METHODS OF IMPLEMENTING THE OPERATIONAL PHASES OF THE HEALTH PROFESSIONALS EDUCATION PROJECT- ISFAHAN HEALTHY HEART PROGRAM (IHHP-HPEP)
Ahmad
Bahonar
MD, MPH, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Alireza
Khosravi
Cardiologist, Assistant Professor, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Hossein
Esmaeelian
MD, Manager of Physical Education Center, Isfahan University of Medical Sciences, Isfahan.
author
Anahita
Babak
MD, Specialist in Community Medicine, Isfahan Provincial Health Center, Isfahan University of Medical Sciences, Isfahan.
author
Nizal
Sarrafzadeghan
Bsc in Public Health, District Health Center, Arak University of Medical Sciences, Arak.
author
Mohamadreza
Rahmati
MD, Manager of Isfahan Provincial Health Center NO1, Isfahan University of Medical Sciences, Isfahan.
author
Ahmad
Jamshidi
Faculty of Nursing and Midwifery School, Isfahan University of Medical Sciences, Isfahan.
author
Maryam
Azad
MD, Isfahan Sport Medicine Association, Isfahan.
author
Pouya
Daneshvar
Professor of Medicine, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
text
article
2010
eng
Abstract BACKGROUND: Knowledge, attitude and practices of health professionals influence the health awareness of clients presenting to the centers for health and treatment. This project was designed and conducted to increase the knowledge and improve the attitudes and practices of health professionals at all levels of the health system, towards prevention and control, as well as diagnosis and treatment of non-communicable diseases, especially cardiovascular diseases. METHODS: The study consisted of three phases: situation analysis, intervention, and re-evaluation. To perform situation analysis, we applied randomized cluster sampling and selected 2000 health workers from the target population. Identical methods were used in control and intervention communities. We designed a questionnaire and determined its reliability and validity. RESULTS: Essential training on risk factors, healthy nutrition, and ways of coping with stress and maintaining adequate physical activity were taught to the target groups via seminars integrated into the health professionals’ in-service continuing education program. The educational materials consisted of books and leaflets. CONCLUSION: Awareness, attitude and practices of health professionals affect the outcome of efforts towards prevention and control of non-communicable diseases and their risk factors both in the society, and in the health professionals’ community. Multiple educational interventions in this study can help to rein in non-communicable diseases. Keywords: Cardiovascular disease, Risk factors, Health education, Prevention, Community-based interventions.
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2010
https://arya.mui.ac.ir/article_10027_7219c965d532b6e7069a3f31dd537eeb.pdf
ORAL CONTRACEPTIVE PILLS CONSUMPTION AND CEREBRAL VENOUS THROMBOSIS
Kavian
Ghandehari
MD FLSP, Professor of Cerebrovascular Disease, Department of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
Hadi
Akhbari
MD, Associate Professor of Rheumatology, Birjand University of Medical Sciences, Birjand.
author
Mehdi
Shams
MD, Resident of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
Abolfazl
Atalu
MD, Resident of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
Azadeh
Afzalnia
MD, Resident of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
Fahime
Ahmadi
MD, Resident of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
Mojtaba
Khazaei
MD, Resident of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
Mohsen
Kalhor
MD, Resident of Neurology, Mashhad University of Medical Sciences, Mashhad.
author
text
article
2009
eng
Abstract BACKGROUND: Causes of cerebral venous thrombosis (CVT) vary around the world. Oral contraceptive pills (OCP) are among the most frequent causes of cerebral venous thrombosis. METHODS: Consecutive patients admitted with cerebral venous thrombosis in Ghaem hospital, Mashhad during 2005-2008 were prospectively investigated. Diagnosis of cerebral venous thrombosis was made by corresponding results of MRI, and MRV or conventional angiography. All of the patients had a complete medical history, physical examination and underwent a standard battery of diagnostic investigations by stroke neurologists. RESULTS: Sixty two patients (51 females, 11 males) with mean age of 32.3, ranged 18-62 years were admitted with cerebral venous thrombosis. Oral contraceptive pills consumption was found as risk factor in 56.8% of females with cerebral venous thrombosis. These females had used LD and HD types of oral contraceptive pills in 97% and 3% respectively. 41% of females with cerebral venous thrombosis; (21/51) were on short term oral contraceptive pills consumption. In this latter group of females, Ramadan and Hadj religious months were the reason of using short term oral contraceptive pills in 86% and 5% respectively. CONCLUSION: Short term oral contraceptive pills consumption is the most common cause of cerebral venous thrombosis in Iranian women. Programs for public awareness should be conducted for reducing use of these pills in short term periods during Ramadan and Hadj months. Keywords: Cerebral venous thrombosis (CVT), Etiology, Oral Contraceptive Pills (OCP).
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2009
https://arya.mui.ac.ir/article_10028_69e86a1b7b16e9210f1280ed73c0d04c.pdf
ARE COMMUNITY –BASED INTERVENTION PROGRAMS EFFECTIVE IN THE YOUTH POPULATION? RESULTS FROM ISFAHAN HEALTHY HEART PROGRAM
Hamidreza
Roohafza
Assistant Professor of Psychiatry, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences. Isfahan.
author
Nizal
Sarafzadegan
Professor of Cardiology, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Maryam
Shahnam
Research Assistant, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Hamidreza
Tolouei
Anesthesiologist, Isfahan University of Medical Sciences, Isfahan.
author
Mehrab
Sharifi
General Practitioner, Isfahan Red Crescent sSociety. Isfahan.
author
Ahmad
Navab
General Practitioner, Isfahan Red Crescent sSociety. Isfahan.
author
Abdolhamid
Ansaripor
General Practitioner, Islamic Revolution Guards Corps, Isfahan.
author
Heidarali
khanbazi
Research Assistant, Isfahan Red Crescent Society, Isfahan.
author
Mohhamadmehdi
Mirzaii
General Practitioner, Shahid Beheshti Police (NAJA), Isfahan.
author
Khatereh
Azad
Research Assistant, Isfahan Red Crescent Society, Isfahan.
author
Djafar
Anaraki
General Practitioner, Deputy of Health, Isfahan University of Medical Sciences, Isfahan.
author
Masoumeh
Sadeghi
Associate Professor of Cardiology, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Firozeh
Sajadi
Research Assistant, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Shahnaz
Shahrokhi
Preventive medicine specialist, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Marzieh
Saidi
Research Assistant, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Gholamhosein
Sadri Pharm
Pharmacist, Deputy of research, Isfahan University of Medical Sciences, Isfahan.
author
text
article
2009
eng
Abstract BACKGROUND: Although the relationship between unhealthy lifestyle and development of non-communicable diseases in the youth has been understood but intervention studies to improve lifestyle behaviors in this age group are low. Consequently, this study was performed to highlight important intervention activity of a NCD prevention and health promotion program for young people and to present its main results in Iran. METHODS: The Youth Intervention Project (YIP) as a part of Isfahan Healthy Heart Program (IHHP) was carried out on all the youth aged 19-25 years in Isfahan and Najafabad counties as intervention areas and Arak as control area. The target groups could be reached in Red Crescent Society, universities, and garrisons. Multifactorial interventions included healthy nutrition, physical activity, coping with stress, and tobacco cessation by more emphasis on hookah smoking. Also, enforcing no-smoking regulations in teahouses and coffee shops was considered. RESULTS: After performing multifactorial interventions, the change of fast food consumption frequency was statistically significant in comparison between intervention and control areas (P for trend<0.05). Percentage of individuals with high stress level were more significant in intervention area compared with control area (P for trend<0.05). Smoking was increased among men and women in both areas whereas the increase was higher in control area (P for trend<0.05). Although daily physical activity frequency was increased in intervention areas but it wasn’t significant compared with control area. Also, decreased trend of carbonated drink consumption were not significant in intervention area compared with control area. CONCLUSION: The lifestyle modification program in the youth was successfully implemented and was shown to have improved some of the youth’s lifestyle behaviors related to healthy lifestyle. Keywords: Intervention,The youth, Non-communicable disease, Lifestyle.
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2009
https://arya.mui.ac.ir/article_10029_dc33eae3b250778bb87a4513a0e1c42b.pdf
GENDER DIFFERENCES IN EXTENT OF CORONARY ARTERY DISEASE AND LEFT VENTRICULAR FUNCTION IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY
Younes
Nozari
Cardiologist; Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Science.
author
Nehzat
Akiash
Resident of Cardiology; Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Science.
author
Anahita
Tavoosi
Resident of Cardiology; Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Science.
author
Nasibe
Akiash
Medical Student; Department of Medicine, Lorestan University of Medical Science.
author
Shirin
Ashkaboosi
General Practitioner, Isfahan University of Medical Science.
author
text
article
2009
eng
Abstract BACKGROUND: Coronary angiography allows a direct evaluation of coronary artery. The aim of this investigation was to evaluate the coronary artery stenosis among males and females underwent coronary angiography (CAG). METHODS: This randomized clinical trial was performed on 620 (425 males and 195 females) patients from March 2006 to September 2007 in the coronary angiographic registry of Imam Khomeini Hospital. The patients were selected for CAG according to the clinical criteria. Hypertension, diabetes, current medication, socio-demographic data, smoking, age and sex were recorded according to medical history and laboratory data. RESULTS: Ejection fraction of left ventricle was significantly higher in women in comparison with men (P = 0.01). No significant differences in the extent of coronary artery disease between men and women were observed. Women with coronary artery disease were older than men (P < 0.001). CONCLUSION: Although our study does not show any gender differences in the number of diseased vessels, it shows higher prevalence of risk factors such as diabetes mellitus and hypertension in women. Keywords: Coronary artery disease, Stenosis, Gender differences
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2009
https://arya.mui.ac.ir/article_10030_e155b7969d2223733f9c80421fdb22f1.pdf
HEMODYNAMIC PHYSIOLOGICAL RESPONSE TO ACUTE EXPOSURE TO AIR POLLUTION IN YOUNG ADULTS ACCORDING TO THE FITNESS LEVEL
Mehdi
Kargarfard
PhD, Associate Professor of Exercise Physiology, Faculty of Physical Education and Sport sciences, University of Isfahan.
author
Reza
Rouzbahani
MD, Specialist in Community Medicine, Isfahan, University of Medical of Sciences, Isfahan.
author
Ayeh
Rizvandi
M.Sc, Faculty of Physical Education and Sport Sciences, University of Azad Khorasgan, Isfahan.
author
Mehdi
Dahghani
M.Sc, Faculty of Physical Education and Sport Sciences, University of Isfahan, Isfahan.
author
Parinaz
Poursafa
M.Sc, Research Assistant, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan,Iran & Environ-mental Protection engineer , Science& Research University, Tehran.
author
text
article
2010
eng
Abstract BACKGROUND: This study aimed to determine the impact of acute exposure to air pollution on the hemodynamic parameters and physical fitness components in two groups of healthy men differing in fitness (trained and untrained) and the correlation of parameters between the areas. METHODS: Thirty four healthy college male students of the University of Isfahan (18 low-fitness, mean age 20.44 ± 2.43 years and 16 high-fitness, age 22.19 ± 2.07 years) participated in this study. First, two environments including high and moderate concentrations of ambient air pollution were determined on the basis of the environmental protection agency. Then, all participants performed a Canadian Aerobic Fitness Test (CAFT) to determine maximal oxygen uptake (VO2max) in sport sciences laboratory. Each participant also performed 2 sub-maximal exercise tests in two environments including polluted. The tests consisted of three phases: phase A, in non-polluted air area (laboratory); phase B, much polluted air area; and phase C, moderate polluted air area. All 3 exercise tests were completed within a 1-week period interval between phases. Maximal oxygen uptake (VO2max), maximal heart rate (MHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and other anthropometric values were measured at end sub-maximal exercise test. Data were analyzed using one-way analysis of variance (ANOVA) with repeated measures and correlation. RESULTS: At baseline, there were no significant difference between the groups in age, height, weight, diastolic blood pressure (DBP); but body mass index (BMI), body fat, resting heart rate (RHR) and systolic blood pressure (SBP) was significantly lower in subjects with high fitness (F 1,32 = 10.96, P < 0.002, F 1,32 = 13.91, P < 0.001, F 1,32 = 21.29, P < 0.001, F 1,32 = 13.72, P < 0.001, respectively). Although, baseline MHR and VO2max were higher in subjects with high-fitness than in students with low-fitness (F 1,32 = 10.07, P < 0.01, F 1,32 = 74.23, P < 0.001, respectively). For both low-fitness and high-fitness subjects the mean physiological and hemodynamic measurements at baseline and after exercise were significantly associated with concentrations of ambient air pollution category (P < 0.05). CONCLUSION: Although statistical significance was found for a number of hemodynamic parameters and physical fitness components in trained and untrained subjects, we speculate that the very small differences in the physiological responses to exercising in urban regions, which are often in contact with air pollution, are of little practical significance and would not affect the performance. Keywords: Air pollution, VO2max, Systolic and Diastolic blood pressure.
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2010
https://arya.mui.ac.ir/article_10031_27a6b63cb9abdb27a98bb6fa533802cc.pdf
ACUTE MYOCARDIAL INFARCTION IN ISFAHAN, IRAN: HOSPITALIZATION AND 28TH DAY CASE-FATALITY RATE
Nizal
Sarrafzadegan
Cardiologist, Director, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Shahram
Oveisgharan
Myocardial Infarction Registry Unit, Surveillance Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Nafiseh
Toghianifar
Quality Control Unit, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Shidokht
Hosseini
Myocardial Infarction Registry Unit, Surveillance Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
Katayoun
Rabiei
Process Evaluation Unit, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences.
author
text
article
2009
eng
Abstract BACKGROUND: This study aimed to investigate 28-day case fatality rate due to acute myocardial infarction (MI) in Isfahan using a standardized surveillance system. METHODS: A prospective longitudinal study was performed on hospitalized myocardial infarction patients in Isfahan, Iran from 2000 to 2004. All hospitalizations due to myocardial infarction (MI) events were recorded via a system adopted from “World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease” (MONICA) project, with ignoring MONICA age limitation. Patients were followed and their families enquired about their patients survival status at 28th day with phone calls and if not available at home visits. RESULTS: Age-adjusted hospital admission rate showed an increase during the study period, rising from 131.67 to 209.27 per 100000, but slowed toward the end of the study. Patients’ mean age was 62.35±12.64, with one third of events documented among female patients. Young patients (< 45 years old) comprised 8.6% of hospitalizations which remained nearly constant through the study. The corresponding figure was about 28% for patients aged less than 55 years. The 28-day case fatality rate was 23.1% for women and 13.2% for men. For individuals aged 35-64 years, the fatality rate was 13.0% for women and 7.7% for men. CONCLUSION: This study showed an increase in myocardial infarction hospital admission rate in Isfahan but the rate of increase is decreasing. A multi-centric community-based myocardial infarction incidence study is needed to elucidate myocardial infarction epidemiology in Iran. Keywords: Myocardial Infarction (MI), Epidemiology, Prevention and control, Cardiovascular diseases, Iran, Fatality rate.
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2009
https://arya.mui.ac.ir/article_10032_d24f477ada40064ff789728e2d555e5f.pdf
NO REFLOW PHENOMENON
Omid
Hashemifard
Interventional Cardiologist, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
text
article
2010
eng
Definition No reflow is a phenomenon in which myocardial ischemia and reduced antegrade flow occur despite the absence of proximal stenosis, spasm, dissection, or embolic cut off of major distal branches.1 In another word no reflow phenomenon means failure of restoration of myocardial flow despite removal of epicardial coronary obstruction.2 The incidence is 2% with plain balloon angioplasty (PTCA), 7% in patients undergoing rotational atherectomy, 12% for primary percutaneous coronary intervention (PCI), and much higher at 42% for PCI of degenerated Saphenous Vein Graft (SVG).3 No reflow is a strong predictor of mortality after PCI. The mortality of patients who developed no reflow has been estimated to be 8% Predictors of no reflow include a higher plaque burden, thrombus, lipid pools by intra vascular ultra sonography (IVUS), higher lesion elastic membrane cross sectional area, preinfarction angina and thrombolysis in myocardial infarction (TIMI) flow grade 0 on the initial coronary angiogram. Mechanism The cause is mainly embolization of atheromatous material (gruel). Particles are composed of cholesterol clefts, lipid rich macrophages, fragments of fibrous cap, necrotic lesion core and fibrin. This is aggravated by microembolization of platelet-rich thrombi that release vasoactive agents (e.g., serotonin and thromboxane A2), leading to intense arteriolar vasopasm in the distal vasculature. In the animal laboratory, experimental no reflow has been shown to be due to the plugging of capillaries by red blood cells and neutrophils, myocyte contracture and local intracellular and interstitial edema.4,5 A loss of capillary autoregulation and severe microvascular dysfunction are the ultimate physiologic consequences of these microscopic anatomic alterations. Debris of varying sizes of particulate has variable effects on microcirculatory plugging. The effect of particle size on microvascular dysfunction has been mostly investigated during rotablation. Rotational atherectomy mostly creates particle size less than 6 micron. These smaller particles pass through the capillary circulation in the same manner as red blood cells. Larger particles, which comprises about 20% of the rotational atherectomy debris or particle load, are trapped in the microcirculation and contribute to slow flow and Creatine kinase (CK) elevations from this procedure5. Some of the more common mechanisms of no reflow is shown in Table 1. Table 1. Proposed Mechanisms of No Reflow Microvascular constriction and vasospasm Distal embolization of thrombus or atherosclerotic debris or both Oxygen free-radical-mediated endothelial injury Capillary plugging by red blood cells and activated Neutrophils Neutrophil-mediated endothelial cell dysfunction or Vasoconstriction Intramural hematoma Loss of capillary integrity due to completed myocardial Infarction Differential Diagnosis The differential diagnosis of an apparent no reflow phenomenon is dissection or acute thrombotic formation in the proximal or distal segment (which is not well appreciated by conventional angiography) and catheter damping. It is occasionally difficult to precisely differentiate these causes and it is sometimes necessary to treat all of them (for example additional stenting in the inlet and outlet of stented lesion). A transport or infusion catheter can be inserted through the wire and advanced to the distal segment of the no reflow area. Then the wire is removed. Pressure gradient between the tip of the microcatheter and guide is measured, and contrast injection through the end hole will help to make distinction between no reflow and proximal obstructive lesion. Then injection of 3-5 cc of contrast agent with slow withdrawal of the catheter into the guide is useful to reveal any proximal disease.1 The results and management are summarized in tables2 and 3. Table 2. Differential diagnosis of No Reflow phenomenon a. If there is a pressure gradient, the cause could be due to proximal vessel obstruction or extensive intragraft pathology. The injection of contrast in the distal vasculature will show a patent distal artery. The treatment is correction of the proximal obstructive lesion. b. If there is no pressure gradient and no single large embolus to explain the reduction of the flow, and the contrast wash out remains poor in distal bed , then the patient has no reflow. This diagnosis of distal microvascular spasm and obstruction is a diagnosis of exclusion. c. If there is no gradient, however, the pullback angiography could show a distal severe lesion that was not seen by conventional antegrade angiography through the guide because the contrast could not reach the distal segment. Correction of the lesion should resolve the apparent no reflow phenomenon and the symptoms of the patient Table 3. The characteristics of No Reflow phenomenon and its differential diagnoses Diagnosis Proximal Lesion No- reflow Distal lesion Pressure gradient (+) (-) (-) Distal flow Patent No flow Slow flow due to distal Lesion Management Supportive measures Treatment of the no reflow phenomenon involves basic supportive measures for the patient, including fluid resuscitation, attention to oxygenation airway management, and blood pressure maintenance with pressors or inotropes (Table 4). Maintenance of blood pressure is especially important, because distal perfusion pressure is necessary for recovery from no reflow and also for delivery of pharmacologic therapy to the distal vascular bed. When no reflow occurs in the right coronary artery or inferior distribution, atropine therapy may be necessary to treat the reflex hypotension and bradycardia that may occur. Intra aortic balloon pump therapy for blood pressure support is another mainstay of treatment in refractory cases.7,8 Table 4. Initial evaluation and treatment of No Reflow phenomenon Excludedissection, thrombus, spasm at lesion site (IVUS, distalcontrast injection, or translesion pressure gradient may be useful) Achieve adequate ACT (250-300 s with unfractionated heparin if a llb/llla inhibitor has been given, >300 s if one has not been given, and 325-375 s with direct thrombin inhibitors) Ensure sufficient oxygenation and airway management Treat vagal reactions (IV atropine and fluids) Maintain adequate perfusion pressure with IV fluids, Vasopressors, inotropes, and IABP if necessary Administer intracoronary nitroglycerin (100-200 μg up to 4 doses) to exclude epicardial spasm Consider administering a glycoprotein llb/llla receptor Inhibitor Administer pharmacologic agents through an infusion catheter or the central lumen of the balloon catheter to assure drug delivery to the distal bed Pharmacologic therapy The basis of most therapies for no reflow is intra coronary pharmacotherapy, which often rapidly restores flow and reestablishes a more stable condition. A wide array of pharmacologic agents has been used for this therapy. None of them have clear proven therapeutic value in a trial setting. Most of the practice involved with pharmacotherapy for no reflow is based on operator experience and thus anecdote. Pharmacologic agents are administered into the affected vascular bed through a distal catheter. When drugs are given through a guiding catheter, they will preferentially flow to areas that have preserved run off. For example, when there is slow flow in the distal circumflex artery injection into a left system guide catheter will result in the injected agent going to the contralateral vessel and never reaching the target vascular bed. Thus an infusion catheter or an over the wire balloon catheter must be delivered distal to the target lesion in the distal vasculature and injections given through this catheter.1 Intracoronary nitroglycerin has been the traditional first line agent for this therapy. However the response of the no reflow phenomenon to nitroglycerin has been poor and it is not realistic to recommend this as a first line therapy. Several other agents have shown more effect (Table 5). Agents that have shown positive results in at least small reported series include adenosine, verapamil, and nitroprusside.11,12 Intracoronary verapamil has a success rate of two thirds in cases of no reflow especially those due to rotational ablation and it also improves all patients who had no reflow during SVG intervention. Nitroglycerin had no effect in this study. Table 5. Intracoronary drug therapy for No Reflow phenomenon First-Line Management Adenosine (10-20 μg bolus) Verapamil (100-200 μg boluses or 100 μg/min up to 1000 μg total dose with temporary pacer on standby) Nitroprusside (50- 00 μg bolus, up to 1000 μg total Dose) Evidence less Strong Rapid, moderately forceful injection of saline or blood (to “unplug” microvasculature) Diltiazem (0.5-2.5 mg over 1 min up to 5 mg) Papavarine (10-20 μg) Nicardipine (200 μg) Nicorandil (2 μg) Epinephrine (50-200 μg) Never Shown to Be Effective Intracoronary nitroglycerin Coronary artery bypass grafting Stent placement at site of original stenosis. If widely patent Thrombolytics )eg, urokinase, tissue plasminogen Activator( Adenosine has similarly been evaluated in a small number of patients with positive results. In one series of vein graft intervention, adenosine was successful in the majority of cases. Multiple doses and higher doses of adenosine have been found to be more effective than low doses. One small experience exists which demonstrates the efficacy of nitroprusside even in cases refractory to intracoronary calcium blockers.5 Forceful injection of saline or blood has been described as a method for hydraulically dislodging platelet aggregates or microthrombi from the distal vasculature.1 Intravenous and intracoronary platelet glycoprotein 2b/3a inhibitors have been described as successful in some cases, but the results seem to be variable. A review of the effects of 2b/3a inhibitor agents in more than 4000 patients in the EPIC Evaluation of 2b/3a Platelet receptor antagonist 7E3 in Preventing Ischemic Complications (and EPILOG) Evaluation in PTCA to improve Long Term Outcome with Abciximab GP 2b/3a Blockade trials failed to show any benefit from the use these agents in SVG interventions. Placebo treated patients had a 16.3% incidence of complications versus 18.6% in those received abciximab.12,13 Various other agents have been described including several other calcium channel blockers. Intracoronary has been described as effective in this setting, as well, and has an advantage because it will not cause blood pressure decline in patients in whom that is already a problem. Skelding et al identified 29 patients in whom intracoronary epinephrine was administered for coronary no reflow. Administration of a mean dose of 139 ± 189 m resulted in establishment of TIMI grade-3 flow in 69% of patients. Mean TIMI flow increased from 1 to 2.7 (P = 0.0001). Heart rate increased on average from 72 to 86 beats per minute, but no cases of rhythm disturbances were noted. Nicardipine has been studied in animal models and was successful in patient experiences. Nicorandil and papaverine has been used with some success intravenously. Intracoronary thrombolytic agents are ineffective, even when thrombotic embolization is grossly visible. Mechanical disruption of these thromboemboli is probably more effective than use of thrombolytic agents.8-11 Prevention No reflow has been a fearful complication of PCI since the inception of balloon angioplasty. It is clear that preventive measures including embolization protection devices should be used in high risk settings for the no reflow phenomenon. SVG intervention has been proven to be safer with embolization protection, and these devices should be used in conjunction virtually all SVG interventions. Mechanical thrombectomy with extraction devices has proven efficacy in preventing no reflow in setting of primary PCI of acutemyocardial infarction AMI.14,15
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2010
https://arya.mui.ac.ir/article_10033_667f3ff10df3e99c1afdfe930392f507.pdf
COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT
Masoud
Poormoghaddas
Professor of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan.
author
Omid
Hashemi Fard
Cardiologist, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan.
author
text
article
2010
eng
Abstract BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation. CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results. CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.
ARYA Atherosclerosis Journal
Cardiovascular research institute, Isfahan University of Medical Sciences
1735-3955
5
v.
3
no.
2010
https://arya.mui.ac.ir/article_10034_abc1fdd3cf227a9175061ef342d8867c.pdf