Twenty-five years ago, embarked the start of the era of cardiovascular surgery using the heart lung machine in the country and as we celebrate this humble beginning, we sought to review the advent and the progress made in this field of science over the course of the years in the country; delve in to the challenges and opportunities that it may present in the future to uphold this great profession.
{"title":"Twenty-five years of Cardiac Surgery in Nepal: Trials, Tribulations and Triumph","authors":"Bijoy G Rajbanshi, S. Pradhan, B. Koirala","doi":"10.3126/njh.v20i2.48936","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48936","url":null,"abstract":"Twenty-five years ago, embarked the start of the era of cardiovascular surgery using the heart lung machine in the country and as we celebrate this humble beginning, we sought to review the advent and the progress made in this field of science over the course of the years in the country; delve in to the challenges and opportunities that it may present in the future to uphold this great profession.","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":"45724604","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}
S. Adhikari, R. Gajurel, C. Poudel, H. Shrestha, S. Thapa, S. Devkota, B. Manandhar, R. Khanal, S. Shakya, V. Yadav, Manju Sharma, Ravi Sahi, Jeevan Thapa
Background and Aims: Coronary artery disease is one of the important causes of deaths in females in many countries. Females with chest pain are more likely to be treated in a different way as compared to males at the time of presentation. Worldwide, there has been a considerable rise in the number of females who are undergoing coronary angiography recently. Methods: This study was a single-centre, prospective, observational study conducted in the department of cardiology, MCVTC, Tribhuvan University, Nepal. The study period was from 5th July 2020 to 4th July 2021.155 female patients with anginal chest pain were enrolled. Data were collected after thorough history taking, physical examination, laboratory investigations, and coronary angiography. They were further divided into three age groups:<50 years,50-65 years and >65 years. Subsequently statistical analysis was done using latest version of SPSS. Results: The mean age of the patients was 59.64 years (SD=11.428). There were 119 (76.77%) postmenopausal patients. The most prevalent risk factor of IHD was HTN (43.87% ). Obesity/overweight was most common (58.62%) in those with age <50 years. DM was most common (26.32%) in age group 50-65 years. HTN was the most prevalent (52.63%) in age group 50-65 years. The maximum proportion of dyslipidemic patients (34.21%) were found in age group 50-65 years. 52.25% patients presented with acute coronary syndrome. 33.55% patients had normal coronary arteries. 11.61% patients had nonobstructive coronary artery disease. Obstructive coronary artery disease was found in 51.61% patients. IN patients with obstructive CAD, LAD was the most commonly involved vessel followed by RCA . Conclusion: Findings from our study shows higher prevalence of risk factors for IHD in Nepalese females. This study also demonstrates that as females get older and become postmenopausal, the number of risk factors for CAD increases. Understanding the risk factors for CAD and angiographic patterns in females could be helpful in implementing optimal treatment strategies in females with angina.
{"title":"Study of Clinical Profiles, Risk Factors and Coronary Angiographic Patterns in Female Patients Presenting with Anginal Chest Pain in a Tertiary Care Centre of Nepal","authors":"S. Adhikari, R. Gajurel, C. Poudel, H. Shrestha, S. Thapa, S. Devkota, B. Manandhar, R. Khanal, S. Shakya, V. Yadav, Manju Sharma, Ravi Sahi, Jeevan Thapa","doi":"10.3126/njh.v20i2.48868","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48868","url":null,"abstract":"Background and Aims: Coronary artery disease is one of the important causes of deaths in females in many countries. Females with chest pain are more likely to be treated in a different way as compared to males at the time of presentation. Worldwide, there has been a considerable rise in the number of females who are undergoing coronary angiography recently. \u0000Methods: This study was a single-centre, prospective, observational study conducted in the department of cardiology, MCVTC, Tribhuvan University, Nepal. The study period was from 5th July 2020 to 4th July 2021.155 female patients with anginal chest pain were enrolled. Data were collected after thorough history taking, physical examination, laboratory investigations, and coronary angiography. They were further divided into three age groups:<50 years,50-65 years and >65 years. Subsequently statistical analysis was done using latest version of SPSS. \u0000Results: The mean age of the patients was 59.64 years (SD=11.428). There were 119 (76.77%) postmenopausal patients. The most prevalent risk factor of IHD was HTN (43.87% ). Obesity/overweight was most common (58.62%) in those with age <50 years. DM was most common (26.32%) in age group 50-65 years. HTN was the most prevalent (52.63%) in age group 50-65 years. The maximum proportion of dyslipidemic patients (34.21%) were found in age group 50-65 years. 52.25% patients presented with acute coronary syndrome. 33.55% patients had normal coronary arteries. 11.61% patients had nonobstructive coronary artery disease. \u0000Obstructive coronary artery disease was found in 51.61% patients. IN patients with obstructive CAD, LAD was the most commonly involved vessel followed by RCA . \u0000Conclusion: Findings from our study shows higher prevalence of risk factors for IHD in Nepalese females. This study also demonstrates that as females get older and become postmenopausal, the number of risk factors for CAD increases. Understanding the risk factors for CAD and angiographic patterns in females could be helpful in implementing optimal treatment strategies in females with angina.","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":"49647732","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}
K. Shaha, Ashok Adhikari, Sajjad Safi, Avisesh Shakya, Sanjay Shrestha
Background and Aims: In the era of left main angioplasty, the aim of this study is to evaluate the applicability of Finet’s law in left main diameter calculation and establish this as a useful feasible alternative tool to intravascular ultrasound in the left main intervention. Methods: A total of 164 patients who underwent coronary angiography at PAHS due to suspicion of coronary artery disease between 1st January 2017 and April 2020 were included. The left main diameter(do-QCA) was calculated using the Quantitative coronary angiographic (QCA) method and correlated with the Left main diameter (do-finets) derived from Finet’s law which takes into account the diameter (d1) of the proximal left anterior descending artery (LAD) and left circumflex (LCX) diameter (d2) derived from QCA, added together and multiplied by the factor of 0.678 i.e do-finets=0.678(d1+d2). Results: Using the Bivariate Pearson correlation method, do-QCA was found to have a positive correlation with do-finets with a correlation coefficient of (r=0.721) significant at the level of P value 0.01 (2-tailed). Conclusion: The application of Finet’s Law using the QCA method has been found to be a handy feasible alternative tool to intravascular ultrasound in calculating the left main diameter for the left main intervention where intravascular ultrasound is not available or economic constraint prevails.
{"title":"Correlation between Left main artery diameter derived by Finet’s Law and direct angiographic quantitative coronary dimension analysis","authors":"K. Shaha, Ashok Adhikari, Sajjad Safi, Avisesh Shakya, Sanjay Shrestha","doi":"10.3126/njh.v20i2.48932","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48932","url":null,"abstract":"Background and Aims: In the era of left main angioplasty, the aim of this study is to evaluate the applicability of Finet’s law in left main diameter calculation and establish this as a useful feasible alternative tool to intravascular ultrasound in the left main intervention. \u0000Methods: A total of 164 patients who underwent coronary angiography at PAHS due to suspicion of coronary artery disease between 1st January 2017 and April 2020 were included. The left main diameter(do-QCA) was calculated using the Quantitative coronary angiographic (QCA) method and correlated with the Left main diameter (do-finets) derived from Finet’s law which takes into account the diameter (d1) of the proximal left anterior descending artery (LAD) and left circumflex (LCX) diameter (d2) derived from QCA, added together and multiplied by the factor of 0.678 i.e do-finets=0.678(d1+d2). \u0000Results: Using the Bivariate Pearson correlation method, do-QCA was found to have a positive correlation with do-finets with a correlation coefficient of (r=0.721) significant at the level of P value 0.01 (2-tailed). \u0000Conclusion: The application of Finet’s Law using the QCA method has been found to be a handy feasible alternative tool to intravascular ultrasound in calculating the left main diameter for the left main intervention where intravascular ultrasound is not available or economic constraint prevails.","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":"44924366","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}
C. Poudel, R. Gajurel, H. Shrestha, S. Devkota, S. Thapa, R. Khanal, S. Shakya, B. Manandhar, V. Yadav
Background and Aims: To assess the difficulties encountered while performing coronary angiography and percutaneous coronary intervention in anomalous right coronary artery arising from the left sinus of Valsalva. Methods: Between January 2016 and December 2020, a total of 23 patients underwent coronary angiography and eight underwent percutaneous coronary intervention for an angiographic significant lesion in the anomalous right coronary artery arising from the left sinus of Valsalva. The vascular approach, usage of catheters, fluoroscopic time, and the amount of contrast used were also assessed. Results: Among 6000 coronary angiography and 1500 percutaneous coronary intervention performed, 33 patients (0.55%) had right coronary artery arising from the left sinus of Valsalva. Altogether, 14 patients had type-A, seven had Type-B, eight had Type-C, and four had Type-D anomalous right coronary artery arising from the left sinus of Valsalva. Coronary Angiography was accomplished with the Tiger catheter in 13 patients, Judkins left JL in 8 patients, and Extra-backup (XB3) in one patient. In the percutaneous coronary intervention group, cannulation was done with Judkins left (JL), Amplatz left (AL), and XB in five, two, and one patient respectively and among five type-A patients, four were cannulated with JL and one with XB; one Type-B with JL4; and two Type-C with AL2. The mean fluoroscopic time and contrast volume consumption for coronary angiography and percutaneous coronary intervention were 9.9 minutes and 47 minutes respectively and 63ml and 229 ml respectively. Conclusion: Coronary intervention of anomalous right coronary artery arising from the left sinus of Valsalva is difficult due to inappropriate selection of guide catheter and is associated with a higher both mean fluoroscopic time and contrast volume. Radial route is equally effective for successful procedure.
{"title":"Coronary Angiography and Percutaneous coronary Intervention in Anomalous Origin of Right Coronary Artery Arising from the Left Sinus of Valsalva","authors":"C. Poudel, R. Gajurel, H. Shrestha, S. Devkota, S. Thapa, R. Khanal, S. Shakya, B. Manandhar, V. Yadav","doi":"10.3126/njh.v20i2.48952","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48952","url":null,"abstract":"Background and Aims: To assess the difficulties encountered while performing coronary angiography and percutaneous coronary intervention in anomalous right coronary artery arising from the left sinus of Valsalva. \u0000Methods: Between January 2016 and December 2020, a total of 23 patients underwent coronary angiography and eight underwent percutaneous coronary intervention for an angiographic significant lesion in the anomalous right coronary artery arising from the left sinus of Valsalva. The vascular approach, usage of catheters, fluoroscopic time, and the amount of contrast used were also assessed. \u0000Results: Among 6000 coronary angiography and 1500 percutaneous coronary intervention performed, 33 patients (0.55%) had right coronary artery arising from the left sinus of Valsalva. Altogether, 14 patients had type-A, seven had Type-B, eight had Type-C, and four had Type-D anomalous right coronary artery arising from the left sinus of Valsalva. Coronary Angiography was accomplished with the Tiger catheter in 13 patients, Judkins left JL in 8 patients, and Extra-backup (XB3) in one patient. In the percutaneous coronary intervention group, cannulation was done with Judkins left (JL), Amplatz left (AL), and XB in five, two, and one patient respectively and among five type-A patients, four were cannulated with JL and one with XB; one Type-B with JL4; and two Type-C with AL2. The mean fluoroscopic time and contrast volume consumption for coronary angiography and percutaneous coronary intervention were 9.9 minutes and 47 minutes respectively and 63ml and 229 ml respectively. \u0000Conclusion: Coronary intervention of anomalous right coronary artery arising from the left sinus of Valsalva is difficult due to inappropriate selection of guide catheter and is associated with a higher both mean fluoroscopic time and contrast volume. Radial route is equally effective for successful procedure.","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":"46693178","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}
B. Karki, J. Ghimire, B. Nepal, A. Mahaseth, A. Sah, Swapnil Pandit, N. Pandey, P. Shah, P. Karki
Background and Aims: Diabetes mellitus is a well recognized risk factor for cardiovascular disease and acute coronary syndrome. It is becoming increasingly clear that pre-diabetic state is also associated with adverse clinical outcomes. However, evidence is limited regarding the prognostic value of 'prediabetes' on the clinical outcome of acute coronary syndrome. So, we aimed to assess the prevalence of prediabetes in acute coronary syndrome patients and its clinical outcome Methods: This was a single center descriptive cross-sectional study to know the prevalence of prediabetes in 115 patients consisting of 71 males and 44 females, admitted with acute coronary syndrome in the Department of Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, between August 2020 to July 2021. Results: Based on the definition of 2020 American Diabetic Association, 35 (30.4%) patients were newly diagnosed diabetic, 46 (40%) patients were prediabetic and 34(29.6%) were non-diabetic. Based on HbA1c alone, 26.1% patients were classified as newly diagnosed diabetic patients, 38.3% patients were classified as prediabetic and 35.7% as non-diabetic. Compared with patients without diabetes, patients with prediabetes tended to have a longer hospital stay (p=0.04), higher creatine level (p=0.01) and higher incidence of heart failure (p=0.046). Conclusion: Prediabetes is common in patients presenting with acute coronary syndrome who are not previously known to have diabetes. Further multi-center studies with long term clinical follow-up are needed to draw a firm conclusion regarding the impact of prediabetes on clinical outcome
{"title":"Prevalence of Prediabetes in Patients with Acute Coronary Syndrome: A Descriptive Cross-Sectional Study","authors":"B. Karki, J. Ghimire, B. Nepal, A. Mahaseth, A. Sah, Swapnil Pandit, N. Pandey, P. Shah, P. Karki","doi":"10.3126/njh.v20i2.48933","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48933","url":null,"abstract":"Background and Aims: Diabetes mellitus is a well recognized risk factor for cardiovascular disease and acute coronary syndrome. It is becoming increasingly clear that pre-diabetic state is also associated with adverse clinical outcomes. However, evidence is limited regarding the prognostic value of 'prediabetes' on the clinical outcome of acute coronary syndrome. So, we aimed to assess the prevalence of prediabetes in acute coronary syndrome patients and its clinical outcome \u0000Methods: This was a single center descriptive cross-sectional study to know the prevalence of prediabetes in 115 patients consisting of 71 males and 44 females, admitted with acute coronary syndrome in the Department of Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, between August 2020 to July 2021. \u0000Results: Based on the definition of 2020 American Diabetic Association, 35 (30.4%) patients were newly diagnosed diabetic, 46 (40%) patients were prediabetic and 34(29.6%) were non-diabetic. Based on HbA1c alone, 26.1% patients were classified as newly diagnosed diabetic patients, 38.3% patients were classified as prediabetic and 35.7% as non-diabetic. Compared with patients without diabetes, patients with prediabetes tended to have a longer hospital stay (p=0.04), higher creatine level (p=0.01) and higher incidence of heart failure (p=0.046). \u0000Conclusion: Prediabetes is common in patients presenting with acute coronary syndrome who are not previously known to have diabetes. Further multi-center studies with long term clinical follow-up are needed to draw a firm conclusion regarding the impact of prediabetes on clinical outcome","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":"49489198","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. Kadel, S. Karki, B. Rauniyar, Sushant Kharel, K. Neupane, K. Acharya, K. Sherpa, C. Adhikari
Background and Aims: The COVID 19 pandemic have affected the patients with ST segment elevation myocardial infarction as the number of patients presenting with STEMI declined substantially and those who underwent primary PCI had poor outcome. Our aim was to analyze the in-hospital and 30-days mortality in STEMI undergoing Primary PCI during second wave of COVID 19. Methods: A prospective cohort study was conducted at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. Convenience sampling of patients who underwent primary PCI were enrolled in this study and were followed up for 30 days. Numerical variables were described as Mean ± Standard Deviation (SD) and categorical variables were described as frequency and percentage. p values were calculated and considered significant if < 0.05. Results: During this study period of 2 months from 1st May 2021 to 30th June 2021, 97 patients with STEMI underwent primary PCI, including 12 (12.47%) COVID 19 positive cases. 30 days mortality was 15.4% including in-hospital mortality of 11.34%. Among COVID 19 positive cases, in-hospital mortality was 33.33% and 30-days mortality was 55.55% which was significantly higher than non COVID 19 patient who underwent primary PCI (P=0.003). Conclusion: Overall, mortality rate of primary PCI during COVID 19 second wave has been increased and mortality of COVID 19 positive patients who underwent primary PCI was significantly higher than non-COVID 19 patients who underwent primary PCI.
{"title":"Impact of COVID 19 on outcome of primary percutaneous coronary intervention in Nepal.","authors":"A. Kadel, S. Karki, B. Rauniyar, Sushant Kharel, K. Neupane, K. Acharya, K. Sherpa, C. Adhikari","doi":"10.3126/njh.v20i2.48863","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48863","url":null,"abstract":"Background and Aims: The COVID 19 pandemic have affected the patients with ST segment elevation myocardial infarction as the number of patients presenting with STEMI declined substantially and those who underwent primary PCI had poor outcome. Our aim was to analyze the in-hospital and 30-days mortality in STEMI undergoing Primary PCI during second wave of COVID 19. \u0000Methods: A prospective cohort study was conducted at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. Convenience sampling of patients who underwent primary PCI were enrolled in this study and were followed up for 30 days. Numerical variables were described as Mean ± Standard Deviation (SD) and categorical variables were described as frequency and percentage. p values were calculated and considered significant if < 0.05. \u0000Results: During this study period of 2 months from 1st May 2021 to 30th June 2021, 97 patients with STEMI underwent primary PCI, including 12 (12.47%) COVID 19 positive cases. 30 days mortality was 15.4% including in-hospital mortality of 11.34%. Among COVID 19 positive cases, in-hospital mortality was 33.33% and 30-days mortality was 55.55% which was significantly higher than non COVID 19 patient who underwent primary PCI (P=0.003). \u0000Conclusion: Overall, mortality rate of primary PCI during COVID 19 second wave has been increased and mortality of COVID 19 positive patients who underwent primary PCI was significantly higher than non-COVID 19 patients who underwent primary PCI.","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":"46159115","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}
Although the World Health Organization has endorsed Patient blood management (PBM) in 2010 many hospitals still seek guidance with the implementation of PBM in clinical routine. This article presents how a Himalayan country; Nepal collaborate to form a task force to develop recommendation implementing PBM in clinical practice for improved outcomes.
{"title":"Patient Blood Management Stewardship Campaign Nepal","authors":"A. Amatya","doi":"10.3126/njh.v20i2.48935","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48935","url":null,"abstract":"Although the World Health Organization has endorsed Patient blood management (PBM) in 2010 many hospitals still seek guidance with the implementation of PBM in clinical routine. This article presents how a Himalayan country; Nepal collaborate to form a task force to develop recommendation implementing PBM in clinical practice for improved outcomes.","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":"42689684","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: Heart failure is a leading cause of hospital admissions each year. In Nepal also the incidence of heart failure is increasing. Acute decompensated heart failure carries a poor prognosis. Most patients respond to intravenous loop diuretics but a substantial proportion of patients are resistant to them and may need additional diuretic agents like metolazone by the principle of “sequential nephron blockade”. Methods: In a hospital-based cross-sectional comparative study, we assigned 68 patients with acute decompensated chronic heart failure patients to receive furosemide at 1 mg/kg twice daily or furosemide at 1 mg/kg twice daily plus metolazone 5mg/day. The primary end-points were daily weight loss, negative water balance (difference between urine output and fluid intake) and symptomatic improvement on NYHA grading. Results: There were 55% males and 45% females in total. There was a significant difference (p-value =0.003) in mean weight loss observed between the two groups on day three, i.e., 0.971±0.6 kg and 1.5±0.78 kg in furosemide group and furosemide plus metolazone group respectively. Mean negative water significantly more in the combination group on day two (450±230.94 ml vs 750.59±416.92 ml) with p-value <0.001 and day three (780.88±352.48 ml vs 504.38±292.46 ml) with p-value 0.001. There was no significant change in symptoms on the basis of NYHA grading between the two groups, duration of hospital stay and adverse events like hypotension, acute kidney injury and dyselectrolytemia. Conclusion: Among patients with acute decompensated chronic heart failure, treatment with combination of furosemide and metolazone was found to be more effective than furosemide alone without significant increase in adverse effects.
背景:心力衰竭是每年住院的主要原因。在尼泊尔，心力衰竭的发病率也在增加。急性失代偿性心力衰竭预后不良。大多数患者对静脉循环利尿剂有反应，但有相当一部分患者对它们有耐药性，可能需要根据“序贯肾元阻断”原则使用额外的利尿剂，如美托酮。方法:在一项以医院为基础的横断比较研究中，我们将68例急性失代偿性慢性心力衰竭患者分配给1 mg/kg每日2次的呋塞米或1 mg/kg每日2次的呋塞米加5mg/天的美唑酮。主要终点是每日体重减轻，负水分平衡(尿量和液体摄入量之间的差异)和NYHA分级的症状改善。结果:男性占55%，女性占45%。第3天，两组患者平均体重减轻量分别为0.971±0.6 kg、1.5±0.78 kg，差异有统计学意义(p值=0.003)。联合用药组第2天(450±230.94 ml vs 750.59±416.92 ml)平均负水明显增多，p值<0.001;第3天(780.88±352.48 ml vs 504.38±292.46 ml)平均负水明显增多，p值<0.001。两组患者在NYHA评分、住院时间、低血压、急性肾损伤、电解质障碍等不良事件的基础上，症状无明显变化。结论:在急性失代偿性慢性心力衰竭患者中，呋塞米联合美唑酮治疗效果优于单用呋塞米，且不良反应无明显增加。
{"title":"Treatment of Acute Decompensated Chronic Heart Failure: Furosemide vs Furosemide and Metolazone: A Cross-Sectional Comparative Study","authors":"U. Risal, P. Karki, P. Shah","doi":"10.3126/njh.v20i2.48870","DOIUrl":"https://doi.org/10.3126/njh.v20i2.48870","url":null,"abstract":"Background: Heart failure is a leading cause of hospital admissions each year. In Nepal also the incidence of heart failure is increasing. Acute decompensated heart failure carries a poor prognosis. Most patients respond to intravenous loop diuretics but a substantial proportion of patients are resistant to them and may need additional diuretic agents like metolazone by the principle of “sequential nephron blockade”. \u0000Methods: In a hospital-based cross-sectional comparative study, we assigned 68 patients with acute decompensated chronic heart failure patients to receive furosemide at 1 mg/kg twice daily or furosemide at 1 mg/kg twice daily plus metolazone 5mg/day. The primary end-points were daily weight loss, negative water balance (difference between urine output and fluid intake) and symptomatic improvement on NYHA grading. \u0000Results: There were 55% males and 45% females in total. There was a significant difference (p-value =0.003) in mean weight loss observed between the two groups on day three, i.e., 0.971±0.6 kg and 1.5±0.78 kg in furosemide group and furosemide plus metolazone group respectively. Mean negative water significantly more in the combination group on day two (450±230.94 ml vs 750.59±416.92 ml) with p-value <0.001 and day three (780.88±352.48 ml vs 504.38±292.46 ml) with p-value 0.001. There was no significant change in symptoms on the basis of NYHA grading between the two groups, duration of hospital stay and adverse events like hypotension, acute kidney injury and dyselectrolytemia. \u0000Conclusion: Among patients with acute decompensated chronic heart failure, treatment with combination of furosemide and metolazone was found to be more effective than furosemide alone without significant increase in adverse effects.","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":"43089092","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}
Madhu S. Giri, R. Shakya, D. Bista, Aastha Manandhar, Dikshya Giri
Background and Aims: Medication adherence among Post myocardial infarction (MI) patient is suboptimal all over the world. Although significant advances have been made in the diagnosis and management of Acute Myocardial Infraction, it is still a major cause of morbidity and mortality worldwide and significant therapeutic challenges to the society. The purpose of the study was to study the medication adherence and to identify the effect of adverse drug reaction (ADR) on medication adherence. Methods: The study was a single center, prospective study carried out in Shahid Gangalal National Heart Centre (SGNHC) in Nepal. The enrolled patients were followed up at 6th weeks after discharge in outpatient department (OPD) visit. Patients were interviewed with Morisky Green Levine (MGL) adherence scale questionnaire to identify medication adherence. The ADR was assessed. Data were analyzed in SPSS version 20. Results: A total of 134 patients were included in the study. The study showed post MI patient were highly adherent to medication (92.5%). ADR was not significantly associated with medication adherence. Conclusion: Patients were highly adherent to medication and the effect of ADR on medication adherence was not significant.
背景和目的：心肌梗死后患者的药物依从性在世界各地都不理想。尽管在急性心肌梗死的诊断和治疗方面取得了重大进展，但它仍然是全球发病率和死亡率的主要原因，也是社会面临的重大治疗挑战。本研究的目的是研究药物依从性，并确定药物不良反应（ADR）对药物依从性的影响。方法：该研究是在尼泊尔Shahid Gangalal国家心脏中心（SGNHC）进行的一项单中心前瞻性研究。入选患者在出院后第6周在门诊部（OPD）就诊时进行随访。采用Morisky Green Levine（MGL）依从性量表对患者进行访谈，以确定药物依从性。对ADR进行了评估。数据在SPSS版本20中进行分析。结果：共有134名患者被纳入研究。研究表明，MI后患者对药物的依从性很高（92.5%），ADR与药物依从性无显著相关性。结论：患者对药物的依从性较高，ADR对药物依从性的影响不显著。
{"title":"Medication Adherence in Post Myocardial Infarction Patients at Shahid Gangalal National Heart Centre","authors":"Madhu S. Giri, R. Shakya, D. Bista, Aastha Manandhar, Dikshya Giri","doi":"10.3126/njh.v19i1.45281","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45281","url":null,"abstract":"Background and Aims: Medication adherence among Post myocardial infarction (MI) patient is suboptimal all over the world. Although significant advances have been made in the diagnosis and management of Acute Myocardial Infraction, it is still a major cause of morbidity and mortality worldwide and significant therapeutic challenges to the society. The purpose of the study was to study the medication adherence and to identify the effect of adverse drug reaction (ADR) on medication adherence. \u0000Methods: The study was a single center, prospective study carried out in Shahid Gangalal National Heart Centre (SGNHC) in Nepal. The enrolled patients were followed up at 6th weeks after discharge in outpatient department (OPD) visit. Patients were interviewed with Morisky Green Levine (MGL) adherence scale questionnaire to identify medication adherence. The ADR was assessed. Data were analyzed in SPSS version 20. \u0000Results: A total of 134 patients were included in the study. The study showed post MI patient were highly adherent to medication (92.5%). ADR was not significantly associated with medication adherence. \u0000Conclusion: Patients were highly adherent to medication and the effect of ADR on medication adherence was not significant.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43535636","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. Prajapati, Bijoy G Rajbanshi, C. Adhikari, D. Sharma
Cardiac Society of Nepal in coordination with World Heart Federation created this scorecard or Cardiovascular profile for identification of different markers for the incidence and prevalence of heart disease in Nepal. The objective of the scorecard was to understand and assess national CVD action from a civil society perspective in an effort to complement and support official government surveillance, monitoring and reporting on CVD.
{"title":"Cardiac Society of Nepal (CSN) and World Heart Federation (WHF) Cardiovascular Diseases Scorecard Project","authors":"D. Prajapati, Bijoy G Rajbanshi, C. Adhikari, D. Sharma","doi":"10.3126/njh.v19i1.45327","DOIUrl":"https://doi.org/10.3126/njh.v19i1.45327","url":null,"abstract":"Cardiac Society of Nepal in coordination with World Heart Federation created this scorecard or Cardiovascular profile for identification of different markers for the incidence and prevalence of heart disease in Nepal. The objective of the scorecard was to understand and assess national CVD action from a civil society perspective in an effort to complement and support official government surveillance, monitoring and reporting on CVD.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46349486","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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