Background and Aims: Coronary collateral circulation can develop early after STEMI and patients having these coronary collaterals have favorable outcomes. The aim of this study was to evaluate the prognostic impact of coronary collateral circulation in STEMI.
Methods: This is an observational prospective study of 106 consecutive STEMI patients undergoing Primary PCI admitted and treated at a tertiary cardiac centre from May 2019 to April 2020. Clinical profile, complications at index admission and atone month follow up were analyzed.
Results: Out of 106 consecutive patients, 50(47%) had early coronary collateral supplying the infarct related artery. The baseline characteristics of the patients in the two groups, with collateral and without collateral, were similar. Among patients with collateral circulation, only 5% had very well developed (Rentrop3) collaterals. The presence of collateral was strongly associated with presence of preexisting angina (p=0.007) and delayed presentation to hospital (p= 0.04). Coronary collateral was more common in non-diabetics, non-anterior wall STEMI and those with mutivessel disease. Compared with the patients without collateral supply, those who had collateral had fewer incidence of in-hospital heart failure (p=0.03) and post MI pericarditis (p=0.04).
Conclusion: In STEMI, development or recruitment of early collateral supply to the infarct related artery was associated with lower rates of heart failure, post MI pericarditis, cardiogenic shock, hospital stay and in-hospital deaths. At 1 month, patients with collateral supply had fewer angina recurrence, reinfarcton and stent thrombosis.
{"title":"Effect of Early Coronary Collateral Circulation in Patients with ST Elevation Myocardial Infarction","authors":"Parash Koirala, Ratna Mani Gajurel, Chandra Mani Poudel, Hemant Shrestha, Sanjeev Thapa, Rajaram Khanal, Smriti Shakya, Shovit Thapa, Surya Raj Pathak","doi":"10.3126/njh.v20i1.54993","DOIUrl":"https://doi.org/10.3126/njh.v20i1.54993","url":null,"abstract":"Background and Aims: Coronary collateral circulation can develop early after STEMI and patients having these coronary collaterals have favorable outcomes. The aim of this study was to evaluate the prognostic impact of coronary collateral circulation in STEMI.
 Methods: This is an observational prospective study of 106 consecutive STEMI patients undergoing Primary PCI admitted and treated at a tertiary cardiac centre from May 2019 to April 2020. Clinical profile, complications at index admission and atone month follow up were analyzed.
 Results: Out of 106 consecutive patients, 50(47%) had early coronary collateral supplying the infarct related artery. The baseline characteristics of the patients in the two groups, with collateral and without collateral, were similar. Among patients with collateral circulation, only 5% had very well developed (Rentrop3) collaterals. The presence of collateral was strongly associated with presence of preexisting angina (p=0.007) and delayed presentation to hospital (p= 0.04). Coronary collateral was more common in non-diabetics, non-anterior wall STEMI and those with mutivessel disease. Compared with the patients without collateral supply, those who had collateral had fewer incidence of in-hospital heart failure (p=0.03) and post MI pericarditis (p=0.04).
 Conclusion: In STEMI, development or recruitment of early collateral supply to the infarct related artery was associated with lower rates of heart failure, post MI pericarditis, cardiogenic shock, hospital stay and in-hospital deaths. At 1 month, patients with collateral supply had fewer angina recurrence, reinfarcton and stent thrombosis.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute purulent pericarditis, although rare in modern antibiotic era, is a life-threatening condition requiring timely diagnosis and aggressive treatment modalities. We report a successfully treated previously healthy immunocompetent 23 years old male patient diagnosed as secondary acute purulent pericarditis caused by methicillin sensitive Staphylococcus aureus with a primary skin abscess. The patient initially presented with complains of fever, chest pain and occasional cough with no significant finding in clinical examination. Electrocardiography showed widespread ST elevation and echocardiography revealed fluid collection with echogenic floaters in pericardial space. Diagnostic pericardiocentesis was done and fluid showed growth of methicillin sensitive Staphylococcus aureus. The patient was managed with anti-inflammatory drugs, appropriate intravenous antibiotic for two weeks, therapeutic pericardiocentesis with intrapericardial vancomycin instillation and fibrinolysis with alteplase to prevent constrictive pericarditis and persistent purulent pericarditis. The patient was followed up in three months and was found to have no residual disease or complication.
{"title":"Intrapericardial antibiotics and fibrinolysis to shorten course of antibiotics and prevent constrictive pericarditis in acute purulent pericarditis due to staphylococcus aureus","authors":"Neeraj Sharma, Parag Karki","doi":"10.3126/njh.v20i1.55194","DOIUrl":"https://doi.org/10.3126/njh.v20i1.55194","url":null,"abstract":"Acute purulent pericarditis, although rare in modern antibiotic era, is a life-threatening condition requiring timely diagnosis and aggressive treatment modalities. We report a successfully treated previously healthy immunocompetent 23 years old male patient diagnosed as secondary acute purulent pericarditis caused by methicillin sensitive Staphylococcus aureus with a primary skin abscess. The patient initially presented with complains of fever, chest pain and occasional cough with no significant finding in clinical examination. Electrocardiography showed widespread ST elevation and echocardiography revealed fluid collection with echogenic floaters in pericardial space. Diagnostic pericardiocentesis was done and fluid showed growth of methicillin sensitive Staphylococcus aureus. The patient was managed with anti-inflammatory drugs, appropriate intravenous antibiotic for two weeks, therapeutic pericardiocentesis with intrapericardial vancomycin instillation and fibrinolysis with alteplase to prevent constrictive pericarditis and persistent purulent pericarditis. The patient was followed up in three months and was found to have no residual disease or complication.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krishnaprasad Bashyal, Ravi Kumar Baral, Anil Bhattarai, Prabhat Khakural, Prashiddha B. Kadel, Bhagawan Koirala
Background and Aims: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an important tool for risk stratification in cardiac surgery. Updated EuroSCORE II (ESC II) is widely regarded as essential for risk stratification and several studies validate its efficacy, but these are fewer in Southern Asia and none in Nepal. Aim of this study was to compare the predicted versus observed early mortality in adults undergoing major cardiac surgeries in Nepalese population. Methods: A prospective observational study was conducted from September 2019 to May 2021 at Manmohan Cardiothoracic Vascular and Transplant Center. Calibration and discrimination of scoring system were main parameters analyzed in total sample and subgroups. Discrimination were observed by plotting receiver operating characteristic (ROC) curves and calculating area under curve (AUC). Two sample t test, McNemar’s test, Fisher’s exact t test and Chi square test were used to derive P value. Results: In this study, 249 patients were evaluated. Poor mortality prediction was shown by statistically significant p value <0.05 across all surgical groups. AUC for total cases, CABG and valve surgeries were 0.835, 0.766, 0.82 respectively. Conclusion The present study underpredicted mortality but displayed good discrimination for overall cardiac surgeries, with excellent discrimination in valve surgeries. As current sample is not entirely comparable to parent study, weak calibration could be attributed to it as etiology was mostly rheumatic with poorer cardiopulmonary reserve in this study versus degenerative etiology in original study.
背景和目的:欧洲心脏手术风险评估系统(EuroSCORE)是心脏手术风险分层的重要工具。更新的EuroSCORE II (ESC II)被广泛认为是风险分层的必要条件，一些研究证实了其有效性，但这些研究在南亚较少，在尼泊尔没有。本研究的目的是比较尼泊尔人群中接受大型心脏手术的成年人的预测和观察到的早期死亡率。方法:2019年9月至2021年5月在曼莫汉心胸血管和移植中心进行了一项前瞻性观察性研究。评分系统的校正和判别是总样本和亚组分析的主要参数。通过绘制受试者工作特征(ROC)曲线和计算曲线下面积(AUC)来观察鉴别。采用两样本t检验、McNemar检验、Fisher精确t检验和卡方检验来推导P值。结果:本研究对249例患者进行了评估。各手术组的死亡率预测较差，p值<0.05有统计学意义。总病例AUC为0.835,CABG为0.766，瓣膜手术为0.82。结论本研究低估了死亡率，但对整体心脏手术有很好的鉴别，对瓣膜手术有很好的鉴别。由于目前的样本不能完全与母体研究相比较，因此校准较弱，因为本研究的病因主要是风湿病和较差的心肺储备，而原始研究的病因是退行性病因。
{"title":"Predictive Value of EuroSCORE II in a Nepalese Tertiary University Hospital – Prospective Observational Study","authors":"Krishnaprasad Bashyal, Ravi Kumar Baral, Anil Bhattarai, Prabhat Khakural, Prashiddha B. Kadel, Bhagawan Koirala","doi":"10.3126/njh.v20i1.54995","DOIUrl":"https://doi.org/10.3126/njh.v20i1.54995","url":null,"abstract":"Background and Aims: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an important tool for risk stratification in cardiac surgery. Updated EuroSCORE II (ESC II) is widely regarded as essential for risk stratification and several studies validate its efficacy, but these are fewer in Southern Asia and none in Nepal. Aim of this study was to compare the predicted versus observed early mortality in adults undergoing major cardiac surgeries in Nepalese population. Methods: A prospective observational study was conducted from September 2019 to May 2021 at Manmohan Cardiothoracic Vascular and Transplant Center. Calibration and discrimination of scoring system were main parameters analyzed in total sample and subgroups. Discrimination were observed by plotting receiver operating characteristic (ROC) curves and calculating area under curve (AUC). Two sample t test, McNemar’s test, Fisher’s exact t test and Chi square test were used to derive P value. Results: In this study, 249 patients were evaluated. Poor mortality prediction was shown by statistically significant p value <0.05 across all surgical groups. AUC for total cases, CABG and valve surgeries were 0.835, 0.766, 0.82 respectively. Conclusion The present study underpredicted mortality but displayed good discrimination for overall cardiac surgeries, with excellent discrimination in valve surgeries. As current sample is not entirely comparable to parent study, weak calibration could be attributed to it as etiology was mostly rheumatic with poorer cardiopulmonary reserve in this study versus degenerative etiology in original study.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transcatheter aortic valve implantation is the most preferred treatment of aortic stenosis in elderly patients at high surgical risk; however, few data exist on the adoption of transcatheter aortic valve implantation for the management of low-flow, low-gradient severe aortic stenosis patients. We present a recent case experience with a 77-year-old man suffering from low-flow, low-gradient, symptomatic severe aortic stenosis with concomitant coronary artery lesions in the left anterior descending and right coronary arteries. He was treated successfully with balloon-expandable transcatheter aortic valve implantation after the percutaneous coronary intervention of the left anterior descending artery and right coronary artery lesion. Post-procedural and 30-day follow-ups showed good functional and hemodynamic improvements with the mean aortic gradient of 3 mmHg (baseline: 30 mmHg) without residual paravalvular leakage. Our first experience with a balloon-expandable transcatheter valve was satisfactory as we observed clinical efficacy and good performance of the balloon-expandable transcatheter aortic valve in low-flow, low-gradient, symptomatic severe AS patients.
{"title":"Transcatheter Aortic Valve Implantation with balloon-expandable valve in low-flow low-gradient severe aortic stenosis in Nepal","authors":"Chandra Mani Adhikari, Birat Krishna Timalsena, Amrit Bogati, Barkadin Khan, Anjana Acharya, Vijay Ghimire, Kshitij Mehta, Dipanker Prajapati","doi":"10.3126/njh.v20i1.55038","DOIUrl":"https://doi.org/10.3126/njh.v20i1.55038","url":null,"abstract":"Transcatheter aortic valve implantation is the most preferred treatment of aortic stenosis in elderly patients at high surgical risk; however, few data exist on the adoption of transcatheter aortic valve implantation for the management of low-flow, low-gradient severe aortic stenosis patients. We present a recent case experience with a 77-year-old man suffering from low-flow, low-gradient, symptomatic severe aortic stenosis with concomitant coronary artery lesions in the left anterior descending and right coronary arteries. He was treated successfully with balloon-expandable transcatheter aortic valve implantation after the percutaneous coronary intervention of the left anterior descending artery and right coronary artery lesion. Post-procedural and 30-day follow-ups showed good functional and hemodynamic improvements with the mean aortic gradient of 3 mmHg (baseline: 30 mmHg) without residual paravalvular leakage. Our first experience with a balloon-expandable transcatheter valve was satisfactory as we observed clinical efficacy and good performance of the balloon-expandable transcatheter aortic valve in low-flow, low-gradient, symptomatic severe AS patients.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"262 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amyloidosis refers to the accumulation of amyloid fibrils in different organs of the body that may result in the dysfunction of the organ systems. Cardiac amyloidosis (CA) is an accumulation of amyloid fibrils in cardiac tissue that leads to an increase in the thickness and mass of the ventricular wall inducing progressive and restrictive infiltrative cardiomyopathy. We present here a case of 62-year-old male with complaints of shortness of breath on exertion, abdominal distention, and leg edema, had elevated jugular venous pressure, pedal edema, and ascites. Echo findings showed biventricular wall thickening, restrictive left ventricular inflow pattern in pulse wave Doppler, and strain pattern characteristic of an infiltrative process. He was thus referred for a cardiac MRI for further evaluation with the suspicion of restrictive cardiomyopathy. Based on the CMR findings and the clinical scenario, the patient underwent a rectal mucosal biopsy that was confirmative of systemic amyloidosis.
{"title":"Demystifying Cardiac Amyloidosis with Cardiac MRI: A case report","authors":"Nirmal Prasad Neupane, Kritisha Rajlawot, Rikesh Tamrakar, Keshika Koirala, Ram Kumar Ghimire, Benu Lohani","doi":"10.3126/njh.v20i1.55050","DOIUrl":"https://doi.org/10.3126/njh.v20i1.55050","url":null,"abstract":"Amyloidosis refers to the accumulation of amyloid fibrils in different organs of the body that may result in the dysfunction of the organ systems. Cardiac amyloidosis (CA) is an accumulation of amyloid fibrils in cardiac tissue that leads to an increase in the thickness and mass of the ventricular wall inducing progressive and restrictive infiltrative cardiomyopathy. We present here a case of 62-year-old male with complaints of shortness of breath on exertion, abdominal distention, and leg edema, had elevated jugular venous pressure, pedal edema, and ascites. Echo findings showed biventricular wall thickening, restrictive left ventricular inflow pattern in pulse wave Doppler, and strain pattern characteristic of an infiltrative process. He was thus referred for a cardiac MRI for further evaluation with the suspicion of restrictive cardiomyopathy. Based on the CMR findings and the clinical scenario, the patient underwent a rectal mucosal biopsy that was confirmative of systemic amyloidosis.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: Pericardial effusion is a common finding in every day clinical practice. It is caused by a range of local and systemic disorders, many of which could be idiopathic. Pericardial effusions can be acute or chronic. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases.
Methods: This is a retrospective study where data from all the cases admitted with pericardial effusion in the SGNHC from January 2021 to December 2022 were included. Altogether 218 cases diagnosed with pericardial effusion established by Echocardiograpy were included. Evaluation for the cause of pericardial effusion was done. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases and age <15 years were excluded. Demographic profile, common causes, the presentation and the clinical outcome of the patients were documented.
Results: Majority of patients were aged between 56-75 years. Most common etiology of pericardial effusion was tuberculosis (56%) followed by heart failure (11%), Hypothyroidism (6.4%) and malignancy (5.6%). Tachycardia was the most common ECG finding in 152 (69.7%) followed by Low voltage ECG in 96 (44%). The most common clinical feature was breathlessness in 85% followed by tachycardia in 56% of the patient.
Conclusion: Tuberculosis, Heart Failure and Hypothyroidism were the common causes of Pericardial effusion with male predominance. Breathlessness was the most common presenting symptom.
{"title":"Clinical profile of patients admitted with pericardial effusion in Shahid Gangalal National Heart Centre, Kathmandu, Nepal","authors":"Keshab Raj Neupane, Rabindra Simkhada, Reeju Manandhar, Subodh Kansakar, Dharmanath Yadav, Arun Kadel, Sushant Kharel, Aashika Thapa, Prinsa Shrestha, Ravi Sahi","doi":"10.3126/njh.v20i1.55003","DOIUrl":"https://doi.org/10.3126/njh.v20i1.55003","url":null,"abstract":"Background and Aims: Pericardial effusion is a common finding in every day clinical practice. It is caused by a range of local and systemic disorders, many of which could be idiopathic. Pericardial effusions can be acute or chronic. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases.
 Methods: This is a retrospective study where data from all the cases admitted with pericardial effusion in the SGNHC from January 2021 to December 2022 were included. Altogether 218 cases diagnosed with pericardial effusion established by Echocardiograpy were included. Evaluation for the cause of pericardial effusion was done. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases and age <15 years were excluded. Demographic profile, common causes, the presentation and the clinical outcome of the patients were documented.
 Results: Majority of patients were aged between 56-75 years. Most common etiology of pericardial effusion was tuberculosis (56%) followed by heart failure (11%), Hypothyroidism (6.4%) and malignancy (5.6%). Tachycardia was the most common ECG finding in 152 (69.7%) followed by Low voltage ECG in 96 (44%). The most common clinical feature was breathlessness in 85% followed by tachycardia in 56% of the patient.
 Conclusion: Tuberculosis, Heart Failure and Hypothyroidism were the common causes of Pericardial effusion with male predominance. Breathlessness was the most common presenting symptom.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A child born with transposition of great arteries should undergo arterial switch, preferably within 2 to 3 weeks of life. Sometimes, this can be extended even up to 2 months of life, if left ventricular mass is adequate. When child presents very late left ventricle may have regressed, so the options left is either left ventricular training and arterial switch or atrial switch. We present here, a 3 years old child presenting with transposition of great arteries, who underwent successful Senning procedure.
{"title":"Report of the successful Senning procedure from Nepal","authors":"Rabindra B. Timala, Marisha Aryal, Santosh Parajuli, Rupak Pradhan, Rheecha Joshi, Nivesh Rajbhandari, Nishes Basnet, Navin Gautam","doi":"10.3126/njh.v20i1.55056","DOIUrl":"https://doi.org/10.3126/njh.v20i1.55056","url":null,"abstract":"A child born with transposition of great arteries should undergo arterial switch, preferably within 2 to 3 weeks of life. Sometimes, this can be extended even up to 2 months of life, if left ventricular mass is adequate. When child presents very late left ventricle may have regressed, so the options left is either left ventricular training and arterial switch or atrial switch. We present here, a 3 years old child presenting with transposition of great arteries, who underwent successful Senning procedure.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135051327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Neupane, Kritisha Rajlawot, K. Koirala, S. Phuyal
Hypertrophic cardiomyopathy (HCM) is a condition of genetic mutation in the cardiac sarcomere that is defined by cardiac hypertrophy, a non-dilated left ventricle, and a normal or increased ejection fraction. It presents with a heterogeneous clinical picture which continues to challenge clinicians to diagnose it clinically. Cardiac magnetic resonance (CMR) - a non-invasive imaging technique is an essential diagnostic tool that reliably confirms the diagnosis, differentiates hypertrophic cardiomyopathy from other etiologies of left ventricular hypertrophy as well as identifies the individuals who are most at risk of sudden cardiovascular events. We present a case of 15 years old female patient with complaints of left-sided chest pain, dyspnea, palpitations, and orthopnea with a history of several episodes of syncopal attacks in the past. Following echocardiography, cardiac magnetic resonance imaging was done for the proper interpretation of the presenting clinical manifestations.
{"title":"Cardiac MRI in the Diagnosis and Prognosis of patients with Hypertrophic Cardiomyopathy (HCM) - A Case Report","authors":"N. Neupane, Kritisha Rajlawot, K. Koirala, S. Phuyal","doi":"10.3126/njh.v20i2.48871","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48871","url":null,"abstract":"Hypertrophic cardiomyopathy (HCM) is a condition of genetic mutation in the cardiac sarcomere that is defined by cardiac hypertrophy, a non-dilated left ventricle, and a normal or increased ejection fraction. It presents with a heterogeneous clinical picture which continues to challenge clinicians to diagnose it clinically. Cardiac magnetic resonance (CMR) - a non-invasive imaging technique is an essential diagnostic tool that reliably confirms the diagnosis, differentiates hypertrophic cardiomyopathy from other etiologies of left ventricular hypertrophy as well as identifies the individuals who are most at risk of sudden cardiovascular events. We present a case of 15 years old female patient with complaints of left-sided chest pain, dyspnea, palpitations, and orthopnea with a history of several episodes of syncopal attacks in the past. Following echocardiography, cardiac magnetic resonance imaging was done for the proper interpretation of the presenting clinical manifestations.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49114476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Sharma, D. Prajapati, U. Shakya, M. Shrestha, Samir Shakya, N. Gautam, R. Manandhar, K. Sherpa, M. Kc, P. Regmi, C. Poudel, C. Adhikari, R. Gajurel, Bijoy G Rajbanshi
The prevalence of rheumatic heart disease is still significant in Nepal, especially in rural areas. It is an important preventable cause of morbidity and mortality in children and young adults. Diagnosis of rheumatic heart disease and acute rheumatic fever is based on clinical, laboratory, and echocardiographic criteria. Diagnosis and management criteria need to be locally relevant and practical to our context for implementation at the national level. The Cardiac Society of Nepal initiated the development of consensus document with aim of providing a reasonable and practical format of diagnostic and management. We hope this document will be helpful for physicians, pediatricians and cardiologists of the country to diagnose and treat acute rheumatic fever and RHD.
{"title":"Consensus Statement of Cardiac Society of Nepal on Diagnosis, Management and Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Nepal","authors":"D. Sharma, D. Prajapati, U. Shakya, M. Shrestha, Samir Shakya, N. Gautam, R. Manandhar, K. Sherpa, M. Kc, P. Regmi, C. Poudel, C. Adhikari, R. Gajurel, Bijoy G Rajbanshi","doi":"10.3126/njh.v20i2.48955","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48955","url":null,"abstract":"The prevalence of rheumatic heart disease is still significant in Nepal, especially in rural areas. It is an important preventable cause of morbidity and mortality in children and young adults. Diagnosis of rheumatic heart disease and acute rheumatic fever is based on clinical, laboratory, and echocardiographic criteria. Diagnosis and management criteria need to be locally relevant and practical to our context for implementation at the national level. The Cardiac Society of Nepal initiated the development of consensus document with aim of providing a reasonable and practical format of diagnostic and management. We hope this document will be helpful for physicians, pediatricians and cardiologists of the country to diagnose and treat acute rheumatic fever and RHD.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42579095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: Acute coronary syndrome is an important health issue. There is paucity of its data in late elderly. We aimed to study their clinical profile and prevalence of conventional risk factors. Methods: Descriptive cross-sectional study conducted at Shahid Gangalal National Heart Centre from February 2022 to May 2022 including 71 consecutive patients of acute coronary syndrome of age >75 years. They were evaluated focusing their chief complaints and cardiovascular risk factors. Results: Mean age was 80.32±4.06 years. Forty (56.33%) were male and 31 (43.66%) were female. Thirty-nine (54.92%) were hypertensive, 29 (40.84%) were diabetic, 18 (25.35%) were smoker, 10 (14.08%) had history of dyslipidemia and 6 (8.45%) had family history of cardiovascular disease. Chest pain was present in 54 (76.05%), dyspnea in 28 (39.43%), sweating in 15 (21.12%) and nausea/vomiting in 8 (11.26%). Palpitation was present in 7 (9.85%), and epigastric pain in 13 (18.30%). Seven (9.85%) gave history of pre-syncope/ syncope and 6 (8.45%) had altered mental status. There was significant correlation of smoking (p=0.02) and types of ACS (p=0.001) with gender. Conclusion: Acute coronary syndrome were plausibility common in late elderly female. Chest pain was commonest complaint in both genders. Dyspnea, sweating and epigastric pain were also common. Pre-syncope/ syncope and altered mental status were also present in some cases. Conventional risk factors were quite common in both genders. These symptoms can be features acute coronary syndrome in elderly hence should be evaluated cautiously.
{"title":"Clinical Profile and Conventional Risk Factors of Acute Coronary Syndrome in Late Elderly Patients","authors":"R. Simkhada, B. Khan, S. Kc","doi":"10.3126/njh.v20i2.48834","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48834","url":null,"abstract":"Background and Aims: Acute coronary syndrome is an important health issue. There is paucity of its data in late elderly. We aimed to study their clinical profile and prevalence of conventional risk factors. \u0000Methods: Descriptive cross-sectional study conducted at Shahid Gangalal National Heart Centre from February 2022 to May 2022 including 71 consecutive patients of acute coronary syndrome of age >75 years. They were evaluated focusing their chief complaints and cardiovascular risk factors. \u0000Results: Mean age was 80.32±4.06 years. Forty (56.33%) were male and 31 (43.66%) were female. Thirty-nine (54.92%) were hypertensive, 29 (40.84%) were diabetic, 18 (25.35%) were smoker, 10 (14.08%) had history of dyslipidemia and 6 (8.45%) had family history of cardiovascular disease. Chest pain was present in 54 (76.05%), dyspnea in 28 (39.43%), sweating in 15 (21.12%) and nausea/vomiting in 8 (11.26%). Palpitation was present in 7 (9.85%), and epigastric pain in 13 (18.30%). Seven (9.85%) gave history of pre-syncope/ syncope and 6 (8.45%) had altered mental status. There was significant correlation of smoking (p=0.02) and types of ACS (p=0.001) with gender. \u0000Conclusion: Acute coronary syndrome were plausibility common in late elderly female. Chest pain was commonest complaint in both genders. Dyspnea, sweating and epigastric pain were also common. Pre-syncope/ syncope and altered mental status were also present in some cases. Conventional risk factors were quite common in both genders. These symptoms can be features acute coronary syndrome in elderly hence should be evaluated cautiously. ","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45227093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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