared with each other.

242 volunteers had normal BP and 58 were hypertensive. The mean systolic blood pressures (SBP) before phlebotomy, ten minutes after the procedure, and one week later were 120, 117, and 122 mmHg, respectively. During the same periods of time, the mean of diastolic blood pressures (DBP) were 77 , 78 and 78 mmHg , in order , while pulse rates on average were 80 , 82 and 76 beats/minute . None of the aforementioned changes were clinically significant. After one week, Hgb decreased by about 0.3 g/dl (P<0.001) and Hct declined on average of 1.7 (P<0.001). Forty six individuals had high DBP and one week after donation, their DBP was reduced by 7 mmHg. Age, body mass index and smoking did not have any significant effect on hemodynamic status.

Hemodynamic changes in healthy blood donors were not clinically significant. It seems that DBP drops desirably in hypertensive individuals. This needs to be evaluated more carefully in future studies.