فهرست مطالب مهنوش فروغی

Ischemic heart disease (IHD) is the main cause of mortality in the world. Presence of significant stenosis in coronary arteries is the cornerstone of diagnosis and treatment in symptomatic patients. Although stenotic coronary arteries due to atherosclerotic lesion is the most cause of IHD, there is no important stenotic lesion(s) in major proportion of symptomatic patients (especially female patients). The aim of this article is to review recent literatures about the important differences of men and women in clinical manifestation, risk factors, diagnosis, and prognosis of microvascular coronary disease.

The search was conducted for articles published between 2011 and 2021 in PubMed using the following key words: ''Women'' AND ['' Coronary microvascular disease'']. Data were collected by reviewing the texts.

Well defined risk factors of IHD may have important role in development of microvascular coronary disease, but exact mechanism of it is unclear. Disorders in coronary microvascular structure or function is common in women and may happen in the absence of stenotic epicardial coronary arteries, while is associated with cardiac events and mortality.

There is limited data about non obstructive coronary disease. The prognosis of IHD is worse in women compared to men; it could be explained by identification of more cardiac risk factors in women and pay attention to different effects of risk factors between men and women, and presence of unique risk factors for women.

Primary cardiac tumors are rare tumors which should be operated urgently. In this study، cardiac myxoma have been evaluated from diagnosis until discharge in a 10 years period and then results including presenting symptoms، approach to the patients were compared with similar study in this center on one decade ago. Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study. Eighteen patients included in the study، 11 female and seven male. Patients’ ages were in the range of 13 to 76 years (mean 53 years). Mean time from diagnosis to operation was 5. 8 days and mean time from surgery to discharge was 8. 6±6. 1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to transe thoracic echocardiography (TTE)، in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94. 4% of all tumors (17 cases) were primary cardiac tumors and only one tumor (5. 6%) was recurrent. In 16 patients (88. 9%) tumor were found in the L. A and in one case، tumor was found in both atria and in another case، tumor was in the ventricle. After tumor excision، atrial septum was repaired primarily in seven cases (38. 9%) and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft (CABG) and another patient underwent concomitant pulmonary valve repair. 14 patients (77. 8%) discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cerebrovascular accident (CVA) developed in two patients. One patient died (5. 6%). Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but advances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size.

The expansion of knowledge and information in different scientific branches necessitates the application of novel methods of educational management such as new methods of evaluation. Earlier studies on cardiovascular residency program in Iranian medical universities showed that little focus has been applied on novel teaching methods of ECG interpretation skills. This study was performed to investigate the effects of formative assessment and giving feedback on cardiovascular medical residents’ ECG interpretation skills in Shahid Beheshti University of Medical Sciences. In this quasi experimental study، twenty two 2nd and 3rd year cardiovascular medical residents of Modares and Talegani medical centers were investigated. Residents were randomly divided into two groups. After conducting pretest، all residents attended 20 weekly sessions on ECG interpretation. Then after 10 and 20 sessions they were reassessed (mid-test and post-test). Residents in case group received the answers of tests (ECG interpretation) while residents in control group did not receive any feedback on correct answers. At the end، the results of pre-test، mid-test، and post-test for two groups were compared using paired t test. Nine (49. 95%) residents were allocated in case group and 13 (59. 9%) in control group. Mean score of pretest in case and control croup were (42. 8±7. 3) and (41. 4±3. 7) respectively out of total score of 100 and no significant difference was observed between two groups at the beginning of study (P=0. 6). After 22 weeks، mean score of post-test reached to 94. 5±2. 4 in case group. This mean score reached to 82. 8±5. 5 for control group. Residents’ post-test mean scores improved in both groups compared to pretest. This improvement was significantly higher in case (feedback) group compared to control group (P<0. 001). The study showed that applying (continuous) formative assessment and giving feedback significantly improve ECG interpretation skills. Therefore we recommended using formative assessment and feedback as a part of educational and evaluative programs.

Atrial fibrillation is the most common but benign arrhythmia following cardiac surgery. Although this arrhythmia is often self-limited and vanishes in about 24 hours upon surgery; a number of arrhythmias might ensue among which some might be really life-threatening. A multitude of therapeutic modalities have been proposed for the prevention of this arrhythmia and one of them is posterior pericardiotomy. This method has not been fully accepted by the peers yet and more studies are needed to prove its efficacy and benefits to the patients. In this single-blind randomized clinical trial, done over a 2-year period from February 2009 to January 2011, the effects of posterior pericardiotomy were evaluated in 174 patients (87 the case and 87 the control groups) undergoing elective coronary artery bypass grafting (CABG). The case group underwent CABG with posterior pericardiotomy while the control group underwent CABG-only operation. The post-operative incidence of arrhythmia, especially atrial fibrillation, was assessed for a week using statistical methods. The prevalence of postoperative atrial fibrillations were fewer in the group undergoing CABG with posterior pericardiotomy compared with the CABG-only group (P<0.004). Posterior pericardiotomy seems to reduce the incidence of atrial fibrillation following elective CABG; therefore, its application is suggested for elective CABGs.

Introduction & Delirium is an acute mental state, characterized by disturbed consciousness and cognitive dysfunction occurring in the setting of a physiological derangement, caused by a medical disorder. Cognitive decline after cardiopulmonary bypass (CPB) surgery, especially in the elderly patients, is of significant concern, since the advent of CPB procedures. Most prospective neuropsychological studies also found postoperative cognitive decline, early after surgery. Nowadays the incidence of postoperative delirium is more than 90% in some reports. Recently, the rate of cardiac surgeries has risen in the aged population, and the social and economic impacts of these complications has increased. We are about to evaluate the relationship between the incidence of delirium after heart surgery and some of the intraoperative factors. During 6 months in a university-affiliated hospital, 250 patients of over 50 years old, who were elected for CABG surgery, enrolled in the study. All patients were examined preoperatively and in the second and seventh postoperative days as well; with a comprehensive neuropsychological and neuropsychiatry assessment; (mini-mental-state examination). DSM-IV was also used to confirm the diagnosis. In this study, the incidence of delirium after open heart surgery was 47%. This study indicates that delirium after heart surgery is associated with CPB time>120 minutes, cross-clamp time>75 minutes, intraoperative HTC<30% and intraoperative temperature<30°C. There was no relationship between EuroScore and Delirium. Although the origin of the postoperative neuropsychological alterations is unclear, the present data suggests an association between some factors and postoperative delirium, and its knowledge can help us to prevent or cure this complication. Yet, a continuous investigation for the prevention of postoperative Delirium incidence and its treatment is essential.