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 aimsRheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal imparting huge familial, social and manpower burden.Materials and methodsThis is a hospital based descriptive cross-sectional study during June 2014 to April 2016 over a period of 22 months at College of Medical Sciences-Bharatpur including 235 patients with clinical and/or echocardiographic evidence of definite rheumatic heart disease.ResultsThe age of the patients ranged from 7 to 76 years with mean age 39.82 ± 4.2 years with female preponderance (F:M = 2.1:1) (p < 0.01). Majority of the rheumatic heart disease patients belonged to 30–44 years (28.78%) followed by 15–29 years (25.75%) and 45–59 years (25.00%). Majority belonged to the low socioeconomic status (60.60%) (p < 0.05). The predominantly involved isolated valve was mitral in 110 patients (46.80%) followed by isolated aortic valve in 22 patients (9.36%) and 79 (33.62%) had dual valvular involvement. The common rheumatic valvular lesions were pure mitral stenosis in 32 (13.61%), isolated mitral regurgitation in 58 (24.68%), combined mitral stenosis/regurgitation in 36 (15.32%), combined mitral/aortic regurgitation in 23 (9.78%) and combined aortic stenosis/regurgitation in 18 (7.66%) patients with few overlappings. The common complications encountered were heart failure in 90 (38.30%) and arrhythmias in 124 (51.00%) patients.130 patients (55.32%) received injectable benzathine penicillin whereas 45 patients (19.15%) preferred oral penicillin V. Surgical intervention was done in 54 (22.97%) patients. 12 (5.10%) expired in the CCU during the course of treatment.ConclusionRHD is a leading cause of heart failure among young populations with requirement of prolonged duration of medical treatment and many of them requiring surgery.

Organophosphorus (OP) compound poisoning is a medical emergency. It is important to know its nature, clinical presentation, severity and outcome in order to take up appropriate measures including proper planning, treatment and prevention. This study was aimed to assess the clinical profile of organophosphorus poisoning. This is a prospective hospital based study conducted at CMS-T.H., Bharatpur, Nepal. The study included 111 patients of organophosphorus poisoning during the period November 2008 to July 2011. The incidence was commoner in females than males with female:male ratio being 1.47:1. Majority of the patients(58.56%) belonged to the age group 16 to 30 years with female predominance(2.25:1). Modes of poisoning were suicidal in the majority (94.59%), accidental in 4.50%. and homicidal in 0.90%. Psychiatric problems were the major precipitating factors. Majority of patients(62.16%) had moderate poisoning (POP scale: 4-7).On admission, dyselectrolytemia and respiratory failure were found in 74.77% and 21.62% respectively.8 patients expired (7.69%). Large amount of OP poison ingestion (>40ml) and increased severity of poisoning (POP scale) were found to have statistical significance with the rate of mortality.

Background & Objectives: Acute Hyper tension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. The study was conducted with the objective to examine the incidence of different types of adverse drug reactions in drug treated hypertensive patients. Materials & Methods:Patients (n=382) who received antihypertensive agents were selected and interviewed using a standardized questionnaire. The Naranjo Algorithm, which categorizes the causality relationship into definite, probable, possible and doubtful, was used for the assessment of the exact nature of Adverse drug reaction (ADR). Results: Calcium channel blockers (CCBs) were the drug class with highest number (22 or 32.84%) of ADRs followed by Angiotensinconverting enzyme Inhibitors (ACEI) in 17 (25.38%), Angiotensin Receptor Blockers (ARB) in 12 (17.91%), diuretics in 10 (14.92%) and beta adrenergic antagonist in six (8.95%). Cardiovascular system (40 or 59.70%) was the most affected followed by central nervous system (16 or 23.88%) and respiratory and dermatological system each in 11 (16.42%) cases. On Naranjo's probability scale, nine (13.4%) of the ADRs were definite, 39 (58.2%) possible, 16 (23.9%) probable and three (4.5%) doubtful.Conclusion: Calcium channel blockers were mostly associated with ADRs while Cardiovascular system was the most frequently affected.Key words: Adver se dr ug r eactions; Antihyper tensive agents; Naranjo Algorithm Citation: Paudel S, Chetty MS, Laudar i S, Subedi ND. Adver se dr ug r eactions of antihyper tensive agents at tertiary care hospital in central Nepal. JCMS Nepal. 2017;13(2):284-9.

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Rheumatic heart disease is the most common heart disease in developing countries. This Global Health Report uses the results of screening…

Objective: Over a million cardiac surgeries are performed every year around the globe. However, approximately 93% of world population living in low- and middle-income countries have no access to cardiac surgery. The incidence of rheumatic and congenital heart disease is high in Nepal, while only 2,500-3,000 cardiac surgeries are performed annually. The aim of our study is to analyze challenges and opportunities of establishing a cardiac surgery program in a peripheral hospital of Nepal. Methods: We analyzed our effort to establish a cardiac surgery program in a peripheral hospital in Nepal. Results: Out of 2,659 consulted and diagnosed patients, we performed 85 open-heart surgeries in 4 years. Mean age of patients was 38.35 ± 14.13 years. The majority of patients were male (62.4% of patients) with 65.9% suffering from rheumatic heart disease. Average intensive care unit stay and hospital stay were 2.32 ± 1.1 and 8.29 ± 2.75 days, respectively. No in-hospital mortality was observed. Conclusion: We conclude that developing cardiac surgical care in a peripheral hospital of a developing country is feasible with support from government, foreign colleagues, local teams, and non-governmental organizations. The availability of a regular cardiac surgery service in the periphery of the country makes such services more accessible for the patients and helps in reducing the long waiting lists and unmanageable workload in the established cardiac centers in the capital city.

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.