Transthoracic echocardiogram (GE, Vivid E95, and Chicago, USA) was performed with use of 2D, M-mode, doppler modalities. Images were taken from the parasternal long axis, parasternal short axis, apical four chambers, and apical five-chamber views. The mitral valve area (MVA) was quantified based on planimetry and pressure half time (PHT) methods. Mitral stenosis (MS) was classified as mild for valve area between 1.6-2.0 cm2, moderate for 1.1-1.5 cm2, and severe for ≤1.0 cm2. Mitral and aortic regurgitation were evaluated

Introduction: Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemiawith an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease inhigh-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndromeand alone account for more than 50% of population attributable risk. This study was conducted tofind out the prevalence of dyslipidemia. Methods: This descriptive cross-sectional study was conducted in 105 patients admitted at thetertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 afterapproval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profilewas obtained within 24 hours of hospitalization with the convenient sampling method. Data wereanalyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at95% Confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participantswas 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides,low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesteroland triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and highlow-density lipoprotein in 22 (21%).  Conclusions: Dyslipidemia is a significant risk factor in patients with acute coronary syndromeand commonly associated with other risk factors. Careful attention to its management may help toreduce further events.

Introduction: There is lack of data on pattern of use of drugs in patients with chronic heart failure (CHF) from Nepalese population. This study was conducted to explore the trends of evidence based medications used for CHF in our population. Methods: This is a cross-sectional study on 200 consecutive patients with New York Heart Association (NYHA) class II to IV symptoms of CHF who attended cardiology clinic or admitted from September 2017 to August 2018 at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Results: Mean age of patients was 54 (range 15-90) years. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart disease, peripartum cardiomyopathy were common etiologies of CHF. Analysis of drugs used in CHF revealed that 85% patients were prescribed diuretics, 58.5% angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 53% mineralocorticoid receptor antagonists (MRAs), 38% beta-blockers (BBs) and 24% digoxin. Digoxin was mainly used as add on therapy for patients with atrial fibrillation (24% of all patients). Antithrombotics (warfarin or aspirin), inotropic agents (dopamine, dobutamine or noradrenaline), antiarrhythmic agent (amiodarone) and nitrates (intravenous glyceryl trinitrate or oral isosorbide dinitrate) were prescribed for 48%, 28%, 5% and 6% patients respectively. All CHF patients with preserved or mid-range ejection fraction (25% of all patients) were prescribed diuretics along with antihypertensive drugs for hypertensive patients. Conclusion: CHF is associated with significant morbidity and mortality due to associated co-morbidities and underuse of proven therapy like BBs, ACEIs or ARBs and MRAs. Careful attention to optimization of different drugs therapy in patients with CHF may help to improve patient outcomes.

Introduction: Atrial fibrillation is a common atrial tachyarrhythmia with an increased risk of thromboembolism. This study aims to provide information about the application of antithrombotic treatment based on risk stratification schemes for stroke in real-life clinical practices. Methods: This was a descriptive cross-sectional study in 260 patients admitted at the tertiary care hospital with a diagnosis of atrial fibrillation from January 2019 to February 2020 after approval from the Institutional Review Committee (ref. no. 207/2018). Convenient sampling was used. Predisposing conditions for atrial fibrillation, risk factors for stroke, and the use of antithrombotics were obtained based on the pre-structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Results: The prevalence of valvular and non-valvular atrial fibrillation was 125 (48.0%), and 135 (51.9%) respectively. Among patients with a non-valvular variant, 102 (75.5%) had a CHA2DS2VASC score of ≥ 2 who were eligible for oral anticoagulants, 13 (9.6 %) patients received it with a majority having sub-therapeutic international normalized ratio. Among patients with valvular type, only 47 (37.6%) patients were receiving oral anticoagulants and 20 (42.5%) patients achieved therapeutic international normalized ratio. Two hundred forty three (93.4%) patients had dilated left atrium (≥40mm), 119 (45.9%) had hypertension and 27 (10.3%) had diabetes mellitus. Conclusions: Antithrombotics were markedly underused in patients with atrial fibrillation. There is a need for proper application of risk stratification schemes for stroke and appropriate use of antithrombotics to prevent thromboembolism.

Background: Chronic kidney disease affects the structure and function of the kidneys over a specific period of time. It is a worldwide public health related problem. It is usually associated with increasing age, hypertension, diabetes, cardiovascular disease and lack of exercise. Materials and Methods: It was a cross-sectional observational study conducted at Nobel Medical College Teaching Hospital. A total 150 patients were enrolled in this study from March 2021 to February 2022. Patients aged 18 years and above diagnosed with chronic kidney disease and treated with dialysis were included in this study. Statistical tools were used to describe the relevant data. Results: Chronic kidney disease was more predominant among males 90 (60%) than females 60 (40%). Thecommon co-morbid conditions were hypertension 51(34%) followed by hypertension & diabetes 40 (26.66%). 115 (76.66%) patients were receivinghemodialysis twice followed by 26 (17.33%) who were receiving it thrice a week. An average of 7.03 drugs per prescription was advised. Commonly used drugs were hydrocortisone 145 (96.66%), torsemide 90 (85.71%), and vitamin D3 105 (75%). Among the complications, the most commonly occurred were chills & rigor 15 (10%) followed by backache 12 (8%). Conclusion: Hydrocortisone, torsemide and Vit.D3, were prescribed medications in CKD patients maintained on hemodialysis. Hydrocortisone was commonly used at this tertiary care hospital. Chills & rigor and backache were complication occurred during hemodialysis.