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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.

INTRODUCTIONMitral stenosis (MS) primarily affects young women at reproductive age. Thus, pregnancy inMS patients is a common clinical problem in countries with high rheumatic disease prevalence like ours. MS contributes to significant morbidity in pregnancy. Pregnancy is associated with a 40-50% increase in cardiac outpur and a decrease ib systemic vascular resistance but, in the presence of severe mitral stenosis, these changes cannot occur. Untreated, the haemodynamic effects of mitral stenosis, together with the risk of thromboembolism, can lead to significanternal and fetal morbidity and mortality. For several decades surgical commisurotomy was being performed during pregnancy in patients with severe MS. However, BMV has been established as an effective method for treating MS in pregnancy with results comparable to surgical commisurotomy. Two BMV techniques have been extensively used: the inoue balloon technique and the transseptal over-the-wire balloon techniques. Studies to date have shown equal efficacy of the two BMV methods in terms of valve enlargement although the inoue approach is ismpler, faster, and yielded similar benefits and is also associated with a lower risk of creating severe mitral regurgitation. However, the efficacy and safety of BMV in our subset is not known. We designed this study to evaluated the safety of BMV for the treatment of MS in pregnant women.

Rheumatic fever (RF) and rheumatic heart disease (RHD) are common inunderdeveloped, deprived and depressed areas of the world. The progression of RHDis rapid in deprived communuties. Prevalence of RF and RHD has sharply declinedin affluent and developed countries, especially after the introduction of antibiotcs.RHD is a preventable disease. RHD is a leading cause of cardiovascular deaths indeveloping countries. The prevalence of RF and RHD varies from place to place. Indeveloping countries, young productive age groups are suffering from this diseasewhile in developed countries it is becoming geriatric disease due to the betterment ofliving standards and prompt awareness upon this disease. Studies and documentationof the current ststus of RF and RHD in Nepal is the present concern.1. Shahid Gangalal National Heart Centre.Address for correspondence : Dr. Yuba Raj Limbu, CardiologyShahid Gangalal National Heart CentreP.O.Box: 11360, Kathmandu, NepalEmail: yrlimbu@yahoo.comKey Words: Rheumatic fever, Rheumatic Heart Disease.

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.

SummaryRwkground: Thickening of mitral leaflets in rheumatic mitral valve stenosis is well described in necropsy studies; however, volume computation of the thickening mitral leaflets has not been attempted. Atrial fibrillation is one of the complications of rheumatic mitral stenosis. Quantitative assessment of thickened mitrd valve and its relation to clinical complications is clinically desirable.Hypothesis: The study was undertaken to compare measurement of mitral valve volume in normal subjects and in patients with rheumatic mitral valve stenosis.Mrrhods: An HP Sonos 2500 echocardiographic system with 5 MHz multiplane transesophageal transducer was used for data acquisition, and TomTec Echoscan computer setup wiis used to off-line volume computation. Study subjects included 10 normal subjects (mean age 44.8 years) and 36 patients with rheumatic nJtral valve stenosis (22 female, 14 male) with an age range of25 to 69 years (mean age 47 f 9.6 years). Mitral valve volumes were compared between the normal subjects and patients with mitral valve stenosis, and further comparison was made between the sinus rhythm (SR) and atrial fibrillation (AF) groups in patients with mitral valve stenosis. In all study subjects, the mitral valve area (MVA) was determined by two-dimensional echocardiography.Re.su/ts: Quantitative three-dimensional (3-D) echocardiography showed that mitral valve volume was significantly lar- Fehruary 20, 1998 ger in patients with mitral valve stenosis than in normal subjects (9.0 f 2.2 and 4.5 2 0.7 ml, respectively, p<0.001). When patients with mitral valve stenosis were divided into the SR and AF groups, mitral valve volume was found to be significantly larger in the AF group than in the SR group (9.76k 2.2 ml.and 7.72 f 1.5 ml, respectively, p < 0.01 ) and patients in the AF group tended to be older (p < 0.05) with larger left atrial diameter (LAD) (p<0.01). However, MVA between the two groups showed no statistical significance ( 1.1 f 0.43 and 1 . O f 0.34 cm2, respectively, p>0.2). When the study subjects were divided into two groups (<50 and 250 years) according to age, the comparison of mitral valve volume between these two groups(9.37 ~2.18and8.56+2.14ml,p>0.2)showed nostatistical significance.Conclusiorzs: Quantitative 3-D echocardiography can be applied for the measurement of mitral valve volume in vivo.Patients with rheumatic mitral valve stenosis with atrial fibrillation have a propensity to have a larger mitral valve volume and are older than the patients with sinus rhythm; however, the age per se does not seem to be a cause for larger mitral valve volume.

Background: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7-10% of patients. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Large thrombolytic trials demonstrate 60% mortality with most effective thrombolytic agent. In between September 2005 to August 2008 total PCI in Shahid gangalal National Heart Centre (SGNHC), Nepal was 452. among them primary PCI (PPCI) in AMI with cardilgenic shock was done in only 16 patients with cardiogenic shock who underwent PPCI, 6 patients are in out of 50% (n=8) patients with cardiogenic shock who underwent PPCI, 6 patients are in routine follow up over 12 months and 2 were doing well in subsequent 6 months but lost in follow up afterwards. Primary PCI in AMI complicated by cardiogenic shock has lower mortality and improved outcome. High cost, high in-hospital mortality, need for trained manpower are the major limitations.

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