Dissertation for obtaining a medical doctorate degree
Abstract
Ischemic heart disease is the most common; It is the most dangerous and one of the most chronic diseases in the world. Sometimes the diagnosis of I.H.D. is difficult because the clinical signs are not always typical. For this reason, the exercise test is one of the most important medical methods to help diagnose I.H.D. if it has a real indication, otherwise it can have various risks for the patient.
This research was done in a cross-sectional and descriptive analytical way on 331 applicants for Hajj pilgrimage, including 250 men (with an average age of 67.49 years) and 81 women (with an average age of 63.21 years). From the total of 331 people examined, clinical interviews and physical examinations were conducted. The obtained clinical results along with laboratory results (including blood sugar, serum cholesterol and triglycerides, urea and creatinine) and ECG findings along with the results and findings of the exercise test in this group of people were extracted and analyzed with the SPSS statistical program and taking into account the various variables investigated in the research. In total, 75 people (22.65%) of the investigated people; They had an abnormal exercise test, of which 23 people (30.67%) had a previous history of IHD, and the most common reason for stopping the exercise test in these 75 cases was severe S.T segment changes and dangerous arrhythmias in 51 (68%) people. According to the results of this research, firstly, there were more abnormal cases of exercise test in women than in men of the same age, which could be due to the careful selection of cases. It has an indication of exercise test without forcing the age condition in women (which exists in the case of men) and according to examinations and expert cardiac counseling in women. Secondly, the results of this research recommend performing an exercise test in pilgrims who have multiple cardiac risk factors such as smoking, diabetes, hypertension, band changes, or clinical signs and symptoms of heart failure, including prominent JVP, edema, and heart murmur.
What it seems; According to the results of this research; Simply, being over 60 years old is not enough as a mandatory reason to perform an exercise test, and there is a need for a comprehensive view and reconsideration in the selection of people with an indication of an exercise test as one of the mandatory examinations before sending Hajj pilgrims.
Key words: I.H.D, exercise test
Introduction
Ischemic heart disease is the most common, serious and one of the most deadly diseases in the world, and this condition causes death, disability and more costs in the countries of the world than other diseases. There are many coronary artery diseases, sometimes the doctor cannot decide from the symptoms in the patient whether he has ischemic heart disease or not, because the symptoms are not completely typical. Exercise test is among the methods that are very important in diagnosing coronary artery disease. It is necessary to explain, just as it is an unforgivable sin not to diagnose ischemic heart disease and not to warn him and those around him, it is also a very wrong thing to label a healthy person with this disease, because if a person is in perfect health and we mistakenly consider him to have ischemic heart disease and limit his daily life and activities, we will create a very bad psychological situation in the person and he will feel hopelessly lost. In these cases and cases such as determining the prognosis of patients with known coronary artery disease and people without symptoms who are supposed to engage in heavy activities or have atherosclerosis risk factors, it is necessary to perform an exercise test to first determine whether there is ischemic heart disease or not and secondly, what is the functional capacity and prognosis of the patients. Medical examinations and tests before the trip and medical care during the Hajj pilgrimage of Baitullah Al-Haram in the country.Considering that the majority of these pilgrims try to hide their illness and problems at various stages of examinations due to the fear of being prevented from traveling to Hajj, and sometimes the initial clinical and paraclinical examination of these people may not show any important pathological findings, and on the other hand, attention to the point that cardiovascular disease, especially ischemic heart problems, causes many problems during the Hajj rituals. This group of pilgrims creates and imposes a lot of costs on the country in terms of medical care and examination before and during the Hajj journey. "Exercise test" is compulsory for women pilgrims over 60 years of age after consultation with a cardiologist, at the discretion of a specialist doctor, and for both sexes under 60 years of age, after initial examinations by the caravan doctor; In case of possible heart problems, it will be done by consulting a cardiologist on a case-by-case basis, at the discretion of the doctor.
In order to investigate the necessity of performing an exercise test and the value of this test in the screening of cardiac ischemia in this special group of people (applicants for Hajj pilgrimage), and to determine the prognosis of these people's heart disease during the Hajj journey. rtl;">Investigating the degree of agreement between the findings of the initial clinical examinations and the electrocardiographic tape with the findings of the exercise test in pilgrims over the age of 60 in Ardabil province in 2013
Sub-objectives:
1 Investigating the positive rate of the exercise test in pilgrims with a positive history in terms of current description, They do not have clinical examination and ECG for ischemic heart disease.
2 Investigating the positive rate of the exercise test in pilgrims who do not have a positive history in terms of history, clinical examination and ECG for ischemic heart disease.
3 Investigating the negative rate of exercise test in pilgrims who have a positive history in terms of history, clinical examination and ECG for ischemic heart disease.
4 Investigating the negative rate of the exercise test in pilgrims who have a positive history in terms of history, clinical examination and electrocardiogram for ischemic heart patients. In 2017, a study was conducted at Tehran University of Medical Sciences on the use of exercise testing in the diagnosis of coronary artery disease in 250 people referred to Imam Khomeini Hospital in Tehran. In 1373, at Shahid Sadoughi University of Medical Sciences, Yazd, it was studied about the use of exercise test in identifying latent cardiac ischemia in 93 diabetic patients, and in 1376, at Qazvin University of Medical Sciences, it was studied about the relationship of atypical chest pain with the result of exercise test in 100 people referred to Bu Alisina Hospital, Qazvin. But due to the specificity of the studied group in this research (pilgrims of Baitullah Al-Haram) and the wide variety in the studied variables, it seems that the present research is unique in its kind and the results obtained can be used by other researchers in further studies in the future. It is cross-sectional and descriptive-analytical.
In the research conducted to collect the information needed for the research, the risk factors of ischemic heart disease including smoking, hookah, high blood fat, high blood pressure, history of previous heart diseases, history of drug use and specialized variables in the field of heart diseases were considered.