Introduction: The most important diagnostic indicator of Acute Coronary Syndrome (ACS) is typical clinical symptoms, like chest pain, but many patients may experience nonspecific (atypical) symptoms. Understanding these symptoms and their associated factors results in early diagnosis and more appropriate treatments. Objective: We aimed to determine atypical clinical symptoms and their predictors in patients with Acute Coronary Syndrome. Materials and Methods: This cross-sectional study was conducted on 1167 patients with ACS hospitalized at a specialized hospital in Rasht City, Iran, between December 2019 and October 2020. The research samples were selected by a consecutive sampling method. Data were collected through a researcher-made questionnaire by interview, in which sociodemographic characteristics, risk factors, disease-related factors, and symptoms of patients with ACS were collected. Data analysis was done by descriptive statistics and multiple logistic regression by the backward LR (likelihood ratio) method. The significance level was set as P<0.05. Results: In this study, 56.3% of the patients were male. The Mean±SD age of the patients was 60.9±11.1 years. About 28.1% of the patients experienced atypical clinical symptoms. The most common atypical symptoms were shortness of breath (29.4%), back pain (18.3%), and left shoulder pain (12.7%). The predictors of atypical symptoms were age (OR=0.98, 95% CI; 0.975 - 0.999, P=0.047), alcohol use (OR=1.86, 95% CI; 1.047 - 3.303, P=0.034), brain diseases (OR=2.36, 95% CI; 1.463 - 3.811, P=0.001), blood diseases (OR=1.45, 95% CI; 1.059 - 2.002, P=0.021), and gastroesophageal reflux (OR=1.31, 95% CI; 1.006 - 1.719, P=0.045) Conclusion: Since more than a quarter of ACS patients have unusual symptoms, detecting these symptoms and related factors can help in early diagnosis and conduct more appropriate medical treatment.

Introduction: Coronary angiography is often associated with complications such as hemorrhage and hematoma that should be considered and be minimized. Objective: This study aimed to determine the effect of Zinc oxide scallop-shell powder as a topical hemostatic agent (composed mainly of calcium) on complications after coronary angiography. These complications include hemostasis time, low back pain, hemorrhage, hematoma, the necessity of sandbags, and patient ambulation. Materials and Methods: The current research was a blind, parallel, randomized clinical trial done on 150 patients under coronary angiography. They were randomly divided into three equal groups of A (control), B (case 1), and C (case 2). In group A, hemostasis was done with manual compression, use of ChitoHem powder, putting sandbag for 4-6 h in a supine position, and getting out of bed after 24 h. In group B, instead of ChitoHem powder, we used Zinc oxide scallop-shell powder. In group C, hemostasis was done with manual compression, Zinc oxide scallop-shell powder, putting sandbag for 1 h in a supine position, and getting out of bed after 2 h. The duration of hemostasis, bleeding, and hematoma after hemostasis and the severity of low back pain were investigated at 8 point intervals during 24 h. Data analysis was done using descriptive statistics indicators and Kolmogorov-Smirnov, ANOVA, Chi Square, Fisher exact test and Kruskal-Wallis tests. Results: The mean ±SD ages of groups of A, B, and C were 60.08 ±11.32, 60.22 ±10.30, and 61.69 (10.61), respectively, which was not statistically different. Furthermore, there was no significant difference between these three groups regarding their demographic information. There were statistically significant differences between groups about the amount of low back pain at the second, third, and fourth hours after angiography (P= 0.001). There was a significant difference in the amount of bleeding between the three groups (P=0.017). The difference in time of hemostasis in the three groups was not statistically significant. Conclusion: The Zinc oxide scallop-shell powder reduces catheter site bleeding after coronary angiography and bed rest time and ultimately the severity of low back pain. Performing a similar study is recommended.