Aim

 The aim of this study was to evaluate the effect of face-to-face education on knowledge, attitude, and believes of acute coronary syndrome patients about heart disease and their reaction to symptoms.

Background

 Coronary artery disease is known as an important health issue. Mortality results from myocardial infarction are highly dependent on time interval between symptoms presentation and reperfusion intervention. Reperfusion leads to the best results, especially if started within the first 60 minutes after beginning the manifestations. Many studies have been conducted to examine strategies for decreasing delay time, but education through media has not received enough attention.

Method

 In this clinical trial, 300 patients referred to Shahid Radjaee Cardiovascular Hospital and diagnosed as acute coronary syndrome were randomly allocated to receive either education and counseling as intervention (n=150) or regular education (control group, n=50). The inclusion criteria were: not having serious complicated co-morbidity such as psychiatric disorder, renal insufficiency, malignancies or neurologic disorders and speaking and comprehending Pesian. Data collection instruments were demographic form and Rapid Early Action for Coronary Treatment (REACT). Data were collected before intervention and one and three months after the beginning of intervention. The data were analyzed by SPSS.

Findings

 The study findings showed high rate of reporting risk factors in both groups. Most patients of both groups had referred to cardiologist. In experimental group, knowledge, attitude and belief scores increased significantly, one and three months after the beginning of the intervention. Between group comparisons showed a statistically significant difference between two groups in terms of knowledge, attitude and belief scores (P≤0.0001).

Conclusion

 Face-to-face education and counseling improves knowledge, attitude and believes of the patients about acute coronary syndrome, thereby, may reduces delay in treatment. Improvement of patients’ knowledge is the basic step for symptom management of the acute coronary syndrome.

Abstract

Aim.This study aimed to compare pulse pressure variation (PPV) with central venous pressure (CVP) in checking out and optimizing fluid volume in mechanically ventilated patients admitted to intensive care unit after cardiac surgery.

Background.In clinical area, assessment of body fluid and determination of the intravascular volume  after major surgeries such as heart surgery is a significant challenge. The initial purpose of intravascular volume assessment in patients with hemodynamic instability is to determine whether they would benefit from fluid administration or not.

Method. In the present study a prospective descriptive-analytic design was used. Thirty mechanically ventilated patients admitted to intensive care units of Rajaee Heart Center, Tehran, Iran, were recruited in the study after cardiac surgery based on inclusion criteria. Data collection tools included demographic and clinical data sheets. Hemodynamic parameters such as CVP, systolic and diastolic pressures (for calculating pulse pressure and its variation) were recorded by bedside monitoring. Cardiac Index (CI) was measured by non invasive continuous cardiac output monitoring (NICCOMO) system. Data were analyzed in SPSS version 20, using statistical tests.

Findings. The mean changes of CVP, before and five minutes after fluid administration, were significantly different (10.10±6.01 mmHg and 12.37±6.34 mmHg, respectively, p=0.015). The mean changes in arterial pulse pressure, before and five minutes after fluid administration, were significantly different (16.94±8.32 mmHg and 12.77±4.02 mmHg, respectively, P=0.005). At the cut point 2.8 lit/min/m2 for CI, the sensitivity and specificity values for PPV>13%, were 0.71 and 0.61, respectively. Also, at the same cut point, the sensitivity and specificity values for CVP<5mmHg, were 0.11 and 0.84, respectively. These findings suggest a higher diagnostic power  of  PPV compared to CVP to assess fluid volume.

Conclusion.It seems that in the mechanically ventilated patients after heart surgery, PPV dynamic index is preferred to CVP static index to evaluate and maintain fluid volume.