heart failure (HF) is still a major problem worldwide with high morbidity and mortality rates. The recently developed medication for HF is still incapable of reducing its morbidity and mortality, and clinical data supporting the efficacy and safety of its mainstay therapy remain insufficient.Arginine-vasopressin (AVP) plays important roles in circulatory and water homeostasis, one of which is water retention through the V2 receptor. In patients with HF, there is an increased level of AVP, contributing to such symptoms as edema, dyspnea, and congestion. Tolvaptan as a selective V2 receptor antagonist, in addition to the conventional therapy, has been shown to cause an increase in net fluid loss, a decrease in body weight, and a reduction in the rate of HF exacerbation. Such evidence has been provided by the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist (ACTIV) in Congestive heart failure (CHF), Efficacy of Vasopressin Antagonism in heart failure Outcome Study With Tolvaptan (EVEREST), Acute heart failure Volume Control Multicenter Randomized (AVCMA), and Study of Ascending Levels of Tolvaptan in hyponatremia 1and 2 (SALT-1 and SALT-2) trials. Tolvaptan can be an alternative diuretic in conjunction with other standard therapies for HF and has already been proved to be able to decrease morbidity and mortality, especially in HF patients with hyponatremia.

Background and Objectives: Acute myocardial infarction (MI) is usually accompanied by leukocytosis and increased neutrophils. However , still it has not been definitely recognized that whether this process is caused by myocardial defects or not. Few studies are availale which have reported about the relationship between neutrophil and short - term risks of myocardial complications such as congestive heart failure (CHF) after MI. In this case neutrophil count can be used as a predictor for CHF in patients with acute myocardial infarction.Materials and Methods: A sectional study was carried out on a population of patients with MI who had been hospitalized in CCU units. Blood samples were withdrawn from all of the patients to count neutrophils and also all interfering agents that could cause an increase in WBC counts were eliminated.Results: Total 50 patients , 84% men and 16% women , were studied. Among these 50 patients , 25 patients were affected by CHF (Ejection Fraction<40%). 32 patients (66%) showed relative neutrophilia (Neutrophil count>66%) while 36% showed no neutrophilia. Two groups were compared by T-test with respect to the average percent of neutrophils and the difference significant statistically ( p=0.001). Totally among 54% of patients who had been affected by CHF,92% showed relative neutrophilia (N> 65 %) at the beginning. Conclusion: This study clearly indicates that the presence of relative neutrophilia in patients with acute MI during the early 12-houre period is completely related to the incidence of CHF at first 4 days.

BACKGROUND AND OBJECTIVE: Coenzyme Q10 (CoQ10) is a provitamin existing in mitocondrial and cellular membranes scavenging free radicals as an antioxidant. This coenzyme also has important role in providing energy in cardiomyocites. Levels of CoQ10 decrease in heart failure. The treatment of severe congestive heart failure is one of the problems in cardiac patients. The aim of this study was to determine the effect of oral administration of CoQ10 in chronic heart failur.METHODS: This quasi-experimental study was carried out on 47 patients with congestive heart failure (CLASS III-IV NYHA). In all patients MM, 2D, and Doppler echocardiography were performed and after that they received oral CoQ10 (100 mg) (red-CoQ10) as daily single dose during next three months. After treatment, echocardiography was performed again and the data including left ventricle size, end systolic diameter, end diastolic diameter and severity of MR before and after treatment were compared and analyzed.FINDINGS: The mean±SD was 60.5±12.8 years. Thirty patients (63.8%) were male and 17 patients (36.2%) were female. More than 10 mm decreases were observed in: left ventricle size (in 8.5%), end systolic diameter (in 12.8%), end diastolic diameter (in 19.1%) and increase in ejection fraction in 70.2% of patients that indicated significant differences as compared to before treatment (p=0.000). In dilated cardiomyopathy, more than 10 mm decreases were observed in: left ventricle size, end systolic diameter, and end diastolic diameter in 7.4%, 14.8% and 11.1% of patients, respectively. But in coronary artery disease, more than 10 mm decreases were observed in: left ventricle size, end systolic diameter, and end diastolic diameter in 9.1%, 18.2%, and 45.4% of patients, respectively. Increases in ejection fraction were 74.1% and 63.6% in dilated cardiomyopathy and coronary artery disease, respectively.CONCLUSION: Based on obtained results, supplementing patients' cardiac medicines with CoQ10 made significant improvements in ejection fraction. Additionally, the results of this study show that CoQ10 is effective in coronary artery disease.

Although the involvement of the heart by malignancy is relatively common, it is unusual for it to be detected premortem. In addition, there is a dearth of data on this subject in the literature. We report a case of Hodgkin’s lymphoma presenting with systemic signs and symptoms including abdominal distension, weakness, pallor, chills and fever, generalized edema, hepatosplenomegaly, and generalized lymphadenopathy, as well as signs of heart failure. Echocardiography revealed pericardial effusion, left ventricular hypertrophy, and lucent myocardial lesions. Right cervical lymph node biopsy established the diagnosis of nodular sclerosing type Hodgkin’s lymphoma with the involvement of the bone marrow at biopsy. After 14 sessions of chemotherapy, systemic and cardiac abnormalities improved. We believe this is the first case of Hodgkin’s lymphoma with cardiac metastasis and heart failure.

Background and Aim: Agents can provide suitable infrastructure for follow-up data analysis and Chronic heart failure (CHF) management due to their many advantages such as autonomy and pro-activeness. The aim of this article is to explain the key points which should appropriately be considered in designing a CHF management system.Materials and Methods: In this literature review, articles with the following keywords were searched in Science Direct, Google Scholar and PubMed databases without regard to their publication year: multi-agent system, chronic heart failure, and chronic disease management.Results: In designing CHF management through a multi-agent system approach, there are key points in general and specific aspects that must be considered; for example, confidentiality and privacy, architecture, appropriate information and communication technology infrastructure, and legal and ethical issues.Conclusion: Clearly, identifying and resolving technical and non-technical challenges are vital to the successful implementation of this technology. Thus, in the design and implementation of agent-based systems, many issues should be considered; for instance, reduced face-to-face communication between patients and doctors that can lead to increased stress in some CHF patients, appropriate architecture and application of communication standards and protocols, the mode of communication between agents, users’ attitudes, supporting stakeholders to use agent technology, sufficient budget, coverage of healthcare costs based on agent technology, financial capability, and identification of opportunities and barriers.

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 paper is to review studies related to fatigue in patients with heart failure.Background. Fatigue is a subjective feeling and a multifactorial phenomenon in patients with heart failure. Fatigue is an important symptom of heart failure; however, lack of information exist regarding this phenomenon. Also, fatigue is considered as a challenge by health care providers and clinical guidelines have paid less attention to fatigue in these patients.Method. This article reviewed studies published regarding fatigue in patients with heart failure. The studies were searched out through scientific databases, including PubMed and Science Direct by the keywords fatigue, predictors, related factors, heart failure and their Persian equivalents.Findings. The literature review revealed that the prevalence of fatigue in patients with heart failure is high and different findings have been reported regarding its severity in these patients. Fatigue and its increasing trend during the disease progress is related to unsatisfactory quality of life and clinical outcome. In various studies, multiple factors including the nature of the illness and psychological factors particularly depression have been reported as predictors of fatigue and its severity in patients with heart failure. Few studies were conducted with the aim of evaluating the effect of non-pharmacological intervention on management of fatigue in these patients.Conclusion. According to the high prevalence of fatigue in patients with heart failure, it is essential to consider timely interventions by health care providers, particularly nurses, for reducing it and improving patients’ well-being. Regarding the limitation of studies and importance of reducing fatigue, it is necessary to conduct further research to evaluate the effect of non-pharmacological interventions on symptom management (especially fatigue) in these patients.