Abstract
Aim. This paper reviews the potential role of hypertensive disorders of pregnancy (HDP) as a risk factor for cardiovascular disease (CVD).
Background. CVD is one of the most important causes of mortality. Paying attention to the risk factors of CVD is of great importance in reducing mortality, the cost of treatment and care and improving health indicators. Over the recent years, HDP have been considered as a risk factor for developing CVD in later life. Method. This review study was conducted by searching out PubMed, Scopus, and Springer databases from 2016 to 2019, based on the availability of articles full text. The keywords included “hypertensive disorder of pregnancy AND cardiovascular disease AND risk AND screening”. At first, 223 articles were found that according to the title and with the elimination of repetitive and non-English language studies, the number of articles was reduced to 17, and 10 papers were reviewed.
Findings. Within the recent years, the incidence of CVD in women with a history of HDP has been considered. The main discussion in numerous studies has been focused on whether the presence of risk factors for CVD before pregnancy leads to HDP and then occurrence of hypertension in later years, or HDP is the risk factor for the onset of CVD in the future.
Conclusion. Pregnancy is considered as a stress test that unveiling CVD, therefore, it is important that the history of HDP to be considered in the list of risk factors for CVD in postpartum years. Annual blood pressure and renal function monitoring, lifestyle modification and paying attention to the CVD risk factors in this group of women is recommended.

Abstract
Aim. This study aimed to investigate the effect of clinical follow-up by a nurse on improving self-care behaviors in people with heart failure.
Background. People with heart failure are frequently hospitalized. One of the main reasons for hospitalization of these patients is the individual's inability to perform self-care behaviors. One of the ways that can help to improve self-care is clinical follow-up of these patients by nurses.
Method. This study was a randomized clinical trial which was conducted between October 2015 to May 2016 in Cardiovascular Medical and Research Center in Tehran. Eighty patients were recruited from the patients hospitalized in cardiac intensive care units and randomly assigned to control and experimental groups. Patients in experimental group received clinical follow-up by a nurse every two weeks by phone or in person. The control group received routine follow-up after discharge. Self-care behaviors were assessed by the checklist before intervention and three month after intervention. The data were analyzed in SPSS using descriptive and inferential statistics.
Findings. The mean score of self-care behaviors, before intervention was 2.64±1.62 in control group and 2.02±1.62 in the experimental group, and there was no statistically significant difference between groups. After intervention, the mean score of self-care behaviors in control and experimental group were 2.38±2.50 and 0.93±7.82, respectively and a statistically significant difference was found between the groups (p≤0.0001).
Conclusion: Clinical follow-up by a nurse can improves self-care behaviors in people with heart failure and help to lessen the burden.

Abstract
Aim. The present study was conducted to compare the effect of e-learning and lecture education on critical care nurses' performance about cardiovascular medication.
Background. The present time is known as the technology development time, and the educational institutions have undergone major changes. The complex learning process should not be limited to classroom and the use of  e-learning can help to overcome some barriers of traditional methods of education in nursing.
Method. This quasi-experimental study was conducted on 70 nurses working in intensive care units of social security hospitals in Isfahan province in 2017. They were recruited to the study and allocated randomly   to either lecture (n=35) or e-learning (n=35) group. Nurses’ performance was evaluated by the questionnaire of cardiovascular medication before and after the interventions, and the effect of two methods of e-learning and lecture training on nurses’ performance scores was compared.
Findings. Both lecture and e-learning methods had a statistically significant effect on nurses' medication performance (P≤0.0001). However, no statistical significant difference was observed between the two groups in terms of changes in nurses' medication performance.
Conclusion. E-learning can be a substitute for lecture education in-service-training of pharmacology topics for critical care nurses.

Abstract
Aim. This study was conducted to compare self-efficacy, life expectancy and death anxiety in people with and without heart disease.
Background. Cardiovascular diseases are the most common cause of mortality in many countries including Iran. This chronic disease may affects self-efficacy, life expectancy and death anxiety.
Method. The present study was a comparative study in which 75 people with heart admitted to Seyyed Al-Shohada hospitals, Urmia, Iran were compared with 75 individuals without heart disease in terms of self-efficacy, life expectancy and death anxiety. To collect the data, the Snyder Life Expectancy Questionnaire, General Sherer's Manual, and Thompson's Death Fear was used. Data were analyzed in SPSS software using descriptive and inferential statistics.
Findings. This study showed a statistically significant difference between people with and without heart disease in self-efficacy (51.36±9.11 against 66.30±10/60) (P≤0.0001) and life expectancy (39.66±8.78 against 46.12±6.87) (P≤0.0001). No statistical significant difference was found between the groups in terms of death anxiety.
Conclusion. It is recommended to take actions for improving self-efficacy and life expectancy in people with heart disease.

Abstract
Aim. This paper aims to review the effect of Extracorporeal Membrane Oxygenation (ECMO) method on treatment of drug poisoning caused by calcium blockers and beta-blockers.
Background. A large proportion of cardiovascular drug poisoning is associated with calcium channel blockers and beta-blockers. Among the various and severe symptoms of poisoning with these drugs, treatment of resistant shock or acute respiratory distress is considered as a challenge. Extracorporeal membrane oxygenation can be used as one of the effective therapies for this type of poisoning.
Method. This study is a literature review that was conducted through searching out databases Web of Science, Scopus and PubMed with keywords "Extracorporeal membrane oxygenation", "ECMO", "Calcium channel blocker" and "Beta blocker" in the title, abstract, and keywords of the articles. The articles with focus on the effects of ECMO on treatment of poisoning caused by calcium blocker and beta-blocker drugs were selected and reviewed.
Findings. Twenty articles were included, in which 23 patients with beta-blocker or calcium blocker poisoning were reported to be treated with ECMO as an adjunct device. VA-ECMO and VV-ECMO were used in 22 and one of cases, respectively. In general, the use of ECMO has been completely successful in more than 90 percent of those patients who suffered from cardiovascular drug poisoning.
Conclusion. In view of the newness of ECMO and the lack of clinical trials in this subject, the results of reported case studies indicate a high success rate of this method in treatment of calcium and beta-blockers poisoning. It is recommended this treatment to be considered by healthcare team to treat beta-blocker or calcium blocker poisoning.

Abstract
Aim. This study was conducted to determine the effect of cognitive-behavioral rehabilitation based on stress immunization training on anxiety, stress and depression in patients with coronary artery bypass graft surgery.
Background. Stress, anxiety and depression that play an important role in coronary artery disorders, are being considered as a hindrance to recovery after CABG. Providing the patient with correct coping strategies with stress seems to be helpful in preventing the recurrence.
Method. The study was a quasi-experimental with control group with pretest-posttest design. The statistical population of this study included patients who had coronary artery bypass graft surgery and referred to the Rehabilitation center of Tehran Heart Hospital, Tehran, Iran. Thirty subjects were selected by continuous sampling method and randomly assigned into experimental and control group. The instruments for data collection were “Depression, Anxiety and Stress Scale” (DASS-21), which completed before and after the intervention. The experimental group was exposed to stress immunization training in 10 sessions of 90 minutes. To analyze the data, multivariate covariance analysis, and one-variable covariance analysis were used in SPSS software.
Findings. Stress immunization training significantly influenced the anxiety (p≤0.0001; F=0.39), stress (p≤0.0001; F=0.35), and depression (p≤0.0001; F=0.68) scores of the experimental group compared to the control group.
Conclusion. Stress immunization training plays an important role in reducing negative emotions (anxiety, stress and depression) in patients with coronary artery bypass graft surgery. It is recommended to use this intervention for patients undergoing CABG.

Abstract
Aim. This review study aims to investigate the impact of reducing Door-to-ECG (DTE) time on on morbidity and mortality of patients with chest pain referred to emergency department.
Background. Chest pain is the second most common reason for referral to an emergency unit. According to American Heart Association, all patients with chest pain presenting to the emergency ward should be approached with an ECG within 10 minutes of entrance to the emergency department. This is considered as the first line of diagnostic tests for myocardial infarction.
Method. In this narrative review study, several databases and search engines including SID, Pub Med, Google Scholar, Web of Science and Scopus were used to find the articles published between 2000 and 2018. The keywords used to search articles were “Door to ECG”, “chest pain”, “emergency unit” and “triage”. The articles selected for review were interventional or descriptive in terms of design, in Persian or English, with available full text. The criterion for selecting articles was the similarity of the their subject with the search keywords including Door to ECG (DTE) time and triage and their value in the early diagnosis and treatment of coronary disorders.
Findings. A total of 20 articles were found. After removing the articles that didn’t meet the inclusion criteria, 11 articles related to the subject of the study remained in review. The significant outcomes of timely triage, appropriate time to perform ECG, barriers to access and suggestions for faster treatment by the system especially the role of nurses, were investigated.
Conclusion. The reduction of triage time and Door to ECG (DTE) time as well as the role of the nurse in those cases are associated with a reduction in the morbidity and mortality of cardiac patients.

Abstract
Aim. The aim of this study was to identify the factors affecting the outcomes in people with heart failure.
Background. Heart failure is a complex clinical syndrome. Due to functional and structural problems occurs in the heart failure and its high prevalence and associated financial burden, it is considered a public health problem. Mortality rate and serious complications from the disease are on the rise. Decreased quality of life and frequent hospitalizations are among these complications.
Method. In this review study, a comprehensive search on scientific databases and search engines such as Science Direct, Ovid, PubMed, Google Scholar, Medline was conducted with the keywords heart failure, education, health literacy education, heart failure knowledge, self care, readmission, family support and heart failure outcomes for papers published between 2003 to 2018.
Findings. Heart failure is associated with many problems and several factors affect the patient. Focusing on previous studies on factors influencing the outcomes of heart failure, we can refer to patient health literacy, self-care, heart failure knowledge and patient family support. Education of affected patients has also influenced the outcomes of the disease and frequent hospitalization of patients.
Conclusion. Patient education based on health literacy has effect on heart failure outcomes.

Aim. The aim of this study was to determine the role of resiliency and life expectancy in predicting psychological well-being of heart failure patients.
Background. Regarding the importance of psychological well-being in improving the health of patients with heart failure, examining the affective variables such as resiliency and life expectancy are of great importance.
Method. This research was a descriptive correlational study. Statistical population consisted of all of Rasht heart failure patients in 2018. 265 heart failure patients were selected using convenience sampling. The data collection instruments were Ryff's psychological well-being, Connor and Davidson’s resilience, and Snyder et al's hope. Abstract
Aim. The aim of this study was to determine the role of resiliency and life expectancy in predicting psychological well-being of people with heart failure.
Background. Regarding the importance of psychological well-being in improving the health of patients with heart failure, examining the relationship of affective variables such as resiliency and life expectancy with psychological well-being is of great importance.
Method. This research was a descriptive correlational study. Statistical population consisted of all of heart failure patients in Rasht, Iran, in 2018. In this study, 265 heart failure patients were selected using convenience sampling. The data collection instruments were the questionnaires Ryff's psychological well-being, Connor and Davidson’s resilience, and Snyder et al.’s hope. The collected data were analyzed using Pearson correlation coefficient and stepwise multiple regression.
Findings. There was a positive relationship of psychological well-being with resiliency (r=0.386) and life expectancy (r=0.396). The regression analysis showed that the meaning of life and subscales of factor thinking and spiritual influences can significantly predict 0.228 of psychological well-being in heart failure patients.
Conclusion. Regarding the determinants of psychological well-being in this research, psychological well-being and quality of nursing care in heart failure patients can be increased using interventions such as resiliency education programs and psychological treatments focusing on hope.
The collected data were analyzed using pearson correlation coefficient and stepwise multiple regression.
Findings. The results of this study revealed positive relationship between resiliency and life expectancy with psychological well-being. The regression showed that meaning of life and subscales of factor thinking and spiritual influences can predict psychological well-being of heart failure patients.
Conclusion. Regarding the determinants of resilience in this research, psychological well-being of heart failure patients can be increased using interventions such as resiliency education programs and psychological treatments focusing on hope.

Abstract
Aim. This study aimed to compare the effect of spaced and mass education on stress and anxiety in candidates for angiography.
Background. Regarding the role of education in reducing stress and anxiety before angiography, comparison of the effect of spaced and mass education seems to be important in managing stress and anxiety in people experiencing this procedure.
Method. In this interventional study, statistical population consisted of candidates for angiography referred to selected hospitals of Isfahan in 2018. Sixty candidates for non-emergency angiography were selected by convenience sampling and were randomly divided into two groups of 30. The data collection instruments were the questionnaires demographic information, Cohen`s Perceived Stress (PSS14) and Spielberger`s Anxiety Inventory. Initially, all three questionnaires were completed by the participants. Then the education was provided by the researcher to the participants of the mass education group individually and face to face for 25 to 45 minutes (according to the participants tolerance) and in the end of the session, a 5 to 10 minutes time were given for answering participants’ questions. In the spaced education group, the educational content was provided by the researcher in three stages of 10 to 15 minutes and in groups of 3 to 6 participants. After the training of both groups, stress and anxiety were measured again by the questionnaires. Data were analyzed in SPSS version 16 using descriptive and inferential statistics.
Findings. Before and after intervention, there was no statistically significant difference between two groups in terms of mean scores of stress, state anxiety and trait anxiety. After intervention, a statistically significant decrease in mean scores of stress, state anxiety and trait anxiety were found in each group compared with before intervention.
Conclusion. Regarding the similar effect of spaced and mass education on stress and anxiety in candidates for angiography, it is recommended to use mass education method for candidates before angiography, since it is more cost effective and time saving than spaced education method.
 

Abstract
Aim. This study was conducted with the aim of determining the effect of peer education on outcome in people with heart failure.
Background. Heart failure is a complex clinical syndrome that is considered as a public health problem due to its chronic, progressive and irreversible nature.
Method. In this review study, a comprehensive search of scientific databases and search engines such as Science Direct, Scopus, PubMed, Google Scholar, and Medline using the keywords heart failure and peer education in both Persian and English language was done to find literature published between 2000 and 2018.
Findings. Studies about the effect of peer education on outcomes of heart failure patients in the country showed that these trainings have examined three outcomes of self-care, quality of life and self-efficacy in people with heart failure, and that this method has had a positive effect on all three components.
Conclusion. Peer education improves self-care, self-efficacy, and quality of life in people with heart failure. It is recommended to use this training program as an effective, cost-effective method without the need for specialized equipment.

Abstract
Aim. The purpose of this study was to report a case of mitral valve thrombosis.
Background. Cardiac valve diseases are among the most important diseases, which is widespread despite many treatments. Among the wide range of treatments, replacement or repair of the valve are among the standard treatments. This treatment has many side effects that can be prevented by adhering to a proper diet. The present reports a rare case of mitral valve thrombosis.
Case Report. A 50-year-old female patient undergoes mitral valve replacement (mechanical) and tricuspid valve replacement (mechanical) dated 2018. After discharge, she was treated with 5 mg Warfarin and 80 mg ASA. She returned to the hospital due to progressive shortness of breath. A rare complication of mitral valve thrombosis was diagnosed.
Conclusion. Mitral mechanical valve thrombosis is a rare but dangerous complication. Although thrombosis is closely associated with anticoagulant drug use, this study and similar studies have shown that there is usually no clear relationship between INR and thrombosis.

Abstract
Aim. This study was conducted to investigate palliative care in people with heart failure.
Background. Heart failure as a syndrome of cardiac dysfunction has a variety of pathophysiology. Progress in knowledge related to heart failure has led to improvement in survival, but the incidence and prevalence of the syndrome is incremental. Cure of the disease is rarely possible and as a chronic disease it can significantly affect the patient, family and health care system. Providing care for patients with heart failure is a complex phenomenon and as the disease progresses to the late stages, palliative care takes a larger part of the caring.
Method. In this review study, scientific databases and search engines such as SID, Scopus, PubMed, and Web of Science were searched for to find articles published from the beginning of 2000 to 2017. The keywords used for the search included heart failure, palliative care and their Persian equivalent. Papers in Persian and English that were available on the common theme of heart failure and palliative care were reviewed.
Findings. A total of 36 English and one Persian article were reviewed. The definitions of palliative care, views on palliative care, palliative care drugs, types of palliative care providers, palliative care models, palliative care delivery to family caregivers, and the future of palliative care were the topics covered in the reviewed articles.
Conclusion. Palliative care for people with heart failure should be considered in line with the treatment plan of these patients. Special attention should be payed to development of specialty palliative care and long-term planning for primary palliative care

Abstract
Aim. The aim of this review was to investigate the role of Catecholamines in the pathogenesis of Takotsubo cardiomyopathy and related nursing care.
Background. Takotsubo cardiomyopathy is an acute syndrome characterized by acute reversible systolic dysfunction of the apical and middle segments of the left ventricle in the absence of significant coronary artery occlusion. It is believed that emotional and physical stressors are the main drivers for the disease. Despite many years of efforts to better understand this disorder, current knowledge is limited, but several authors have agreed on the relationship between Catecholamines and the development of this syndrome.
Method. This study was carried out by searching the databases and search engines (PubMed, Google Scholar, and Web of Science) to find full text articles published between 2014-2018 using the keywords "Broken heart syndrome", "Apical ballooning syndrome", "Takotsubo cardiomyopathy", "Stress-induced cardiomyopathy", “Catecholamines”, “Nursing” and “Nursing care”. Of 392 articles, 21 were included in the study.
Findings. Among the various hypotheses, Catecholamine-induced microvascular dysfunction is currently the most accepted hypothesis. Stressful stimuli can increase the activity of the Hypothalamus-Pituitary- Adrenal axis and release Catecholamine. If Catecholamines are the leading cause of Takotsubo cardiomyopathy, it is quite possible that prescribing exogenous Catecholamines cause this condition.
Conclusion. Although many studies have attributed some of the Catecholamine toxicity to the pathophysiology of Takotsubo cardiomyopathy, due to the potential impact on current treatment strategies, further study is required. Due to cardiovascular side effects, the use of Catecholamines for therapeutic purposes requires more evidence. Regarding the similarity of the symptoms of this syndrome with myocardial ischemia, nursing care in this type of cardiomyopathy is very important.

Abstract
Aim. The aim of this study was to determine the relationship of family members’ health literacy and performance in face of myocardial infarction.
Background. Myocardial infarction is one of the most important causes of death and disability in developed and developing countries. Proper performance of patients' attendance in early hours of myocardial infarction event plays an important role in reducing mortality and morbidity. Health literacy is also known as one of the major determinants of understanding information about health.
Method. In this descriptive-correlational study, 286 family members of patients experiencing myocardial infarction that witnessed the vent were recruited in the study by convenience sampling method and based on inclusion criteria of reading and writing literacy and age over 18 years old. Data were collected using a demographic form, Iranian adult health literacy questionnaire (HELIA) and the questionnaire performance during myocardial infarction. Data were analyzed in SPSS version 22 using descriptive statistics (frequency distribution, mean, standard deviation) and inferential statistics (mean comparison, correlation and regression tests).
Findings. Health literacy mean score (61.49±21.05) showed an adequate level. “Assessment skills” and “decision making and application of health information” had, respectively, the lowest (52.68±25.30) and the highest (68.07±19.87) mean score among health literacy dimensions. There was a statistically significant relationship of health literacy with age, education and medical profession in the family (P≤0.0001). Only 17.98 percent of the participants had a good level of performance (Scores 6.8 to 10). The history of myocardial infarction in patient and the duration of the patient transition from the onset of pain to arrival to the hospital showed a statistically significant relationship with performance, meaning that family members of patients with a history of myocardial infarction were able to transfer their patient to the hospital in less than half an hour (P≤0.0001). A statistically significant relationship was found between health literacy and performance; those with higher level of health literacy had better performance. Of the health literacy domains, only understanding had a significant relationship with performance (P=0.004).
Conclusion. Although the mean score of health literacy was adequate, the participants hadn't good performance. Therefore, improving the performance of community and family members by health service providers including nurses, mass media, practitioners, and health promotion planners for educational interventions is recommended. Proper planning to increase specific health literacy can prevent adverse outcomes in this area.