Cardiovascular diseases (CVD) accounts for approximately 12 millions deaths annually and is the commonest cause of death globally, CVD is also the major contributor to the burden of premature morbidity and mortality and accounted for 85 millions disability adjusted (DALY) life years In 1990. It has been estimated that during the 25 years period from 1965-1990 mortality from coronary artery diseases (CAD) fell by 50% in Australia, Canada, France & US and 60% in Japan and Finland. The identification of major risk factors and effective control of them through population-based strategies of prevention were mainly responsible for this decline. The rise and subsequent decline in CAD epidemic in almost all industrialized countries in the later half of twentieth century has been well documented, but most of the developing countries are experiencing alarming increase of the disease.

BackgroundContrast-induced nephropathy (CIN) is one of the leading causes of morbidity and mortality including increased financial burden in high risk patients undergoing percutaneous coronary intervention (PCI).MethodsThis is an observational prospective study. We aimed to study the incidence of CIN in Nepalese populations and compare the outcome to international reprinted values with coronary artery disease (CAD) undergoing PCI. All consecutive patients with CAD undergoing PCI between February 2010 and July 2010 were enrolled in the study.ResultsOne hundred fifty-two patients were enrolled in the study during six months period. Twenty (13.20%) patients developed CIN following PCI. Out of them 70% were diabetics and 30% were non-diabetics. Mean age of patients was 58.5 ± 23 years; male:female ratio was 2.7:1. Mean contrast volume injected was 160.3  ±  78.3  mL. Diabetic patients 21.8% (14/64) had significant CIN compared to non-diabetic patients 6.8% (6/88) following PCI (<0.01).ConclusionsCIN is a common complication following PCI especially in diabetics. Despite the use of iodinated material we had similar incidence of CIN comparing the incidence of CIN among various radiocontrast compounds used to visualize vessels. None of the patients received hemodialysis as compared to available studies and there was no observed mortality.

Background and Aims: : Chronic obstructive pulmonary disease (COPD) is highly prevalent in the Nepalese population. It is associated with significant extrapulmonary effects among which cardiovascular complications are most common . Echocardiography evaluation mainly focused on effects on the right heart function is a salient tool to evaluate the presence of degree of pulmonary hypertension and also identify those group of patients who need more early aggressive therapy for the underling lung disease . We aimed to prospectively study the patients with diagnosed COPD with echocardiogram for evaluating the right heart . Methods: An observational , cross sectional study was done on 50 patients with COPD who were admitted at Bir Hospital and underwent echocardiographic evaluation from Dec 2015 -Dec 2016 . All echocardiogaphic parameters focused on right heart and its function were assessed . Results: Out of total 50 COPD patients studied , majority of them were female (32 patients ,64%). The mean age group of the studied patients was 60.9 ±11.4 years . Pulmonary hypertension defined as sPAP>30 mmHg was evident in all of the patients ; with 30 patients (60% ), 14 (28 %) and 6(12 %) patients having severe, moderate and mild pulmonary hypertension respectively . RV dysfunction was evident with reduced average TAPSE values (1.59± 0.38 cm) and elevated RIMP values (0.58±0.16). Conclusion: Majority of COPD patients had evidence of pulmonary hypertension. Echocardiogram can be a helpful tool to assess early changes on the right heart size and function in patients with COPD and also monitor these patients for rapid progression of the illness .

Cardiovascular disease is one of the global leading causes of death . Although indeveloped countries overall cardiovascular death is declining due to long term declineof rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease,heart disease is still the leading cause of death. In developing countries prevalence ofcoronary heart disease (CHD) is in increasing trend and cardiovascular disease patternis changing. Cardiovascular disease pattern of this region is revealed in this study.Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively.Proportionate distribution of all admitted cases was calculated and arranged inaccording with sequence order.Rheumatic heart disease was found the commonest, which constituted 27.3%, followedby coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronicobstructive pulmonary disease (COPD) with cor pulmonale (7.7%) was fourth insequence order then respectively came diabetes mellitus (DM) coexisted with CHD orhypertension, dilated cardiomyopathy (DCM), cardiac arrhythmia without organicheart disease, congenital heart disease, infective endocarditis, rheumatic fever,pericardial effusion etc. Readmission rate within one year was 12.3% and mortalityrate was 2.7%. Conclusion: Rheumatic heart disease is the commonest heart diseasefollowed by coronary heart disease and hypertension. COPD with cor pulmonale,diabetes coexisted with CHD or hypertension, DCM and cardiac arrhythmia withoutorganic heart disease are also common heart diseases.Key Words: Cardiovascular diseases, Disease pattern.

Background and Aims-

Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains a major clinical issue and a challenging condition to treat. Congenital coronary anomalies are likely to be under-recognized, as completing an anatomic assessment in a very large portion of the population would seem unfeasible. However, we present a case report with image of a 49 year old male presented with acute non-ST elevation ACS for which he underwent diagnostic angiography of the coronary system which revealed a common origin of both right and left main coronary artery from right sinus of Valsalva with significant obstructive lesion in the mid segment of right coronary artery. However, due to financial constraints CT angiography could not be done in this patient to identify the detail anatomy and the course of the anomalous left coronary artery origin (L-ACAOS). He was managed medically with dual antiplatelets, beta blockers, nitrates and ACE inhibitors.

Coronary artery disease (CAD), predominately manifest in older individuals, is a devastating disease precisely because an otherwise healthy person in the prime of life may die or become disabled without warning. When the afflicted individual is under the age of 40, the tragic consequences for family, friends, and occupation are particularly catastrophic and unexpected. Fortunately, the incidence of myocardial infarction (MI) and symptomatic CAD in young adults is low; most studies show that only about 3% of all CAD cases occur in this age range. Premature CAD is defined as cardiac events occurring before the age of 45 in men and 55 in women. In its severe form it is defined as CAD occurring below the age of 40 years. Prematurity and severity suggests that the disease starts at an early age and has a malignant course. In this study, we aim to investigate the major risk factor (smoking, Hypertension, Diabetes and dyslipidemia ) as defined by ACC-AHA pattern in ACS patient 40years or below admitted in Shahid Gangalal National Heart Centre (SGNHC) from April 2008 to April 2009. There were all together 54 ACS patients, male 44(81%) and female 10(19%). HTN is the risk factor which was more commonly diagnosed and treated, while Dyslipidemia, DM and IFG were not usually diagnosed in young patient before they were diagnosed CAD. Dyslipidemia was the most common comprising 83.3% followed by HTN 70%, smoking 70%, abnormal blood glucose level 50%, DM in 22.2% while IFG in 27.7 %. High total cholesterol (48%) is the common form of dyslipidemia followed by high LDL (44.4%), low HDL in 31.4%. When non modifiable risk factor family history is excluded, 85% of the patients have two or more risk factors of CAD. When smoking along with family history is excluded 94.5% of the patients have 1 or more risks factors for CAD.

Cardiovascular disease is the commonest cause of death globally and is the major contributor to the burdenof premature mortality and morbidity. Coronary artery disease ( CAD) is greatest killer of mankind. Coronaryartery disease in western industrialized countries show a declining trend. However developing countrieshave shown an alarming increase. The identification of major risk factors and effective control of themthrough population based strategies of prevention were mainly responsible for this decline.A few cases ofacute myocardial infarction were seen in Kathmandu ,Nepal in 1950 and in the sixties the incidence startedrising rapidly. In a study between 1960-1968 a total of 150 cases were reported with myocardial infarctionin Kathmandu , Nepal. Although national datas for incidence and prevalence on CAD in Nepal is notavailable, hospital based datas on admission pattern in different hospitals of Kathmandu, capital city ofNepal show 40 fold increase in incidence of acute myocardial infarction (AMI) in last 30 years. Prevalenceof coronary artery disease (CAD) estimated from these figures of AMI cases indicate that 5 % of adultpopulation in Kathmandu suffer from CAD. Hence, Coronary artery disease is emerging as epidemic in Kathmandu, Nepal.Key Words: Coronary artery disease (CAD), acute myocardial infarction (AMI), Epidemic.