The Journal of Tehran University Heart Center

Investigating Thirst Dimensions in Heart Failure Patients Using the Theory of Unpleasant Symptoms: A Cross-Sectional Study

2025-04-26T10:42:14+00:00

Background: Thirst, a distressing complication in heart failure (HF) patients, arises from factors such as vasoconstriction in the salivary glands, alterations in the sympathetic nervous system, fluid restriction, nursing care practices, and pharmacotherapy. This study aimed to explore the dimensions of thirst in HF patients using the Theory of Unpleasant Symptoms (ToUS).

Methods: A descriptive cross-sectional study was conducted on 217 HF patients admitted to hospitals affiliated with Shahid Beheshti University of Medical Sciences, namely Imam Hossein, Luqman Hakim, and Shahid Modares in Tehran, Iran, from May through November 2020. Participants were selected through purposive sampling based on inclusion criteria. Data were collected using the Demographic Survey Form (DSF), Thirst Intensity Visual Analogue Scale (TI-VAS), Thirst Frequency Scale (TFS), and Thirst Distress Scale (TDS). Descriptive and analytical statistics were employed for data analysis using SPSS (version 20).
Results: The mean ± standard deviation scores for thirst intensity and thirst distress were 47.53±26.37 (moderate level) and 25.92±8.13 (high level), respectively. A significant proportion of patients (35.9%) experienced high levels of thirst distress. Additionally, 61% of participants reported feeling thirsty almost daily over the past month, with thirst persisting throughout the day. Key predictors of thirst intensity and distress included educational level; HF class; living conditions; fluid restriction; use of angiotensin-converting enzyme inhibitors, β-blockers, aldosterone antagonists, and diuretics; and the presence of diabetes.

Conclusion: Given the high prevalence and distressing nature of thirst in HF patients, nurses should prioritize assessing thirst during care delivery. Identifying contributing factors and predicting thirst intensity during patient history-taking can enhance management strategies.

Classification of Cardiac Arrhythmias Using Fractal Dimensions

2025-04-26T10:42:13+00:00

Fractals are an intriguing mathematical tool that enables us to model the intricate structures found in nature and comprehend the complexity of such objects. They serve as a valuable resource for better understanding our world. Fractal objects are typically characterized by their fractal dimension, which plays a vital role in the analysis of fractal signals. In this study, we define the concept of fractal dimension and present various methods for its calculation. We demonstrate that the electrocardiogram (ECG) is a fractal signal, allowing us to classify heartbeats based on fractal theory. Our goal is to develop a digital technique for ECG signal analysis, with the aim of achieving accurate diagnosis of cardiovascular diseases.

Prevalence and Short-Term Outcomes of Postprocedural Complete Heart Block in Congenital Heart Disease Correction in Children

2025-04-26T10:42:12+00:00

Background: Complete heart block (CHB) is a known complication of congenital heart disease (CHD) corrections in children. However, data on the prevalence and short-term outcomes of postprocedural CHB in this population are scarce.

Objectives: This study aimed to investigate the prevalence and short-term outcomes of postprocedural CHB in pediatric patients undergoing surgical or transcatheter procedures to correct CHD.

Method: A retrospective cohort study was conducted on pediatric patients under 18 years old who underwent CHD corrections between March 2019 and April 2020 at a tertiary cardiac center in Isfahan, Iran. Patients with a history of arrhythmia or heart block before surgery were excluded. The medical records of these patients were reviewed to identify cases of postprocedural CHB. The prevalence, risk factors, and short-term outcomes of postprocedural CHB were analyzed.

Result: This study involved 840 patients with a mean age of 3.4 ± 4.3 years, with 47.8% being male. CHB was identified in 22 patients (2.6%) during the postprocedural period, with a prevalence of 0.6% in the transcatheter group and 4.7% in the surgical group. Patients with postprocedural CHB were younger than non-CHB patients. The most common CHDs were patent ductus arteriosus and ventricular septal defect (VSD). Univariate and multivariate regression analyses showed that the type of procedure (surgical method) and the type of CHD (VSD) correlated with postprocedural CHB. Patients who developed postprocedural CHB had a longer mean stay in the pediatric cardiac critical care unit than non-CHB patients. The postoperative in-hospital mortality rate was 5.2%, with no correlation between CHB occurrence and in-hospital mortality.

Conclusion: The findings highlight the importance of attentive monitoring for postprocedural CHB, particularly in younger patients, to facilitate timely intervention and improve outcomes. Further research is warranted to explore the long-term complications and risk factors associated with postprocedural CHB in this patient population.

Correlation between Left Atrial Echocardiographic Deformation Parameters and Invasive Left Ventricular End-Diastolic Pressure Measurements

2025-04-26T10:42:11+00:00

Background: The noninvasive estimation of elevated left ventricular end-diastolic pressure (LVEDP) is a critical step in assessing left ventricular diastolic dysfunction (LVDD). Nonetheless, most echocardiographic parameters currently used for this purpose have significant limitations. Recent studies have highlighted the utility of left atrial (LA) strain as a noninvasive method for estimating LVEDP. This study aimed to explore the correlations between LA deformation parameters, measured using speckle-tracking echocardiography (STE), and invasively obtained LVEDP.

Methods: This prospective study involved 82 patients in sinus rhythm who underwent left heart catheterization at our center. All participants underwent comprehensive transthoracic echocardiography and peak atrial longitudinal strain (PALS) assessment via STE within 12 hours before catheterization.

Results: LVEDP was elevated in 45 patients (54.9%) and normal in 37 (45.1%). PALS, LA ejection fraction, and septal E’ showed moderate inverse correlations with LVEDP (r= −0.590, P=0.001; r= −0.463, P=0.001; and r= −0.449, P=0.001, respectively). The E/E’ ratio also exhibited a moderate correlation with LVEDP (r=0.567, P=0.001). Lateral E’ and the E/A ratio demonstrated weaker inverse correlations with LVEDP (r= −0.231, P=0.037 and r= −0.229, P=0.038, respectively). In multivariate logistic regression analysis, age (OR, 1.14, 95% CI, 1.02 to 1.27), PALS (OR, 0.77, 95% CI, 0.65 to 0.91), and the E/E’ ratio (OR, 1.36, 95% CI, 1.11 to 1.89) were identified as independent predictors of an LVEDP≥12 mm Hg. PALS demonstrated the highest diagnostic accuracy for predicting an LVEDP≥12 mm Hg, with an AUC of 0.849 (95% CI, 0.764 to 0.935; P<0.001). A PALS cutoff value of 35% yielded a sensitivity of 81.1% and a specificity of 81.4% for predicting elevated LVEDP.

Conclusion: PALS emerged as a reliable noninvasive parameter for predicting elevated LVEDP. Its application may facilitate the earlier identification of LVDD.

The Effect of Implementing Orem’s Self-Care Model on the Quality of Life of Patients with Myocardial Infarction: A Quasi-Experimental Study

2025-04-26T10:42:10+00:00

Background and Objective: Myocardial infarction (MI) is one of the most prevalent cardiovascular disorders and a progressively debilitating condition. Patients with MI often experience a reduced quality of life (QoL), primarily due to the severe complications associated with the disease. Enhancing QoL and self-care practices in these patients is essential. Self-care training is a potential strategy to improve QoL in this population. Consequently, this study aimed to explore the impact of implementing Orem’s self-care model on the QoL of MI patients admitted to the ICU.

Methods: This study utilized a quasi-experimental design and was conducted between February 2021 and August 2022. The study population consisted of 70 MI patients hospitalized in the ICU of a hospital in Ilam City. Eligible patients, based on inclusion and exclusion criteria, were divided into intervention and control groups. Data were collected using a questionnaire comprising 3 sections: 1) demographic information, 2) needs assessment based on Orem’s model, and 3) the MacNew Heart Disease Health-related Quality of Life questionnaire. The intervention group received four self-care training sessions (each lasting 30–45 minutes) delivered through in-person, virtual, and phone-based methods, along with a self-care training booklet. Participants in both groups completed the QoL and self-care questionnaires before the intervention, as well as 2 weeks and 2 months after the intervention, via face-to-face visits or phone/virtual interviews. The collected data were analyzed using SPSS, version 26. The normality of the data was confirmed using the Kolmogorov-Smirnov test, and repeated-measures ANOVA was employed to compare QoL scores across different dimensions between the intervention and control groups before and after the implementation of Orem’s model.

Results: The findings revealed no significant difference in the mean QoL scores between the intervention and control groups before the intervention (mean difference =5.2±2.3; P=0.05). However, after the intervention, a significant difference in the mean QoL scores was observed between the 2 groups (mean difference =15.9±8.1; P=0.001).

Conclusion: Orem’s self-care training effectively enhanced the QoL of MI patients, indicating that the approach is a viable non-pharmaceutical strategy for improving QoL in this patient population.

Cost-Effectiveness of Icosapent Ethyl for Ischemic Cardiovascular Events

2025-04-26T10:42:09+00:00

Background: Icosapent ethyl (IPE) has demonstrated efficacy and safety in reducing the risk of ischemic cardiovascular disease. This study aimed to systematically gather and synthesize existing cost-effectiveness analyses of IPE combined with statin therapy for cardiovascular risk reduction in primary and secondary prevention settings.

Methods: Comprehensive electronic searches were conducted across PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the NHS Economic Evaluation Database (NHS EED), and the Health Technology Assessment (HTA) database to identify relevant literature (up to May 2024). From an initial pool of 580 studies, 11 met the predefined inclusion criteria.

Results: The findings demonstrated that IPE significantly decreased hospitalization and mortality rates compared to standard treatments. The study indicated that IPE provided greater quality-adjusted life years and life-years gained than statin therapy alone. However, IPE is more expensive than conventional medications, such as statins. For instance, the 1-year cost of IPE is $3768 in Australia and $3497 in the United States per patient. Additionally, the results revealed that the threshold for assessing the effectiveness of IPE ranged from $50,000 to $150,000 in the United States and AUD 50,000 ($39,000) in Australia.

Conclusion: Based on the current study, IPE is cost-effective, with a higher probability of cost-effectiveness in patients undergoing secondary prevention than those in primary prevention

Primary Ewing Sarcoma in the Right Ventricle in an Adult Patient: A Case Report

2025-04-26T10:42:03+00:00

Ewing sarcoma, a highly aggressive round-cell neoplasm of unknown origin, rarely occurs as a primary cardiac tumor. In this intriguing case, we describe an instance of primary Ewing sarcoma in an adult patient’s right ventricle (RV). The patient, a 27-year-old man, presented with symptoms including epigastric pain, fever, tachycardia, nausea, vomiting, shortness of breath, and a dry cough. Imaging studies, including a computed tomography scan and echocardiogram, revealed an anterior mediastinal mass arising from the free wall of the RV and extending into the pericardium. The mass exerted pressure on the RV outflow tract and the pulmonary artery. Surgical intervention was deemed necessary based on the clinical presentation and paraclinical findings. The mass was meticulously dissected from the cardiac tissue, and the RV outflow tract was resected, along with the pulmonary valve and the main pulmonary artery. These structures were replaced with a composite Dacron graft, anastomosed to the bifurcation of the main pulmonary artery. Additionally, the mass near the superior vena cava and the pulmonary vein region was carefully excised. The patient was successfully weaned off the cardiopulmonary bypass pump in stable condition and transferred to the ICU. Histopathological analysis confirmed the diagnosis of small round cell sarcoma, specifically Ewing sarcoma. Following recovery, the patient was discharged and scheduled for regular follow-up appointments. Following discharge, the patient was referred to a radiotherapy center and underwent radiotherapy. During a follow-up examination 1 year later, no signs of disease recurrence or progression were observed, offering a promising outlook. This case underscores the importance of timely referral and treatment for cardiac Ewing sarcoma, which may significantly improve prognosis.

Left Ventricular Tubercular Myocarditis with Unique Imaging Features on Cardiac MRI: A Case Report

2025-04-26T10:42:06+00:00

Myocarditis is a rare manifestation of tuberculosis, often associated with high morbidity and mortality. Cardiac magnetic resonance imaging (MRI) is a critical imaging tool for assessing infiltrative myocardial conditions. We describe the case of an adult patient from a tuberculosis-endemic region who presented with sudden-onset symptomatic arrhythmias. Cardiac MRI findings included heterogeneous signal intensity in the left ventricular myocardium, altered myocardial nulling time, and a patchy “zebroid-like” pattern of late gadolinium enhancement. Additionally, necrotic supraclavicular and retroperitoneal lymphadenopathy were observed. Fine-needle aspiration cytology of the affected lymph node revealed epithelioid inflammatory granulomas. The patient was diagnosed with disseminated tuberculosis and tubercular myocarditis. Following the initiation of a standard anti-tubercular regimen, significant clinical improvement was noted at the 2-month follow-up.

Successful Management of Post-Infarction Ventricular Septal Rupture: A Case Report

2025-04-26T10:42:05+00:00

Background: Post-infarction ventricular septal rupture (PIVSR) is a rare but severe mechanical complication of myocardial infarction (MI) associated with a high mortality rate. Hemodynamic instability is inevitable both during the progression of the condition while awaiting timely surgical intervention and in the postoperative period. Continuous hemodynamic monitoring can enhance the observation of a patient’s circulatory status, facilitate prompt and targeted interventions, and ultimately improve prognosis.

Case Presentation: A 65-year-old man presented with dyspnea 19 days after the onset of MI. He was referred to our hospital with symptoms of acute heart failure and a grade IV/VI pansystolic murmur audible at the apex. Echocardiography revealed a 14 mm ventricular septal defect at the apical region, accompanied by a left-to-right shunt. The patient was stabilized in the cardiovascular care unit and scheduled for ventricular septal rupture (VSR) closure and coronary artery bypass grafting. The procedure was performed on the 16th day of hospitalization. Postoperatively, the patient developed shock due to bleeding and cardiac tamponade, necessitating 2 redo surgeries. Despite these complications, the patient ultimately survived following extensive stabilization efforts.

Conclusion: Hemodynamic monitoring and stabilization are critical factors in determining the prognosis of patients with PIVSR. Timely diagnosis of postoperative complications that compromise hemodynamics, combined with a collaborative interdisciplinary team approach, can enhance treatment strategies, significantly reduce fatal complications and morbidity, and ultimately improve the patient’s likelihood of survival.

Coexistence of Hemoglobin D and Thalassemia Trait: A Rare Phenomenon with Cardiac Presentation

2025-04-26T10:42:04+00:00

Hemoglobin D (HbD) is a hemoglobin variant predominantly found in the northwestern regions of India, such as Punjab and Gujarat, as well as in Pakistan, Iran, and other countries. This variant results from a genetic mutation at the 121st amino acid residue, where glutamic acid is replaced by glutamine. HbD can occur in either homozygous or heterozygous forms. Individuals with HbD typically remain asymptomatic throughout their lives. Nonetheless, HbD can occasionally coexist with sickle cell disease, leading to clinical manifestations. The co-inheritance of HbD with thalassemia, though rare, is believed to present clinically, though such cases are scarcely documented in the literature.

This article reports a case from the Bathinda district of Punjab involving a patient with coexisting HbD and thalassemia trait who presented with severe cardiac symptoms, potentially as a late consequence of hemoglobinopathy due to underlying chronic anemia. Additionally, we propose an algorithm designed to assist clinicians and diagnostic laboratory experts in the streamlined evaluation of hemoglobinopathies. This is particularly relevant given the limited availability and affordability of genetic allele testing in most clinical settings.