Background and Aims: Insertion of transesophageal echocardiography probe in cardiac surgical patient is a routine practice for surgical planning and decision making. However it may increase the endotracheal tube cuff pressure as it lies adjacent to the posterior wall of trachea. The aim of this study is to evaluate the changes in cuff pressure after insertion of the transesophageal echocardiography probe and after completion of initial manipulation of the transesophageal echocardiography probe during various examinations in adult cardiac surgical patients. Methods: Thirty six patients undergoing elective cardiac surgery requiring Transesophageal Echocardiography (TEE) monitoring were enrolled in the study. After induction of general anesthesia and endotracheal intubation cuff pressure were measured at 3 points of time; just after intubation (T1), after transesophageal probe insertion (T2) and after initial completion of TEE study (T3). The mean increase in cuff pressure at various point of time were compared. Results: The cuff pressure (mean±SD) at T1, T2 and T3 were 24.61±2.72, 30.22±5.61 and 32.25±4.45 cm of H2O respectively.The cuff pressure increased significantly from T1 to T2 (p<0.001) and from T1 to T3 (p<0.001). The cuff pressure was > 30 cm of H2O in 18 (50%) of patients at T3 which was readjusted back to 25-30 cm of H2O by with drawing air from the cuff. Conclusion: Endotracheal tube cuff pressure should be routinely monitored either intermittently or continuously after transesophageal echocardiography probe insertion till it is in situ and pressure should be readjusted to avoid unwanted complications.
{"title":"The Effect of Transesophageal Echocardiography Probe Insertion in Endotracheal Tube Cuff Pressure in Adult Cardiac Surgical Patients.","authors":"S. Parajuli, Parbesh Kumar Gyawali, Suraj Kc","doi":"10.3126/NJH.V18I1.36785","DOIUrl":"https://doi.org/10.3126/NJH.V18I1.36785","url":null,"abstract":" Background and Aims: Insertion of transesophageal echocardiography probe in cardiac surgical patient is a routine practice for surgical planning and decision making. However it may increase the endotracheal tube cuff pressure as it lies adjacent to the posterior wall of trachea. The aim of this study is to evaluate the changes in cuff pressure after insertion of the transesophageal echocardiography probe and after completion of initial manipulation of the transesophageal echocardiography probe during various examinations in adult cardiac surgical patients. \u0000Methods: Thirty six patients undergoing elective cardiac surgery requiring Transesophageal Echocardiography (TEE) monitoring were enrolled in the study. After induction of general anesthesia and endotracheal intubation cuff pressure were measured at 3 points of time; just after intubation (T1), after transesophageal probe insertion (T2) and after initial completion of TEE study (T3). The mean increase in cuff pressure at various point of time were compared. \u0000Results: The cuff pressure (mean±SD) at T1, T2 and T3 were 24.61±2.72, 30.22±5.61 and 32.25±4.45 cm of H2O respectively.The cuff pressure increased significantly from T1 to T2 (p<0.001) and from T1 to T3 (p<0.001). The cuff pressure was > 30 cm of H2O in 18 (50%) of patients at T3 which was readjusted back to 25-30 cm of H2O by with drawing air from the cuff. \u0000Conclusion: Endotracheal tube cuff pressure should be routinely monitored either intermittently or continuously after transesophageal echocardiography probe insertion till it is in situ and pressure should be readjusted to avoid unwanted complications.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"18 1","pages":"49-51"},"PeriodicalIF":0.2,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49487486","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}
Ajay Adhikaree, R. Malla, R. Sah, A. Maskey, S. Rajbhandari, D. Sharma, B. Gautam, Shaneez Najmy
Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation. Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1st July 2018 to 30th June 2019. Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e’(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively. Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e’ ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.
背景和目的：超声心动图评估心房颤动患者的左心室舒张功能是一项挑战，因为尽管心房压力正常，但心房跳动（a波）的丧失、搏动间的变异性和左心房扩大使通常基于指南的估计变得困难和不准确。因此，采用额外的超声心动图参数是必要的，这是棘手的，并且具有不同的结果。因此，本研究的目的是研究心房颤动患者舒张功能的各个方面。方法：这是一项基于医院的前瞻性横断面观察性研究，于2018年7月1日至2019年6月30日在加德满都国家医学科学院心脏科和加德满都Shahid Gangalal国家心脏中心进行。结果：共对92例患者进行了研究。约三分之一（34.8%）的患者出现舒张功能障碍。舒张功能障碍患者的E/E'比值（14.65±2.21 Vs 7.66±1.18）、E/Vp比值（1.57±0.14 Vs 1.20±0.11）、等容舒张时间（53.06±13.82ms Vs 89.33±9.88ms）和肺静脉舒张波减速时间（203.09±26.13ms Vs 292.25±36.32ms）与无舒张功能障碍患者相比有显著差异，敏感性为90.6%，分别为84.4%、81.2%和78.1%。结论：舒张功能障碍是心房颤动患者常见的疾病。超声心动图参数如E/E’比值、等容舒张时间、E/Vp比值和舒张肺波减速时间对检测舒张功能障碍具有高度敏感性。
{"title":"Echocardiographic assessment of Diastolic Function in patients with Atrial Fibrillation","authors":"Ajay Adhikaree, R. Malla, R. Sah, A. Maskey, S. Rajbhandari, D. Sharma, B. Gautam, Shaneez Najmy","doi":"10.3126/njh.v16i2.26312","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26312","url":null,"abstract":"Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation. \u0000Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1st July 2018 to 30th June 2019. \u0000Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e’(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively. \u0000Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e’ ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":"58 11","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41259612","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. Sherpa, R. Sah, A. Maskey, R. Malla, D. Sharma, S. Rajbhandari, M. Kc, R. Tamrakar, Sumisti Shakya, Birat Krishna Timilsina, A. Hirachan, P. Koirala, Ajay Adhikari, S. Nazmy
Background and Aims: Despite improvements in clinical care, evidence from both industrialized and developing countries indicates that the prevalence of subclinical cardiac dysfunction in individuals with well-controlled HIV infection may approach 50% and represent a newly recognized comorbid condition. The aim of our study was to reveal abnormalities in cardiac function using conventional transthoracic echocardiography and left ventricular strain imaging in HIV infected patients without cardiovascular disease. Methods: This was a hospital based, single center descriptive cross-sectional comparative study conducted in National Academy of Medical Sciences (NAMS), Bir Hospital which included HIV patients with baseline examination including a patient medical history, clinical examination, baseline CD4 count, viral load and a standardized transthoracic echocardiography and strain imaging examination and the findings were compared among age and sex frequency matched healthy adult population. Results: Our study enrolled 142 patients out of which 95 HIV positive patients (mean age 36.7±9.2 years with 58% female) and 47 healthy control (mean age 33.7±8 years with 57.4% female). The median duration of HIV diagnosis was 7 years (IQR 2, 10) and median CD4 count was 464 cells/mm3 (IQR 259,750). There was no significant difference in conventional echocardiographic parameters between two groups except for transmitral E velocity that was lower in HIV group (P value of 0.001). The HIV population has lower mean global longitudinal strain (GLS) value of -19.92% ± 2.54 SD compared to the healthy control population with mean of -21.39% ± 1.54 SD(P value of 0.001) and patients with CD4 count less than 300 cell/mm3 had GLS value significantly lower than -18% (P value of 0.05). Conclusion: HIV infected population without established cardiovascular disease have subclinical left ventricular dysfunction revealed by GLS imaging technique.
{"title":"Evaluation of left ventricular systolic function by Myocardial Deformation Imaging in asymptomatic HIV patients","authors":"K. Sherpa, R. Sah, A. Maskey, R. Malla, D. Sharma, S. Rajbhandari, M. Kc, R. Tamrakar, Sumisti Shakya, Birat Krishna Timilsina, A. Hirachan, P. Koirala, Ajay Adhikari, S. Nazmy","doi":"10.3126/njh.v16i2.26310","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26310","url":null,"abstract":"Background and Aims: Despite improvements in clinical care, evidence from both industrialized and developing countries indicates that the prevalence of subclinical cardiac dysfunction in individuals with well-controlled HIV infection may approach 50% and represent a newly recognized comorbid condition. The aim of our study was to reveal abnormalities in cardiac function using conventional transthoracic echocardiography and left ventricular strain imaging in HIV infected patients without cardiovascular disease. \u0000Methods: This was a hospital based, single center descriptive cross-sectional comparative study conducted in National Academy of Medical Sciences (NAMS), Bir Hospital which included HIV patients with baseline examination including a patient medical history, clinical examination, baseline CD4 count, viral load and a standardized transthoracic echocardiography and strain imaging examination and the findings were compared among age and sex frequency matched healthy adult population. \u0000Results: Our study enrolled 142 patients out of which 95 HIV positive patients (mean age 36.7±9.2 years with 58% female) and 47 healthy control (mean age 33.7±8 years with 57.4% female). The median duration of HIV diagnosis was 7 years (IQR 2, 10) and median CD4 count was 464 cells/mm3 (IQR 259,750). There was no significant difference in conventional echocardiographic parameters between two groups except for transmitral E velocity that was lower in HIV group (P value of 0.001). The HIV population has lower mean global longitudinal strain (GLS) value of -19.92% ± 2.54 SD compared to the healthy control population with mean of -21.39% ± 1.54 SD(P value of 0.001) and patients with CD4 count less than 300 cell/mm3 had GLS value significantly lower than -18% (P value of 0.05). \u0000Conclusion: HIV infected population without established cardiovascular disease have subclinical left ventricular dysfunction revealed by GLS imaging technique.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43793043","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. K. Rawat, B. Shrestha, R. Juneja, Y. Mehta, N. Trehan
The outcome after off pump coronary artery bypass grafting (OPCAB) surgery has been promising. These good outcomes relate to the benefits of avoiding extra corporeal circulation. Some of the reported advantages include a lower incidence of renal complications, pulmonary complication, adverse neurological event, reduced transfusions requirement and attenuation of the systemic inflammatory response. If the patient has associated preoperative complicated neurological issues, then perioperative management will be more challenging and requires extensive care and precautions.We present a case with symptomatic meningioma and unstable angina who underwent successful urgent OPCAB surgery without further neurological deterioration.
{"title":"Anesthesia for Off Pump Coronary Artery Bypass Surgery in a Patient with Brain Tumor","authors":"S. K. Rawat, B. Shrestha, R. Juneja, Y. Mehta, N. Trehan","doi":"10.3126/njh.v16i2.26321","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26321","url":null,"abstract":"The outcome after off pump coronary artery bypass grafting (OPCAB) surgery has been promising. These good outcomes relate to the benefits of avoiding extra corporeal circulation. Some of the reported advantages include a lower incidence of renal complications, pulmonary complication, adverse neurological event, reduced transfusions requirement and attenuation of the systemic inflammatory response. If the patient has associated preoperative complicated neurological issues, then perioperative management will be more challenging and requires extensive care and precautions.We present a case with symptomatic meningioma and unstable angina who underwent successful urgent OPCAB surgery without further neurological deterioration.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47274902","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. Gautam, K. Sherpa, R. Poudel, P. Shrestha, D. Sharma, R. Sah, R. Malla, A. Maskey, M. K.C, S. Rajbhandari
Background and Aims: Atherosclerosis is an inflammatory process involving arteries in various organs. Carotid intima medial thickness (CIMT) can be useful noninvasive tool to detect atherosclerosis for diagnosis of significant cardiovascular disease. We aim to study the association of CIMT with severity of Coronary Artery Disease (CAD). Methods: This was a cross sectional, observational study conducted in 81 patients with mean age of 59.9± 8.5 years with a diagnosis of CAD undergoing coronary artery bypass graft (CABG) surgery. The CIMT was measured with B-mode ultrasound in all patients and association with severity of CAD was measured. Results: The prevalence of increased CIMT in our study group was 31% and carotid plaque was 69%. Presence of carotid plaque was significantly associated with severe grade CAD stenosis (t = 4, p < 0.001) and presence of Chronic Total Occlusion (CTO) (p = 0.028). There was no significant correlation between mean CIMT and severity of CAD expressed as mean percentage stenosis (r = 0.179, p = 0.11) but patients with CTO had higher mean CIMT value than non-CTO group (0.86 ± 0.21 Vs 0.73 ± 0.18; p = 0.027). We found that diabetic population had greater mean CIMT values than nondiabetic population (0.82 ± 0.21 Vs 0.72 ± 0.17; p = 0.017) and higher prevalence of carotid plaque (p = 0.02). Similarly, females were more likely to have increased CIMT than males (p=0.004). Conclusion: We found that increased CIMT was associated with presence of CTO. Presence of carotid plaque was associated with severe grading of CAD and CTO. Carotid ultrasound can be useful noninvasive modality to predict presence of significant CAD.
背景和目的:动脉粥样硬化是一种累及各器官动脉的炎症过程。颈动脉内膜中层厚度(CIMT)是一种有用的无创检测动脉粥样硬化的工具，可用于诊断重大心血管疾病。我们的目的是研究CIMT与冠状动脉疾病(CAD)严重程度的关系。方法:这是一项横断面观察性研究，对81例平均年龄59.9±8.5岁的冠心病患者进行了冠状动脉旁路移植术(CABG)。所有患者均采用b超测量CIMT，并测量其与冠心病严重程度的相关性。结果:我们研究组中CIMT升高的发生率为31%，颈动脉斑块发生率为69%。颈动脉斑块的存在与严重级别CAD狭窄(t = 4, p < 0.001)和慢性全闭塞(CTO)的存在显著相关(p = 0.028)。平均CIMT与以平均狭窄百分比表示的CAD严重程度之间无显著相关性(r = 0.179, p = 0.11)，但CTO患者的平均CIMT值高于非CTO组(0.86±0.21 Vs 0.73±0.18;P = 0.027)。我们发现糖尿病人群的平均CIMT值高于非糖尿病人群(0.82±0.21 Vs 0.72±0.17;P = 0.017)，颈动脉斑块患病率较高(P = 0.02)。同样，女性比男性更有可能增加CIMT (p=0.004)。结论:我们发现CIMT的增加与CTO的存在有关。颈动脉斑块的存在与CAD和CTO的严重分级有关。颈动脉超声是一种有用的非侵入性方法，可以预测是否存在显著的CAD。
{"title":"Association of Carotid Intima Media Thickness with the severity of Coronary Artery Disease in patients undergoing Coronary Artery Bypass Graft Surgery in a tertiary care center","authors":"B. Gautam, K. Sherpa, R. Poudel, P. Shrestha, D. Sharma, R. Sah, R. Malla, A. Maskey, M. K.C, S. Rajbhandari","doi":"10.3126/njh.v16i2.26315","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26315","url":null,"abstract":"Background and Aims: Atherosclerosis is an inflammatory process involving arteries in various organs. Carotid intima medial thickness (CIMT) can be useful noninvasive tool to detect atherosclerosis for diagnosis of significant cardiovascular disease. We aim to study the association of CIMT with severity of Coronary Artery Disease (CAD). \u0000Methods: This was a cross sectional, observational study conducted in 81 patients with mean age of 59.9± 8.5 years with a diagnosis of CAD undergoing coronary artery bypass graft (CABG) surgery. The CIMT was measured with B-mode ultrasound in all patients and association with severity of CAD was measured. \u0000Results: The prevalence of increased CIMT in our study group was 31% and carotid plaque was 69%. Presence of carotid plaque was significantly associated with severe grade CAD stenosis (t = 4, p < 0.001) and presence of Chronic Total Occlusion (CTO) (p = 0.028). There was no significant correlation between mean CIMT and severity of CAD expressed as mean percentage stenosis (r = 0.179, p = 0.11) but patients with CTO had higher mean CIMT value than non-CTO group (0.86 ± 0.21 Vs 0.73 ± 0.18; p = 0.027). We found that diabetic population had greater mean CIMT values than nondiabetic population (0.82 ± 0.21 Vs 0.72 ± 0.17; p = 0.017) and higher prevalence of carotid plaque (p = 0.02). Similarly, females were more likely to have increased CIMT than males (p=0.004). \u0000Conclusion: We found that increased CIMT was associated with presence of CTO. Presence of carotid plaque was associated with severe grading of CAD and CTO. Carotid ultrasound can be useful noninvasive modality to predict presence of significant CAD.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49044396","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}
P. Regmi, U. Shakya, Ajay Adhikaree, Jigyasa Regmi Paudyal
Background and Aims: Rheumatic Heart Disease (RHD) is the most common heart disease among children and young adults in Nepal. Identifying the prevalence of RHD is important in planning RHD prevention program. There are few studies on RHD conducted among children of unreached population of Nepal. This study aimed to determine the epidemiological status of RHD among school going children living in rural and underdeveloped community of Jajarkot, Nepal. Methods: This is a cross-sectional study of 6,147 school going children of age group 5 to 16 years from 24 randomly selected schools of Jajarkot in the month of May, 2018. A team of cardiologists from Nepal Heart Foundation examined the children. Diagnosis of RHD was confirmed by echocardiography. Selected socio-demographic data were collected. All positive cases were reviewed by senior cardiologist. Information obtained were analyzed. Frequency and percentage for the categorical data were calculated. Prevalence was reported as cases per thousand school children. Results: The overall prevalence of RHD was 7.32 per 1000 schoolchildren. Borderline RHD was 1.30 per 1000 and definite RHD 6.02 per 1000. On severity scale, mild RHD was 6.18, moderate RHD 0.81 and severe RHD 0.33 per 1000 respectively. Prevalence of RHD varied with age, sex, ethnicity, and severity. RHD was found higher among males, 10-16 years age group and underprivileged children. Conclusion: Jajarkot is found to be a RHD endemic zone in Nepal where prevention efforts should be initiated urgently.
{"title":"Rheumatic Heart Disease in school going children: A cross-sectional epidemiological profile of Jajarkot, Nepal","authors":"P. Regmi, U. Shakya, Ajay Adhikaree, Jigyasa Regmi Paudyal","doi":"10.3126/njh.v16i2.26293","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26293","url":null,"abstract":"Background and Aims: Rheumatic Heart Disease (RHD) is the most common heart disease among children and young adults in Nepal. Identifying the prevalence of RHD is important in planning RHD prevention program. There are few studies on RHD conducted among children of unreached population of Nepal. This study aimed to determine the epidemiological status of RHD among school going children living in rural and underdeveloped community of Jajarkot, Nepal. \u0000Methods: This is a cross-sectional study of 6,147 school going children of age group 5 to 16 years from 24 randomly selected schools of Jajarkot in the month of May, 2018. A team of cardiologists from Nepal Heart Foundation examined the children. Diagnosis of RHD was confirmed by echocardiography. Selected socio-demographic data were collected. All positive cases were reviewed by senior cardiologist. Information obtained were analyzed. Frequency and percentage for the categorical data were calculated. Prevalence was reported as cases per thousand school children. \u0000Results: The overall prevalence of RHD was 7.32 per 1000 schoolchildren. Borderline RHD was 1.30 per 1000 and definite RHD 6.02 per 1000. On severity scale, mild RHD was 6.18, moderate RHD 0.81 and severe RHD 0.33 per 1000 respectively. Prevalence of RHD varied with age, sex, ethnicity, and severity. RHD was found higher among males, 10-16 years age group and underprivileged children. \u0000Conclusion: Jajarkot is found to be a RHD endemic zone in Nepal where prevention efforts should be initiated urgently.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41720110","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}
Shaneez Najmy, R. Paudel, Ajay Adhikari, R. Manandhar, C. Adhikari, R. Sah, R. Malla, A. Maskey, D. Sharma, S. Rajbhandari
Background and Aims: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF presentations to the emergency department of a tertiary cardiac center in Nepal1. Present study evaluated the prevalence and characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG). Methods: In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing CAG, at Shahid Gangalal National Heart Centre, were evaluated. Results: The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%) with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years, smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter (iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which, smoking was the independent predictor of CAD. Conclusion: Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries, which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.
{"title":"Coronary Artery Disease prevalence in Heart Failure with Reduced Ejection Fraction","authors":"Shaneez Najmy, R. Paudel, Ajay Adhikari, R. Manandhar, C. Adhikari, R. Sah, R. Malla, A. Maskey, D. Sharma, S. Rajbhandari","doi":"10.3126/njh.v16i2.26314","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26314","url":null,"abstract":"Background and Aims: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF presentations to the emergency department of a tertiary cardiac center in Nepal1. Present study evaluated the prevalence and characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG). \u0000Methods: In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing CAG, at Shahid Gangalal National Heart Centre, were evaluated. \u0000Results: The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%) with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years, smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter (iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which, smoking was the independent predictor of CAD. \u0000Conclusion: Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries, which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42804041","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}
P. Koirala, R. Gajurel, C. Poudel, H. Shrestha, S. Devkota, S. Thapa, S. Thapa, S. Pathak
Background and Aims: Percutaneous Coronary Intervention (PCI) is the preferred method of revascularization in Acute ST Elevation Myocardial Infarction (STEMI). Our aim was to study the clinical profile and outcomes of patients who underwent PCI for STEMI at tertiary cardiac centre of Nepal. Methods: It is a retrospective, single centre study, performed at Tribhuvan University, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal. All patients who underwent PCI for STEMI from November 2015 to July 2018 were enrolled in this study. All the data were collected from hospital registry and cath lab records. Results: The Study showed that out of 232 patients who presented with STEMI, 74.5% were male with average age of 57.39 years. The mean time of presentation after onset of symptom/s was 17.5 hours. About 66% patients presented in less than 12 hours of symptoms onset, 21% presented at 12-24 hours of symptoms onset and 13% patients presented late. Primary PCI was done in 87% of patients. Almost all patients (98.2%) underwent coronary artery stenting with drug eluting stents. Multivessel PCI during index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% cases. Average LVEF at discharge was 44.73%. There were 8 deaths, all after Primary PCI. In-hospital mortality rates for patients presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%. Conclusion: This study has reemphasized that PCI is effective in the management of STEMI cases in Nepal with improving mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one of the prime focuses for effective management of STEMI.
{"title":"Study of clinical profile and outcomes of Percutaneous Coronary Intervention in ST Elevation Myocardial Infraction","authors":"P. Koirala, R. Gajurel, C. Poudel, H. Shrestha, S. Devkota, S. Thapa, S. Thapa, S. Pathak","doi":"10.3126/njh.v16i2.26318","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26318","url":null,"abstract":"Background and Aims: Percutaneous Coronary Intervention (PCI) is the preferred method of revascularization in Acute ST Elevation Myocardial Infarction (STEMI). Our aim was to study the clinical profile and outcomes of patients who underwent PCI for STEMI at tertiary cardiac centre of Nepal. \u0000Methods: It is a retrospective, single centre study, performed at Tribhuvan University, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal. All patients who underwent PCI for STEMI from November 2015 to July 2018 were enrolled in this study. All the data were collected from hospital registry and cath lab records. \u0000Results: The Study showed that out of 232 patients who presented with STEMI, 74.5% were male with average age of 57.39 years. The mean time of presentation after onset of symptom/s was 17.5 hours. About 66% patients presented in less than 12 hours of symptoms onset, 21% presented at 12-24 hours of symptoms onset and 13% patients presented late. Primary PCI was done in 87% of patients. Almost all patients (98.2%) underwent coronary artery stenting with drug eluting stents. Multivessel PCI during index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% cases. Average LVEF at discharge was 44.73%. There were 8 deaths, all after Primary PCI. In-hospital mortality rates for patients presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%. \u0000Conclusion: This study has reemphasized that PCI is effective in the management of STEMI cases in Nepal with improving mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one of the prime focuses for effective management of STEMI.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46254174","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}
R. Rajbhandari, R. Tamrakar, Y. Limbu, S. Singh, S. Kc
Background and Aims: Patients with Coronary artery disease who undergo percutaneous coronary intervention (PCI) are prescribed with maintenance aspirin dose that vary between 75 mg to 300 mg daily. The objective of this study is to evaluate the effects of high dose versus low dose aspirin doses prescribed on hospital discharge in PCI. Methods: All the patients who had undergone PCI at our hospital from 2017 February to October 2017 were enrolled in the study. They were divided into two groups receiving low dose (<200mg) aspirin and high dose (>200mg) aspirin. Patients were interviewed on phone after completion of one year for the possible complications and new ischemic events during the follow up period. Results: Among 150 patients selected 101 fulfilled the criteria and sixty patients (59.4%) were discharged on low-dose aspirin 75-150mg and 41 patients (40.6%) were discharged on high-dose aspirin of 300mg. The mean age in low aspirin group was 59.8±13.19 years and 49.4±10.7 years in high aspirin group. Although high aspirin dose patients did not complain of epigastric pain more often, upper GI bleeding was significantly higher in high aspirin group 7.5% vs 11.1% (p<0.05). One patient in high aspirin group had hemorrhagic stroke while low aspirin group had none. One patient in high aspirin had sudden cardiac death at home. Clinically, there was no significant difference in new ischemic events during follow up period. Conclusion: In patients with coronary artery disease undergoing PCI, discharge on high-dose rather than low-dose aspirin may increase the rate of bleeding without providing additional ischemic benefit.
背景和目的:接受经皮冠状动脉介入治疗(PCI)的冠状动脉疾病患者，每日给予75 - 300毫克阿司匹林维持剂量。本研究的目的是评估高剂量阿司匹林与低剂量阿司匹林对PCI患者出院的影响。方法:选取2017年2月至2017年10月在我院行PCI术的患者为研究对象。他们被分为两组，服用低剂量(200mg)阿司匹林。随访一年后对患者进行电话随访，了解随访期间可能出现的并发症和新的缺血性事件。结果:150例患者中101例符合标准，出院时使用低剂量阿司匹林75 ~ 150mg患者60例(59.4%)，出院时使用高剂量阿司匹林300mg患者41例(40.6%)。低剂量组平均年龄59.8±13.19岁，高剂量组平均年龄49.4±10.7岁。高剂量阿司匹林组上消化道出血发生率明显高于高剂量阿司匹林组(7.5% vs 11.1%) (p<0.05)。高剂量阿司匹林组有1例出血性中风，低剂量阿司匹林组无。一名服用高剂量阿司匹林的患者在家中发生心源性猝死。临床方面，随访期间两组新发缺血事件发生率无显著差异。结论:在接受PCI的冠状动脉疾病患者中，出院时使用高剂量阿司匹林而不是低剂量阿司匹林可能会增加出血率，但不会提供额外的缺血益处。
{"title":"High dose versus low dose Aspirin after Percutaneous Coronary Intervention in Coronary Artery Disease","authors":"R. Rajbhandari, R. Tamrakar, Y. Limbu, S. Singh, S. Kc","doi":"10.3126/njh.v16i2.26319","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26319","url":null,"abstract":"Background and Aims: Patients with Coronary artery disease who undergo percutaneous coronary intervention (PCI) are prescribed with maintenance aspirin dose that vary between 75 mg to 300 mg daily. The objective of this study is to evaluate the effects of high dose versus low dose aspirin doses prescribed on hospital discharge in PCI. \u0000Methods: All the patients who had undergone PCI at our hospital from 2017 February to October 2017 were enrolled in the study. They were divided into two groups receiving low dose (<200mg) aspirin and high dose (>200mg) aspirin. Patients were interviewed on phone after completion of one year for the possible complications and new ischemic events during the follow up period. \u0000Results: Among 150 patients selected 101 fulfilled the criteria and sixty patients (59.4%) were discharged on low-dose aspirin 75-150mg and 41 patients (40.6%) were discharged on high-dose aspirin of 300mg. The mean age in low aspirin group was 59.8±13.19 years and 49.4±10.7 years in high aspirin group. Although high aspirin dose patients did not complain of epigastric pain more often, upper GI bleeding was significantly higher in high aspirin group 7.5% vs 11.1% (p<0.05). One patient in high aspirin group had hemorrhagic stroke while low aspirin group had none. One patient in high aspirin had sudden cardiac death at home. Clinically, there was no significant difference in new ischemic events during follow up period. \u0000Conclusion: In patients with coronary artery disease undergoing PCI, discharge on high-dose rather than low-dose aspirin may increase the rate of bleeding without providing additional ischemic benefit.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48093147","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}
R. Paudel, R. Sah, M. Kc, D. Sharma, A. Maskey, R. Malla, S. Rajbhandari, P. Kc, R. Tamrakar, B. Gautam, K. Sherpa
Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT. Results: Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56 years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong correlation between MLS index and MVA by planimetry ( r = 0.89, p<0.001) and MVA by PHT (r=0.95, p<0.001). MLS index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT. Conclusion: MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.
{"title":"Assessment of Rheumatic Mitral Stenosis severity by Mitral Leaflet Separation Index","authors":"R. Paudel, R. Sah, M. Kc, D. Sharma, A. Maskey, R. Malla, S. Rajbhandari, P. Kc, R. Tamrakar, B. Gautam, K. Sherpa","doi":"10.3126/njh.v16i2.26316","DOIUrl":"https://doi.org/10.3126/njh.v16i2.26316","url":null,"abstract":"Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. \u0000Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT. \u0000Results: Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56 years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong correlation between MLS index and MVA by planimetry ( r = 0.89, p<0.001) and MVA by PHT (r=0.95, p<0.001). MLS index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT. \u0000Conclusion: MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.","PeriodicalId":52010,"journal":{"name":"Nepalese Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3126/njh.v16i2.26316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47382298","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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