Background & Objectives: Acute cor onar y syndr ome (ACS) is an emerging cardiac problem in the young population in Asia and Nepalese population is not an exception to this. Early ACS in young age imparts huge familial and social economic burden. Early identification and proper management strategy is still a challenging problem in developing countries like Nepal where there are limited coronary intervention centers. The study was conducted with objective to study the clinical spectrum, etiologies, coronary angiographic characteristics and their clinical outcomes. Materials & Methods: This is a cross-sectional study carried out in a tertiary hospital in central Nepal. Forty patients with acute coronary syndrome with age less than 40 years were enrolled in the study. Results: Majority of the patients were males with male: female=1.8:1. Twenty six (65%) patients were having ST segment elevation myocardial infarction followed by non-ST elevation myocardial infarction in nine (22.50%) patients and unstable angina in five (12.50%). patients. The most common risk factors were smoking, systemic hypertension, diabetes mellitus and dyslipidemia. Majority were having single vessel disease. Twenty (50%) patients had undergone primary angioplasty followed by thrombolysis in seven patients and the rest were managed medically because of late presentation. In-hospital major adverse cardiac events and mortality were higher among STEMI than NSTEMI and unstable angina. Conclusion: Acute coronary syndrome in the young is increasing in the Nepalese population. This group of population should be well educated and made aware of the potential coronary risk factors and their modification.

Background and Aims: The implications of radio-contrast induced nephropathyare disastrous. In Nepal there is scarcity of data on contrast induced nephropathy. This observational descriptive study was undertaken to study the incidence of contrast induced nephropathy and to identify risk factors (predictors) for the development of contrast induced nephropathy in patients undergoing coronary angiography and angioplasty in atertiary care hospital. Methods: The subject consists of 540 patients undergoing coronary intervention from 2011 to 2013 were enrolled by convenient sampling technique. Two hundreds ten patients were excluded from the study. Therefore, a total of 330 patients were studied and analyzed. Contrast induced nephropathy was defined as an increase of >25% or >0.5 mg/dl in pre-catheterization serum creatinine at or after 48 h after percutaneous coronary intervention. Estimated glomerular filtration rate as calculated by applying the 4 variables Modification of Diet in Renal Disease Study equation. Standard definitions were used to define the variables. Results: Twenty seven (8.18%) patients experienced contrast induced nephropathy. The incidence of contrast induced nephropathy in patients with baseline creatinine clearance <60 ml/min was 45.9%. Contrast induced nephropathy developed in 10% of anemic and 12.5% diabetic patients. The amount of the contrast agent administered was similar for both groups of patients (138.20±91.34ml vs. 175.56±118.86ml; p =0.254). No correlation was found between the amount of contrast agent administered and the change of serum creatinine concentration. Multivariate logistic regression analysis found that baseline e-GFR and baseline hemoglobin were independent predictors for Contrast induced nephropathy. Conclusion: The overall incidence of Contrast induced nephropathy after coronary intervention in this study is high. Patients with both preexisting renal insufficiency and anemia were at high risk of Contrast induced nephropathy. DOI: http://dx.doi.org/10.3126/njh.v11i1.10975 Nepalese Heart Journal 2014;11(1): 3-11

Background: Atrial deptal defect device closure has become the preferred method in the treatment of atrial septal defect. We aim to study the in-hospital complications of atrial septal defect device closure procedure.Methods: It was a single center, retrospective study conducted from Febuary 2016 to January 2019. Cardiac catheterization laboratory records of all consecutive patients who underwent atrial septal defect device closure was included and the in-hospital complications were been retrospectively reviewed.Results: During the study period, a total of 566 patients were attempted for device closure. In 557 (98.4%) of cases device was implanted. Among the 557 patient in which device was implanted 401(71.9%) were female. Age ranged from 5 years to 72 years with the mean of 30.9 years. Transient ST segment elevation 15 (2.6 %)was the commonest complication followed by pericardial tamponade 4 (0.7%), and cardiac arrhythmias 3 (0.5%). Conclusions: Atrial deptal defect device closure can be done safely with a high success rate and a low complication rate.Keywords: Amplatzer duct occluder; atrial septal defects; in hospital complications; transcatheter device closure.

Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.

BackgroundDoor-to-balloon (DTB) time of 90 min during primary angioplasty is considered as the benchmark duration. Shorter DTB time is preferable, and longer duration can have poor clinical outcomes.MethodsA cross-sectional observational study of three months in Shahid Gangalal National Heart Center was conducted in which all patients undergoing primary angioplasty were included. The DTB time was calculated, and the different determining factors were studied.ResultsSeventy-nine patients undergoing primary percutaneous intervention were studied. The median DTB time was 79 minutes (Interquartile range [IQR] 59–115 min). Forty-six (58.2%) patients had a DTB time of less than 90 min. DTB time varied significantly with direct visit vs transfer (p = 0.029) and office time visit (9 am–5 pm) vs off time (5 pm–9 am) (p = 0.012). DTB time did not differ between any infarct-related vessels (p = 0.471), number of vessels involved (p = 0.638), and the added procedures (defibrillation, thrombosuction, and temporary pacemaker insertion) (p = 0.682) during angioplasty. No significant differences were recorded according to age (p = 0.330), gender (p = 0.254), hypertension (p = 0.073), diabetes (p = 0.487), heart failure (p = 0.316), and baseline left ventricular ejection fraction (LVEF) (p = 0.819).ConclusionThe median DTB time in primary angioplasty was less than 90 minutes. The significant determining factors were timing of hospital visit (office vs off time) and type of visit (direct vs transfer). There can be improvement in factors determining DTB time to lower it further.

Background: Device closure is an attractive alternative in the management of Ventricular Septal defect (VSD). Aims and Objective: The aim of the study was to access the safety and early outcome of VSD device closure at Shahid Gangalal National Heart Centre, Nepal. Materials and Methods: The study was single center, retrospective study. All the VSD cases who were attempted for VSD device closure during December 2016 to February 2019 were included. Catheterization laboratory records for VSD type and size, Device type and size were retrospectively reviewed. Hospital records were reviewed for in-hospital complications.    Results: Sixty-one VSD cases were attempted for device closure. VSD was successfully closed in 55 (90.1%) patients. The mean age of the patient was 11.1 years. Twenty-nine (52.7%) were female and 26 (47.3%) were male. Perimembranous VSD in 49 (89 %) and muscular VSD in 6 (11 %) patients. The size of VSD ranged between 2 and 12mm (Mean 5.4mm). The VSD was closed with Amplatzer duct occluder I, Amplatzer duct occluder II, Amplatzer muscular VSD occluder and Memopart PDA device in 24 (43.7%), 26 (47.3%), 4 (7.2 %) and one patient (1.8%) patients respectively. The postoperative complications were insignicant residual leak across device in 2 (3.6%) patients, mild pericardial effusion in one (1.8%) patient. None of the patient had new onset tricuspid regurgitation, aortic regurgitation and complete heart block. One patient developed Right bundle branch block, one developed Left bundle branch block, one developed Junctional rhythm. There was no mortality. Conclusion: VSD device closure can be safe and effective if patients are selected properly.

Background & Objectives: Coronary artery disease is the common cardiac disease in Nepal. The objective of the study is to explore different risk factors for coronary artery disease.Materials & Methods: This was cross sectional  hospital based study studying the baseline clinical and angiographic characters in ST Myocardial infarction who had Primary Percutaneous coronary intervention (PPCI) in College of Medical Science Teaching Hospital (CMSTH).Results: There were 95 cases with male 77 (82.1%)   and female 18 (17.9%). The mean age overall was 60.05 ± 12.2. The mean age of male was 59.9 ± 12.5 and of female was 60.5 ± 11.2 years. Apart from chest pain, common clinical symptoms were sweating in 60 (63.2%) cases, dyspnea in 41 (43.2%), nausea/vomiting in 38 (40%), dizziness in 17 (17.9%) and epigastric pain in nine (9.5%) cases. Common risk factors were smoking in 83 (87.7%) cases, hypertension 59 in (51.6 %), diabetes in 24 (25.3%), dyslipidemia in 24 (25.3%) and family history in six (6.3%) cases. Common angiographic variables were single vessel disease (SVD) in 45 (47.4%), double vessel disease (DVD) in 20 (21.1%) and triple vessel disease (TVD) in 30 (31.6%) cases. Infarct related artery were Right coronary artery (RCA) in 43 (45.3%), Left circumflex artery (LCx) in seven (7.4 %) and Left anterior descending artery (LAD) in 45 (47.4 %) cases.Conclusion: Patients visiting CMSTH had classical symptoms and risk factors of myocardial infarction. Single vessel disease and Left anterior descending infarction was the most common vessel involved.

Introduction: Atrial fibrillation is common cardiac arrhythmia in elderly causing morbidity and mortality. Methods: A cross-sectional study was conducted in College of Medical Sciences Teaching Hospital from August 2013 to Jul 2016. All in-patients diagnosed with atrial fibrillation were included. Results: Two hundred five patients were studied from August 2013 to July 2016. Mean age was 63.95 ±16.5 years.  There were 105 (51.2%) male and 100(48.8%) female.  There were 154(75.1%) nonvalvular and 51 (24.9%) valvular causes for atrial fibrillation. Common presentations were SOB (41%), palpitations (27.8%), stroke (16.1%), fatigability (1.5%), abdominal pain (1.9%), chest pain (2.9%), pneumonia (1%), limb pain (0.5%) and severe bleeding (2.4%).  For  valvular causes, common lesions were disease of mitral valve (90 %) in isolation or mixed with aortic valve (23.5%). Warfarin was used in   32(62.7%) with mean INR of 2.038 ± 0.6. Seventeen (53.1% )  had INR below  2. In nonvalvular cases, types were paroxysmal (55.2%), persistant(34.4%) and permanent(10.4%). Elderly age, hypertension(30.5%), ischemic heart disease(13.6%), dilated cardiomyopathy(14.9%) , degenerative multivalvular heart disease(14.9%) , atrial septal defect(3.9%), lung cancer(2.3%), mitral valve prolapsed (0.6%), hyperthyroidism(1.9%), alcoholism (0.6%) , and  pericardial effusion(1.2%)  were common risk factors. CHADS(2) calculated 2 or more were in 98(63.6%)  patients. Warfarin was used in 39 patients(25.3%) and 103 patients(66.9%) received aspirin in CHADS(2) score 2 or more.  Mean INR in nonvalvular AF was 1.5 ±0.4. Conclusions: Atrial fibrillation is a common arrhythmia  as a result of valvular or nonvalvular origin. Common presentations were shortness of breath, palpitations and stroke. Common risk factors were old age, hypertension and heart failure. Warfarin is underused in nonvalvular  causes in our settings. Keywords: atrial fibrillation; valvular; nonvalvular; warfarin underuse.