Effect of Valsalva maneuver on echocardiographic findings in patients with ischemic heart disease

evaluate the effect of Valsalva maneuver on ventricular systolic and diastolic functions, and measurement of NT-proBNP as a marker of heart failure

patients will be enrolled in two groups: group 1: patients with mild coronary artery disease group 2: patients with severe coronary artery disease

Study will be conducted in 3 hospitals affiliated to Shiraz University of Medical Sciences:Faghihi Hospital, Nemazi hospital, and Alzahra Hospital. Serum NT-proBNP level of all patients measured at first 4 hours hospital admission period. Studies conducted during the second phase of Valsalva maneuver. Patients are blown on a narrow serum tube attached to the mercuric barometric device to 40 mm Hg pressure for 10 seconds. Systolic and diastolic indicators once before Valsalva and once during stage 2 of maneuver are measured

inclusion criteria:male or female, more than 18 years old, diagnosed with acute coronory syndrom, able to co-operate valsalva maneuver, unstable angina, STEMI, N-STEMI exclusion criteria: previous heart failure, history of several myocardial infarction, need emergency PCI or CABG, chronic respiratory distree or asthma,Persistent ischemia

patients diagnosed with possible primary Acute Coronary Syndrome (ACS); unstable angina pectoris, STEMI and NSTEMI

The left atrium end-systolic volume ؛The left atrium volume index; The right atrium end-systolic area; The right ventricle end-systolic and -diastolic dimensions, The left ventricle (LV) ejection fraction; The peak flow velocity in early diastole (E-wave) and during the atrial contraction (A-wave) as well as the E/A ratio; Left and right ventricular systolic function; and serum NT-proBNP level willbe measured at first 4 hours hospital admission period in and its relation with echcardiographic changes will be studied

the participants are familiar with Valsalva manoveur method and echocardiography. the observer, who will complete the questionnaire, will not be familiar with the groups. the data analyzer will not know the study groups. However, the main researcher (cardiologist) had information about the groups, and all echocardiography will be performed by a different cardiologist.