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The moral intelligence of healthcare professionals in the cardiac operating room is one of the most important aspects of professional competence. However, moral intelligence is an abstract and multidimensional concept that needs to be clarified and described based on organizational culture and environment. Therefore, there is a need to design a specific scale for measuring the moral intelligence of healthcare professionals in the cardiac operating room. This study aims to design and assess the psychometric properties of a moral intelligence scale for healthcare professionals in the cardiac operating room. The present study was a mixed method study with a sequential exploratory approach. The research was conducted in 2023–2024 in Iran. The first phase data were collected from 20 healthcare professionals and were analyzed by conventional content analysis method. In the second phase, the validity and reliability of the instrument were evaluated by involving 300 healthcare professionals in the cardiac operating room. The moral intelligence of health care professionals in the cardiac operating room was defined as moral sensitivity combined with moral commitment and moral courage for the provision of quality care that respects the principles of medical ethics. After deducing the conceptual framework, the moral intelligence scale for healthcare professionals in the cardiac operating room was developed with three dimensions: "moral sensitivity," "moral commitment," and "moral courage." 11 items were removed during testing to ensure content validity. Face validity was confirmed with impact scores > 1.5 for all items. A scale was developed through factor analysis with three factors that accounted for 73.04% of the observed variance. The instrument's reliability using Cronbach's alpha coefficient calculation was reported as 0.94 for the entire instrument. The testretest showed no statistically significant difference between the pre and post-test scores of moral intelligence (p = 0.51). The moral intelligence scale demonstrated acceptable psychometric properties. The moral intelligence scale for health care professionals in the cardiac operating room demonstrated acceptable psychometric properties. This instrument may serve to assess the moral intelligence of healthcare professionals and determine the need for educational interventions to reduce the ethical challenges and improve the moral intelligence of this healthcare. [ABSTRACT FROM AUTHOR]

Background: SARS-CoV-2 may affect vital organs. The present study investigated the histopathology of pulmonary and cardiac tissues with clinical correlation in deceased patients with COVID-19. Methods: We obtained pulmonary and cardiac tissues from 30 deceased patients with COVID-19 in Tehran, Iran, from January to May 2021. Sampling was performed through a percutaneous needle biopsy. After slide preparation, two expert pathologists studied them. We assessed the correlation between clinical and pathological data by Fisher's exact test. Results: The mean age of the patients was 73.8 ± 13.4 years, and the male-to-female ratio was 23/7. The most common underlying disease was hypertension (HTN) in 25 patients (83%). Fifty-five tissue samples were achieved, including 28 pulmonary and 27 cardiac samples. Our results showed that all patients (100%) developed diffuse alveolar damage (DAD), and 26 (93%) developed hyaline membrane formation. The most common phase of DAD was the exudative-proliferative phase in 16 (57.1%). Three cardiac samples (11%) revealed myocarditis, and seven (26%) showed cardiomyocyte hypertrophy. In univariate analysis using Fischer's exact test, myocarditis had significant relationships with C-reactive protein (CRP) levels higher than 80 mg/dL (P = 0.008) and elevated cardiac troponin levels higher than two-fold (P = 0.01). Conclusion: COVID-19 can affect the major vital organs. However, only myocarditis had a significant relationship with the circulating levels of inflammatory factors. [ABSTRACT FROM AUTHOR]

Hydatid cyst mainly involves the liver and lung; however, it can rarely involve cardiac tissue. This study describes the presence of hydatid cysts in the heart with considerable disease points in Tehran, Iran. Two cases aged between 25 to 50 years with cardiac hydatid cyst involvement were identified in 2021 in Tehran, Iran. Epicardial hydatid cyst between a left anterior descending coronary artery (LAD) and left obtuse marginal artery (OM) on the left ventricle, and in the second case, intrapericardial cyst attached to the pulmonary trunk with a thin base were identified. The cardial cysts were resected, and the patients recovered without any complications. Cardiac hydatid cyst is a very rare disease. Rapid diagnosis and surgical and medical care are necessary for treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: The new coronavirus causes systemic inflammation and damage to various organs. So, this study aimed to follow up patients with COVID −19 after recovery for three months by performing cardiac, pulmonary and laboratory tests. MATERIALS AND METHODS: This was a prospective cohort study of COVID-19 patients who were discharged from Baharloo Hospital. The diagnosis of COVID-19 was confirmed by PCR or long CT scan. Inclusion criteria were age over 18 years and patients with more than 50% of pulmonary involvement in lung CT scan. The patients were called to Baharloo hospital three months after recovery and were examined for cardiac, pulmonary and blood tests. RESULT: Our study included 178 participants with mean age of 55.70, and 50.6% of them were male. Among pulmonary factors in the hospital, 71.9%, 15.7%,1.7%,19.1% and 53.4% had positive GGO, consolidation, reverse halo sign, traction bronchiectasis and vascular enlargement, respectively. After three months follow up, percentage of patients who had reticulation, honeycombing, fibrotic brand and bullae were 12%, 1.1%,8.4% and 0%, respectively. The Mean values of FVC and FEV1 were reported 4.21 and 3.01, respectively. Among Cardiac factors, positive PVC, PAC and mean Pap were decreased after three months. Only Growth in myalgia and Decreased sense of taste were statistically significant. Also, D dimer, UA protein, PMN, Ferritin CRP, PMN, LDH and HB amounts had decreased significantly. CONCLUSION: Our study indicated that in addition to pulmonary changes, rapid damage to other organs and the occurrence of cardiac symptoms and changes in laboratory result were also reported in patients recovered from COVID-19. [ABSTRACT FROM AUTHOR]

Background & Aims: The aging of the population has caused an increase in the number of elderly people who receive treatment for cardiovascular disease. The prevalence of coronary artery disease is higher in the elderly, and on the other hand, complications after cardiac events are worse in the elderly. The most common cause of death in the elderly is cardiovascular disease. Rapid restoration of blood flow can lead to myocardial survival, preservation of cardiac function, and prolongation of the patient's life, and many clinical trial studies have been conducted to investigate the effect of Thrombolytics, and their results showed that Thrombolytics preserve ventricular function. Primary coronary angioplasty was defined as the primary revascularization strategy for acute myocardial infarction without or with prior thrombolytic therapy. In the last two decades, it has been shown that the complications of coronary artery syndrome have decreased with the development of therapeutic strategies such as revascularization, medical treatment, and risk factors in follow-up after discharge. Data from many cardiovascular centers have shown that angioplasty not only leads to a significant reduction in mortality but also in coronary ischemic events. Elderly people who have concurrent diseases such as lung diseases, kidney diseases, and cerebrovascular accidents and suffer from coronary accidents accept angioplasty with caution. This is even though in symptomatic patients with chronic coronary disease, revascularization leads to the resolution of symptoms and improvement of the patient's life expectancy. Despite the effects of coronary artery disease on the quality of life, morbidity, and mortality of the elderly, in the majority of cardiovascular studies, the elderly 75 years and older were significantly less expressed and directly due to advanced age, and complex co-morbidities, and significant physical and cognitive disabilities., fatigue, living in a nursing home, and decline in daily functioning were excluded from the study. Therefore, recent guidelines cannot provide evidence-based recommendations for the diagnosis and treatment of coronary diseases in the elderly. Choosing the correct treatment strategy for the elderly with acute coronary artery disease is due to the importance of the burden of care from the economic, social, and family points of view. Also, few studies are comparing the effect of medical treatment with revascularization in the elderly 75 years and older. The aim of the study is to determine whether elderly people benefit from primary angioplasty compared to medical treatment alone and the side effects of each of these treatments in the elderly. Methods: The present study is a prospective cohort type, which was approved by the ethical code IR.TUMS.MEDICINE.REC.1397.934 in the ethical code commission of the Faculty of Medicine of Tehran University of Medical Sciences and 97 samples were taken in 9 months from June 2018 to the end of March. were collected and then for 24 hours and 30 days after the treatment (medical/angioplasty), the elderly (mostly 60 years old) with acute coronary artery disease were followed up in terms of the effectiveness and side effects of the treatments. All elderly people diagnosed with acute coronary syndrome hospitalized in two teaching hospitals of Tehran University of Medical Sciences were included in the study and evaluated in two groups. The first group of the interventional treatment group: was patients who were diagnosed with acute coronary syndrome and were treated with angioplasty from the beginning, and the second group, the optimal medical treatment group: patients who were treated with standard medical treatment from the beginning (including Thrombolytics, oral beta blockers, intravenous nitrates, antiplatelet Duals such as aspirin and Clopidogrel, intravenous anticoagulants such as heparin or enoxaparin, statin and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 2) were included according to the latest guidelines. In this prospective cohort study, all patients aged 60 years and older with the acute coronary syndrome were collected by face-to-face interview and case evaluation from two teaching hospitals, Tehran University of Medical Sciences from 2018, and they were divided into two primary and medical angioplasty groups in terms of complications., mortality and efficacy of 24 hours and 30 days were compared. Results: Out of 120 patients with an average age of 71.2±8.2 years, 52 and 68 patients received primary angioplasty and medical treatment, respectively. The majority of patients in the primary angioplasty group were male (57.7%) and female (57.4%) in the medical group (p=0.07). In the first 24 hours, comparing the two groups with the logistic regression method, atrial fibrillation was significantly 11 times higher in the medical group (p=0.016) and improvement of angina in the primary angioplasty group was 3.8 times higher (p=0.04). The 30-day mortality rate was significantly higher in the medical group (p=0.006). Conclusion: These results indicate that we overestimate the risks associated with revascularization in the elderly and deprive people of useful treatments. With increasing age, despite the significant reduction of hospital and short-term mortality by about 5 times, increasing the rate of angina recovery and fewer complications in angioplasty, this treatment method is less often chosen in elderly patients, and elderly people are less likely to choose this method due to their age. They are denied treatment. There are sufficient reasons for the elderly and very elderly with good tolerance to angioplasty. The success rate of immediate angioplasty and the survival rate without complications are similar to young patients, so old age is not a contraindication for angioplasty. Also, old age is not an independent risk factor for poor prognosis. In addition, complete revascularization in very elderly patients may improve prognosis and reduce the incidence of cardiac events. This study included limitations. Collecting samples from two different hospitals, one of these hospitals was not able to perform angioplasty in patients with angioplasty indication due to the lack of an angiography department, and the patients were forced to undergo medical treatment, which also led to a decrease in the number of The samples included in the angioplasty group and the bias in the selection of patients with real indications for medical treatment. On the other hand, it also leads to an increase in complications. The low sample size and the age of the patients included in the study were among the limitations of this study. [ABSTRACT FROM AUTHOR]

Background: COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has turn into a pandemic and has extended all over the world. Since the virus has the potential ability to severely impair heart and liver, analyzing the biochemical parameters is a suitable approach for clinicians to assess the outcome. Methods: This study was conducted along with 614 recognized COVID-19 patients. All samples were from Emergency department of Sina Hospital in Tehran, Iran, from February to May, 2020. Results: A total of 614 COVID-19 patients with mean age of 57.8 years (16-94 years) consisting of 385 (62.7%) male and 229 (37.2%) female were studied. Patients with COVID-19 had no significant difference between cardiac and liver parameters on the presentation and discharge time (p-value=0.05). Patients with COVID-19 had significant correlation in Lactate dehydrogenase (LDH), Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), and Total Bilirubin with recovery and mortality outcome (p-value=0.05). Also, high sensitivity cardiac Troponin-I, LDH, AST, and ALT in patients with COVID-19 were significantly associated with high in-hospital mortality (p-value<0.05). Conclusion: Several laboratory parameters may ease the evaluation of COVID-19 in-hospital mortality. Cardiac and liver parameters are critical in assisting COVID-19 cases. [ABSTRACT FROM AUTHOR]

Background: Foot-and-mouth disease (FMD) is a highly infectious viral disease, recognised to affect animals in the order Artiodactyla. The disease is rarely fatal in adult animals, however high mortality is associated with neonatal and juvenile infection. Case presentation: Five puppies died after being fed lamb carcases, the lambs having died during an outbreak of FMD in Iran. Following a post-mortem examination, cardiac tissue from one of the dead puppies was subjected to virus isolation, antigen ELISA, real-time RT-PCR, sequencing and confocal microscopy to assess the presence and characteristics of any FMD virus. The virological and microscopic examination of the cardiac tissue provided evidence of FMD virus replication in the canine heart. Conclusions: The data generated in this study demonstrate for the first time that FMD virus can internalise and replicate in dogs and may represent an epidemiologically significant event in FMD transmission, highlighting the dangers of feeding diseased animal carcases to other species. The reporting of this finding may also focus attention on similar disease presentations in dogs in FMD endemic countries allowing a better understanding of the prevalence of such events. [ABSTRACT FROM AUTHOR]

Background: Children with mitral valve prolapse (MVP) may be prone to ventricular arrhythmias due to transmural dispersion of repolarization (TDR). This study aimed to assess alterations in ventricular repolarization in children with MVP and to investigate their relationships with the degree of mitral regurgitation. Methods: Fifty children with MVP and 50 age- and sex-matched healthy children as controls were studied. Twelve-lead electrocardiography and echocardiography were performed in all the subjects. TDR parameters were QT and QTc intervals, QTc dispersion, Tp-e interval, Tp-e interval dispersion, Tp-e/QT, Tp-e/QTc, JTc, JTc dispersion, Tp-e/JT, and Tp-e/JTc. Results: The mean age of the 50 patients with MVP was 12.45±2.50 years (F/M: 15/35). There were no significant differences in QT and QTc intervals between the 2 groups. QTc dispersion (P=0.001), Tp-e dispersion interval (P=0.002), Tp-e/QTc (P=0.001), JTc dispersion (P=0.023), Tp-e/JT (P=0.004), and Tp-e/JTc (P=0.002) were significantly higher in the patients with MVP than in the healthy controls. Positive correlations were found between Tp-e dispersion interval and Tp-e/QTc and an increase in the degree of mitral regurgitation (P=0.012, r=0.42 and P=0.004, r=0.31, respectively). Additionally, positive correlations were detected between JTc dispersion and Tp-e/JTc and an increase in the degree of mitral regurgitation (P=0.032, r=0.20 and P=0.024, r=0.42, correspondingly). Conclusion: In this study, TDR was damaged in children with MVP and was positively correlated with an increase in the degree of mitral regurgitation. It appears that children with MVP are prone to life-threatening ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim The aim of this study was to explore cardiac patients' perception of patient-centred care. Background Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction. Design This study is a descriptive qualitative study. Methods Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews. Findings The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions. Conclusions Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care. Implications for practice Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care. [ABSTRACT FROM AUTHOR]

Objectives: Electrocardiographic (ECG) changes are reported frequently after acute strokes. It seems that cardiovascular effects of strokes are modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. We aimed to determine the pattern of ECG changes associated with pathophysiologic categories of acute stroke among patients with/ without cardiovascular disease and to determine if specific ECG changes are related to the location of the lesion. Materials and Methods: The electrocardiographic records of 361 patients with acute stroke were studied to assess the relative frequencies of ECG abnormalities among the pathophysiologic categories of stroke. Results: In the present study, the most common ECG abnormalities associated with stroke were T-wave abnormalities, prolonged QTc interval and arrhythmias, which were respectively found in 39.9%, 32.4%, and 27.1% of the stroke patients and 28.9%, 30.7%, and 16.2 of the patients with no primary cardiac disease. We observed that other ECG changes comprising pathologic Q- wave, ST-segment depression, ST-segment elevation, and prominent U wave may also occur in selected or nonselected stroke patients; thereby simulate an acute myocardial injury. We observed an increased number of patients with abnormal T-wave and posterior fossa bleedings and more rhythm disturbances for ischemic lesions, localized in the anterior fossa. Conclusion: Ischemia-like ECG changes and arrhythmias are frequently seen in stroke patients, even in those with no history or signs of primary heart disease, which support a central nervous system origin of these ECG abnormalities. Further study is necessary to better define the brain-heart interaction. [ABSTRACT FROM AUTHOR]

Background: Myocardial ischemia is one of several causes of prolonged QT dispersion. The aim of this study was to evaluate the effect that percutaneous coronary intervention has on the depolarization and repolarization parameters of surface electrocardiography in patients with chronic stable angina. Methods: We assessed the effects of full revascularization in patients with chronic stable angina and single-vessel disease who underwent percutaneous coronary intervention. Twelve-lead electrocardiograms were recorded before intervention and 24 hours subsequently. We measured parameters including QRS duration, QT and corrected QT durations, and JT and corrected JT duration in both electrocardiograms and compared the values. Results: There were significant differences between the mean QRS interval (0.086 ± 0.01sec vs. 0.082 ± 0.01 second; p value = 0.01), mean corrected QT dispersion (0.080 ± 0.04 sec vs. 0.068 ± 0.04 sec; p value = 0.001), and mean corrected JT dispersion (0.074 ± 0.04 sec vs. 0.063 ± 0.04 sec; p value = 0.001) before and after percutaneous coronary intervention. No significant differences were found between the other ECG parameters. Conclusion: Our data indicate that the shortening of corrected QT dispersion and corrected JT dispersion in patients undergoing percutaneous coronary intervention is prominent. [ABSTRACT FROM AUTHOR]

Background: Coronary Artery Disease (CAD) is one of the leading causes of mortality and morbidity all over the world. One of the most important predictors of the outcome of the coronary stenosis is the site of the lesions i.e. Proximal versus nonproximal lesions. This study designed to evaluate the relationship between CAD risk factors and site of stenosis. Methods: In this case- control study in the patients undergone coronary angiography (CAG) in Imam Khomeini Hospital, Tehran, Iran a total of 125 CAD patients with proximal lesion in CAG enrolled the study as case group and equal sex and age matched number of patients with non proximal lesion selected as control group. Two groups were compared based on presence or absence of DM, hypertension, hyper cholestrolemia, hypertriglyceridemia and cigarette smoking. Results: Relative frequency of DM was 33.6% and 10.4% in case and control group respectively (p< 0.0001). Relative frequency in two groups were 33.6 vs 28.8% For HTN (p= 0.41), 30.4% vs 29.6% for hyper cholestrolemia (p= 0.89), 19.2% vs 16.8% for hypertriglyceridemia (p= 0.062) and 28.8 vs 39.2 for C/S (p= 0.08). Multivessle disease was significantly more prevalent in diabetics compared with non diabetic patients 89.1% vs 61% (p< 0.0001), no relationship was seen with HTN (p= 0.41), Hyper cholestrolemia (p= 0.052) hypertriglyceridemia (p= 0.38) and cigarette smoking (p= 0.375). Conclusion: Proximal involvement of coronary arteries and multivessle disease in CAD patients is related to history of DM but not to history of hypertension, hypercholestrolemia, hypertriglyceridemia and cigarette smoking. [ABSTRACT FROM AUTHOR]

Introduction: Determining the underlying etiology of syncope provides valuable prognostic information and expedites the implementation of a therapeutic strategy. This study aimed to evaluate the ability of Canadian Syncope Risk Score (CSRS) in differentiating cardiogenic and non-cardiac syncope., Methods: The present diagnostic accuracy study was conducted on adult patients with syncope, who presented to the emergency departments of Shohadaye Tajrish and Imam Hossein Hospitals in Tehran from March 2018 to March 2019. The data required for determining CSRS were collected during the initial assessment and the underlying etiology was confirmed through further diagnostic follow-up under the supervision of a cardiologist or neurologist. Finally, the screening performance characteristics of the score were calculated., Results: 300 patients with the mean age of 56.38 ± 19.10 years were studied. The source of syncope was cardiac in 133 (44.3%) and non-cardiac in 137 (55.7%) patients. The area under the ROC curve of CSRS in differentiating cardiac syncope was 0.77 (95% CI: 0.715-0.824). At a cutoff point of -1.5, the sensitivity and specificity of the score were calculated to be 73.68% (95% CI: 65.21-80.75%) and 73.05% (95%CI: 75.54-79.47%), respectively., Conclusion: The present study reveals that CSRS has fair accuracy in differentiating the source of syncope and has no superiority over a clinical examination. Therefore, we do not recommend relying on the CSRS to differentiate between cardiac and non-cardiac syncope alone., Competing Interests: Declaration of Competing Interest The authors hereby declare that there is no conflict of interest regarding the present study., (Copyright © 2018. Published by Elsevier Inc.)