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 Background & Objective: Despite all improvements in diagnosis and treatment, one third of patients with Myocardial infarction lose their life. Different studies have shown that cardiac arrhythmia are the most common cause of death in MI, and cardiac blocks are one of the important groups of these arrhythmia, which are effective in prognosis, duration of hospitalization and hospital mortality of the patients.

  Methods : In this study, 630 patients with AMI, who were admitted in CCU of Bou-Ali hospital in Ardabil from January 1998 to January 2001 were studied and the data were callected with the help of questionnaires and secondary data analysis method. The data were analyzed with statistical methods.

  Results : 9.4% of cases in this study had AV block and 30.2% had bundle branch block. 40.5% of men and 37.6% of women had at least one kind of block(in AV node or bundle branch), but no significant relation was found between sex and these blocks. Also, 62% of in-hospital mortalities of patients with AMI were in association with blocks (AV or bundle branch) and only 38% of mortalities were without blocks. This showed a meaningful relation between hospital mortality and these kinds of blocks (p <0.05 ).

 Conclusions: The total frequency of AV and bundle branch blocks due to AMI, was 39.6% which is similar to other studies, but what is remarkable in this study, is the higher prevalence of bundle branch blocks due to AMI.

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  Background & Objectives: Acute myocardial infarction (AMI) is one of the most common causes of admissions in industrialized countries and each year a lot of deaths occur due to this disease. AMI is commonly associated with leukocytosis and an elevated neutrophil count. It is not clear whether neutrophilia is a cause or effect of acute myocardial injury and heart failure. Nevertheless, proving such a correlation will have a lot of clinical utilities.

  Methods: From among 146 patients hospitalized by AMI diagnosis in the CCU ward of Shahid Madani hospital, 68 patients (having our inclusion criteria) took part in this cross-sectional and analytical study. The criteria for AMI were clinical symptoms, ECG criteria and paraclinical findings. CBCH₁ was performed for the patients. All the patients were evaluated for presence or absence of congestive heart failure (CHF) in first 4 days of hospitalization. The data were analyzed with SPSS software using t-test and Chi-square.

  Results: Mean neutrophil count was 11291 in patients with evidence of congestive heart failure (CHF) and 8440 in those without it (P =0.01). This difference was statistically significant. Among 23 patients with CHF, 16 had neutrophil counts >8500, but among 45 patients without CHF only 19 cases showed this value (Odds ratio=3.12, P=0.03). Also among 35 patients with neutrophil counts >8500, 24 patients had ejection fraction (EF) of less than 45% and 11 cases had EF>45%(P=0.015).

Conclusion: In this study we found a direct correlation between neutrophilia on admission and the presence of CHF and echocardiographic left ventricular dysfunction in first 4 days of hospitalization. So the patients with high neutrophilia need more invasive treatments to reduce the possibility of CHF.

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Background & Objectives: Coronary artery diseases and acute myocardial infarction are among the most common causes of death worldwide. Revascularization techiques have a major role in the management of this disease. Thrombolytics especially stereptokinase have been widely used because they do not require any expertise. Stereptokinase therapy may cause reperfusion of infarct area which in turn can result in arrhythmia. This study was performed to determine the sensitivity and specificity of developing reperfusion arrhythmias in predicting left ventricle function in patients with anterior myocardial infarction.

Methods: This descriptive and cross-sectionel study was conducted on 100 patiens with acute anterior myocardial infarction who were admitted to CCU ward of Buali hospital and received stereptokinase. The patients with history of heart failure and contraindication to stereptokinase therapy and patients who had died in the first 6 hours of myocardial infarction were excluded from the study. During the first 24 hours after admission echocardiography was performed for obtaining left ventricle ejection fraction. The data were gathered and analyzed with SPSS saftware using descriptive and inferential statistics.

Results: 52% of the patients encountered arrhythmia during receiving stereptokinase,  33% of whom had normal left ventricle function and 19% encountered significant dysfunction of left ventricle. From remaining 48% who didn’t encounter arrhythmia, 21% had normal function of left ventricle and in the rest of them it was impaired.

Conclusion:This study showed that the creation of arrhythmia due to reperfusion can predict the consistency of LV functioning with a sensitivity of 61% and a specificity of 58%. Moreover, there is a meaningful relationship between reperfusion arrhythmia and continuation of left ventricle functioning after treatment with streptokinase.

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  Background & Objective: Myocardial infarction is a comman cause in hospitalized patients with mortality rate of about 30%. Ontime diagnosis, earlier management and simply (time) factor have very important role in effective treatment, prevention of progression of injury and improvement of prognosis in the patients. Nearly 60% of mortality in this disease is in the first hour after onset of symptoms. Therefore this study was done to evaluate the refferal process, admission and hospitalization in patients with myocardial in farction at Buali hospital Ardabil.

  Methods: This descriptive and cross-sectional study was done on 77 patients with primary diagnosis of acute myocardial infarction based on clinical findings and ECG changes in the form of 1mm ST segment elevation in two adjacent leads or new LBBB or LBBB with unknown onest. Fourteen subjects were excluded from the study based on subsequent examination of continuous ECG and enzymatic evidence rulling out the presence of MI. Data were analyzed with descriptive and inferential statistics.

  Results: Referral time of patients after onset of symptom was 6.72 ± 5.53 hours. 73.02% of the patients referred with delay (90 minutes after onset of symptom). Mean referral time after onset of symptoms was 7.15±7.07 hours, 60.32% of the patients were outpatients, 34.92% were samples referred by other medical centers and 4.76% by emergency service in the latter group there was no delay in referring time. Mean admission time from emergency room to CCU was 1.04±0.94 hours. 47.62% of the patients underwent thrombolytic therapy with stereptokinase. In this group mean time from entrance to emergency until beginning thrombolytic therapy (Door to Needle time) was 1.22±0.34 houre.

  Conclusion: Because earlier beginning of thromolytic therapy had important role in decreasing mortality and morbidity in patients with myocardial infarction, we can increase survival rate in these patients by recognizing factors delaying, admission and earlier initiation of treatment.

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 Background & Objectives: Different studies have reported conflicting results on increased rate of early mortality after acute myocardial infarction (AMI) in females compared to males after adjustment for age and other confounding factors. The female gender plays a crucial role in early mortality after AMI. The aim of this study was to assess the role of gender as an important key factor in early mortality after acute myocardial infarction.

 Methods: In this research, patients (80 females and 174 males) with acute myocardial infarction were studies for six months (2003-2004) in terms of risk factors of coronary artery diseases, clinical conditions at admission, treatment modalities in the hospital and at the time of discharge, clinical accidents at the hospital and mortality and during one month after acute myocardial infarction and after being discharged.

 Results: Intrahospital mortality odds ratio for females compared to males was 2 (confidence interval 95%: 0.951-4.208). Mortality odds ratio during one month after acute myocardial infarction and discharge for females compared to males was 4.586 (confidence interval 95%: 1.294-16.252). This rate after adjustment for age was 3.15 (confidence interval 95%: 0.857-11.579) and after adjustment for confounders was 5.387 (confidence interval 95%: 1.296-22.393). In severe clinical conditions females referred to hospitals with more delay compared to men. Females were treated less than males with streptokinase, aspirin, betablockers and invasive diagnostic and treatment procedures. They received calcium channel blockers and nitrate much more than males.

 Conclusions : Females in comparison with males were at higher risk for early mortality (during one month after acute myocardial infarction and discharge). Age was not considered as the most important and potential factor for this higher rate.

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  Background & Objective: Electrocardiography is a useful method in predicting coronary artery occlusion site, left ventricular function and the prognosis of patients with acute myocardial infarction. Accurate localization of coronary artery occlusion and the extent of ischemic area are very important in decision making for invasive procedures to restore coronary perfusion.

  Methods: In this prospective study the abnormal findings of first recorded electrocardiogram in 100 patients with acute myocardial infarction w ere compared with coronary angiography findings and the value of ST-T changes in predicting coronary artery occlusion site was evaluated.

  Results: In acute anterior wall infarction, ST elevation in aVR (p=0.001), right bundle branch block (p=0.001) and ST depression in V5 strongly predicts LAD occlusion at its proximal part. Also ST depression, especially equal or more than 1 mm, in inferior leads indicates proximal LAD occlusion. The absence of such ST depression in these inferior leads correlates with distal LAD occlusion (p=0.01).ST depression of aVL also is a sign of distal LAD occlusion (p=0.01).In acute inferior wall infarction ≥ 1 mm ST depression in leads I, aVL and greater ST elevation in lead III than lead II refers to RCA involvement.

  Conclusion: In acute anterior myocardial infarction electrocardiography can help to differentiate proximal LAD lesion from its distal involvement. Also it is useful in determining the culprit vessel in acute inferior wall infarction and helps to recognize high risk patients with major benefit from invasive reperfusion strategies.