Background: Pain is a symptom of discomfort or tissue injury experienced by patients. Amongpatients in intensive care unit (ICU), pain is a common phenomenon. Objectives: The purpose of this study was to evaluate the effect of preferred music listening on behavioral measures of pain, as an indicator of pain assessment, in patients undergoing coronary artery bypass graft surgery (CABG). Patients and Methods: This blinded clinical trial was performed on 60 patients admitted to ICU following CABG. Patients intubated and those under mechanical ventilation were unable to report their pain. The study population was randomly divided into two groups of control and music intervention groups (preferred music listening). In the intervention group, preferred music (including classical, instrumental and traditional music as well as Quran recitation) was played via a headphone for 30 minutes. In the control group, patients were in bed at the same time and only mute headphones were used. The pain levels of patients were assessed at three time intervals; a) during rest, b) 10 minutes prior to receiving music, following a painful procedure (e.g., change of position for dressing change) and c) in the final 3 minutes of music following a painful procedure using the method of “critical care pain observation tools” (CPOT). Results: The mean pain behavior scale score 10 minutes prior to receiving music, following a painful procedure, was 2.77 ± 1.04 in the music intervention group and 2.33 ± 1.12 in the control group. The score increased after a painful procedure compared to that before the procedure in the control group and reached 2.67 ± 1.124; this increase (0.34 unit) in the control group was statistically significant (P = 0.008). In contrast, the score in the music intervention group dropped to 2.20 ± 1.06 and statistical tests showed a significantly reduced pain behavior scale score in the music intervention group (P < 0.001). Conclusions: The results of this study showed beneficial effect of preferred music listening on reducing pain sensation during painful procedures in intubated patients after CABG.

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Background: In a cardiac patient, anxiety is the result of the individual’s perception of the treatment and is characterized by inability to predict, control, or achieve the desired treatment outcomes. Objectives: This study was carried out to investigate the extent of clinical anxiety in patients who underwent a cardiac rehabilitation program with different attitudes toward the disease risk factors. Patientsand Methods: The administrative data of this retrospective study were obtained from the database of the cardiac rehabilitation department of a hospital in Iran. The demographic and clinical information of 603 patients from April 2006 to April 2011 was collected using compiled forms of this database, the Beckanxiety inventory, and the structured clinical interview for axis I disorders. The univariate analysis of variance and the Bonferroni post-hoc analysis were used for data analysis. Results: After controlling for gender and educational level, we observed statistically significant differences in the modified means between the patients who considered the behavioral risk factors and those who considered the physiological risk factors (P = 0.012, MD = 5.03) and between the patients who regarded the behavioral risk factors and those who regarded the psychological risk factors (P = 0.0005, MD = 5.32) as the underlying cause of their cardiac condition, which means that the level of anxiety in the physiological and psychological groups was higher than that in the behavioral group. Conclusions: The anxiety of patients can be controlled through alteration in their attitudes toward the disease risk factors on the grounds that psychological or physiological factors per se do not trigger the occurrence of the disease, whereas behavioral risk factors, as the controlling agent, significantly influence its occurrence.

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Context: In this review, we tried to evaluate the incidence, prognosis and treatment options in patients with iatrogenic pathology of the aortic artery due to interventional procedures in cardiology. Evidence Acquisition: Our search strategy involved an investigation in the PUBMED database for every available article in peer reviewed journals between 1975 and 2015, for subjects related to iatrogenic pathology of the aortic artery, following interventional procedures in cardiology (coronary angiography or angioplasty, trans-catheter aortic valve implantation (TAVI) or intra-aortic balloon pump (IABP) counterpulsation placement). Results: Iatrogenic pathology of the aorta is a rare, but potentially lethal complication of invasive vascular techniques. The development of these complications should be considered in cases of unexplained hypotension, acidosis or lower limb ischemia after catheter-based interventions. With increased experience, most of the vascular complications associated with the transfemoral approach may be managed percutaneously. Conclusions: With the increase in interventional procedures in cardiology, iatrogenic pathology of the aorta is seen more frequently, and every cardiologist should know how to diagnose and treat this group of diseases.

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Background: Coagulopathy after cardiopulmonary bypass (CPB) may lead to increased morbidity and mortality. Routine conventional coagulation tests are not always suitable to detect rapid changes in patient’s coagulation status. A point-of-care instrument such as ROTEM (rotational thromboelastometry) is a timely and comprehensive method to evaluate hemostasis during cardiac surgery may reduce the need for blood transfusion. Objectives: In this study, ROTEMwas compared to coagulation tests routinely performed during cardiac surgery for postoperative bleeding volume and consumption of blood products. Patients and Methods: Fifty patients undergoing cardiac surgical procedures were enrolled. Blood was obtained before the operation and after CPB weaning. Twenty-five of patients were checked only by traditional blood coagulation test and 25 other patients were checked by ROTEM in addition to routine coagulation tests. The results of these two groups of patients were compared. Results: There was a significant correlation between platelet count (PLT) and fibrinogen level with EXTEM-MCF (r = 0.79, P value: 0.008, r = 0.55, P value: 0.04 respectively). EXTEM-CT was correlated with prothrombin time (PT) (r = 0.56, P value: 0.01) and International normalized Ratio (INR) (r = 0.57, P value: 0.01). There was a significant correlation between PLT count and fibrinogen level with INTEM-MCF (r = 0.69, P value: 0.02, r = 0.71, P value: 0.01, respectively). INTEM-CT was correlated with partial thromboplastin time (PTT) (r = 0.57, P value: 0.02). There was a significant correlation between FIBTEM-MCF and fibrinogen level (r = 0.80, P value: 0.001). HEPTEM was not correlated with any of the coagulation variables. Postoperative consumption of packed blood cell (BPC) was increased in non-ROTEM group in comparison with ROTEM group (645.17 ± 279.16 in Non-ROTEM vs. 387.50 ± 262.88 in ROTEM, P: 0.03) Conclusions: ROTEM can be used to detect postoperative hemostatic changes following cardiac surgery appropriately and can be useful to choose suitable blood products that may reduce the need for blood transfusion, contributing to better patient blood management.

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Background: Ablation will efficiently lead to sinus rhythm preservation, which consequently improves left ventricular function; however, the strain rate and its indices as functional systolic factors of the left ventricle have not been studied. Objectives: To assess the improvements in different patterns of radial, longitudinal, and circumferential strain rates separately. Methods: In this case series, 31 patients with symptomatic tachycardia who were candidates for ablation between october 2011 and March 2012 in our tertiary cardiovascular center in Iran were enrolled. Patients underwent trans-thoracic echocardiography 24 hours before and 24 hours and three months after ablation, and left ventricular ejection fraction deformation indices were assessed using the two-dimensional (2D) speckle tracking method during normal sinus rhythm. Results: Strain and strain rate indices in different aspects (radial and circumferential in the short axis view, and for longitudinal in the long axis view) improved remarkably during the three-month follow-up period (P< 0.05). The improvements in ventricular indices were usually between 24 hours to three months after ablation. The systolic strain rate (SR) and strain (SN) were significantly different at echocardiographic views before and 24 hours after ablation (P< 0.05), which revealed that myocardial function developed in the first 24 hours of ablation. Conclusions: Echocardiography and 2D speckle tracking strain imaging shows improvements in left ventricular deformation indices in atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) patients for the mean systolic strain and strain rate at 24 hours and the three-month follow-up. In spite of the normal LVEF, even during sinus rhythm, deformation indices maybe abnormal before and after ablation.

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Introduction: Antiphospholipid syndrome (APS) associated with intra-cardiac thrombus and pulmonary embolism is infrequent. However, the presence of pleural effusion is extremely rare. Case Presentation: A 42-year-old woman, admitted with palpitation, dyspnea and history of stroke and thrombocytopenia is described. Doppler sonography revealed deep vein thrombosis. Moreover, subsequent investigation confirmed the presence of right atrial thrombus, pulmonary arteries embolism and bilateral pleural effusion. Inferior vena cava thrombosis was confirmed during cardiac surgery and all thrombi were removed subsequently. Laboratory studies revealed the diagnosis of APS. The patient experienced deep vein thrombosis one year later and no evidence of recurrent disease was documented after three years follow up. Conclusions: APS complicated by inferior vena cava thrombosis coexistence of pulmonary embolism and intra-cardiac thrombus is not previously reported. Moreover, presence of pleural effusion with these conditions describes a unique case of APS.

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Background: Pacemaker implantation is a well-approved method for certain bradyarrhythmias. In children with single-chamber pacemakers, and in those with sinus node dysfunctions, there are no intrinsic mechanisms for rate modulation. Rather, rate modulators serve to provide the required rate. Objectives: The aim of this study was to assess the efficacy of pacemaker rate modulators in children. Patients and Methods: Twenty pacemaker-dependent children with single-chamber ventricular pacemakers were compared with the same number of children of the same age range without pacemakers. Efficacy of the rate modulators was assessed with treadmill exercise testing and compared with controls. Basal heart rates, exercise tolerance, maximal heart rates, and rate change slopes were studied. Results: Basal heart rates, maximal heart rates, and exercise tolerance were significantly lower in the children with pacemakers. Age, sex, and body mass index had no effect on the heart rate slope during the exercise test. There was no significant difference between epicardial and endocardial pacemakers. Conclusions: In the children in this study, pacemaker accelerometers failed to meet physiological demands.

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Background: Maternal diabetes is associated with increased teratogenic effects on fetuses; it affects the structure and functions of fetal heart and alters the fetal-placental circulation. Although several articles have demonstrated fetal cardiac malformation and defects in diabetic mothers, ventricular systolic and diastolic function has not been properly investigated, particularly in Iran. Objectives: The aim of this study was to assess ventricular function using tissue Doppler imaging (TDI) in fetuses of diabetic mothers compared with fetuses of non-diabetic mothers in the Iranian population. Patients and Methods: Twenty-one diabetic pregnantwomenat 28 weeks’ gestation were enrolled as the case group, and 35 healthy pregnant women at the same gestation were considered as the control group. Fetal echocardiography, including TDI, was carried out for all cases. The variables measured by echocardiography were as follows: the systolic annular peak velocity (Sa), late-diastolic annular peak velocity (Aa), and diastolic annular peak velocity (Ea) waves on the lateral and septal walls of the left ventricle (LV) at the mitral valve annulus using TDI; mitral inflow E and A waves using pulse Doppler; and inter-ventricular septum thickness using two-dimensional (2D) echocardiography. Results: According to cut-off value of 6.3% for hemoglobin A1C (HbA1c), only one patient with HbA1c = 8 had uncontrolled diabetes. In 20 other patients with controlled diabetes, the mean HbA1c was 4.78 ± 1.22%. There was no significant difference between groups according to maternal age (29.24 ± 5.86 in the case group vs. 28.58 ± 4.42 in the control group, P = 0.6). No significant difference was found in the septal thicknesses between the two groups (P = 0.39). Moreover, there were no statistically significant differences between groups in terms of other echocardiography variables (P > 0.05). Conclusions: We did notfindsignificant differences in ventricular function or ventricular septal thickness in the fetuses of mothers whowere referred to our hospital with a previous diagnosis of diabetes mellituscompared with the fetuses of non-diabetic mothers. This could be due to early identification, appropriate treatment, and tightly controlled diabetes in our study population. It should be noted that only pregnant women who were being closely monitored by their gynecologist were referred to us, so there may be some bias in our case selection; moreover, only patients who have taken steps to control their diabetes, so that only one of them had an abnormal HbA1c level. Other possible reasons for our results are over-diagnosis of gestational diabetes by gynecologists and an inadequate number of participants in our study.

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Introduction: Left atrial dissection and hematoma are a life threatening condition, which are rarely seen following percutaneous coronary interventions. Diagnosis of these complications may sometimes be difficult, despite the use of the latest imaging techniques. The case presented in this paper is the first case of left atrial dissection and hematoma as complications following primary percutaneous coronary intervention. Case Presentation: A 65-year-old male patient was admitted to the emergency department and acute inferolateral myocardial infarction was diagnosed. The left atrial hematoma as a rarely complication is developed in patients undergoing primary percutaneous coronary intervention. Conclusions: Preoperative echocardiography, applied before elective and emergency percutaneous coronary interventions, plays a key role in detecting many intervention-related complications in the post-intervention period.

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Background: Coronary artery disease (CAD) is one of the major causes of death and disability all over the world. The increasing prevalence of CAD as well as its high economic cost makes it a serious health problem in Iran. Objectives: The study aimed to evaluate the impact of gender differences on healthy lifestyle measures among patients with CAD. Patients and Methods: In this descriptive cross-sectional study, 412 patients with CAD (239 men and 173 women) were selected between January 2015 and June 2015. Data were collected by demographic characteristic forms and a healthy lifestyle questionnaire. The data were analyzed using SPSS software with appropriate statistical tests. Results: There was no significant difference in age, blood pressure, and cholesterol between the two genders (P = 0.573, P = 0.092, P = 0.438). Men were more educated than women (P = 0.000), and had higher levels of low-density lipoprotein and high-density lipoprotein (P = 0.000). The mean of healthy lifestyle scores was 19.2±4.2 for the men and 18.8±3.2 for the women. Overall, there was no significant difference between two genders in healthy lifestyle scores (P = 0.342). However, among the healthy lifestyle subscales, women had healthier nutrition (P = 0.000) and were less inclined to smoke and drink than men (P = 0.000). Men had more physical activity (P = 0.000), more health responsibility (P = 0.000), and more health-based purchases (P = 0.000). There was no significant difference between the two genders in stress management (P = 0.272). Conclusions: The results indicated that the patients’ lifestyles were unhealthy overall. However, tendency towards healthy behaviors was different betweenmenand women. Therefore, it is important and necessary to emphasize gender differences in prevention and health promotion programs.

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Introduction: Brucella endocarditis, although an uncommon complication of brucellosis, is the main cause of the mortality related to this disease. The best therapy is a combination of antibiotic administration with valve replacement. After treatment of the first episode of endocarditis, new infection may be occurred as a relapse or reinfection. Case Presentation: In this report, we described a patient with brucella endocarditis complicated with a reinfection of the mechanical prosthetic valve after one year of follow-up. Conclusions: Both medical and surgical management should be done for better treatment of brucella endocarditis. Repeat infection is a problem during follow-up.

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