Shahid Gangalal National Heart Centre Research Articles

Morphological features of myocardial bridging in patients who underwent CT coronary angiography in the National Heart Centre of Nepal

Abstract Objective Multidetector computed tomography is considered a reliable, non-invasive modality for diagnosing myocardial bridging. The prevalence of myocardial bridges varies greatly based on the technique used to identify the anomaly. We aimed to evaluate the frequency and morphological features of myocardial bridging in patients who underwent ECG-gated 640 slice Multidetector computed tomography coronary angiography at Shahid Gangalal National Heart Centre. Methods A retrospective cross-selectional study was conducted at Shahid Gangalal National Heart Centre. From 1 January 2021 to 30 June 2021, 1068 consecutive patients were enrolled, and the frequency and morphological features of myocardial bridging among those patients were evaluated. Results Among the 1068 patients examined, 141 had one or multiple Myocardial bridging (13.2%). Out of 141 patients, 94.3% of bridging was superficial, while only 5.7% was deep. 97.9% of myocardial bridging was located in the left anterior descending artery, and 86.2% was present in the mid-segment of the left anterior descending artery. Conclusion Multidetector computed tomography is an effective noninvasive method for the diagnosis of myocardial bridging. The frequency of myocardial bridging in our study was 13.2%.

Accuracy of Electrocardiography Criteria for Left Ventricular Hypertrophy in Hypertensive Patients at Shahid Gangalal National Heart Centre

Accuracy of Electrocardiography Criteria for Left Ventricular Hypertrophy in Hypertensive Patients at Shahid Gangalal National Heart Centre

Acute Myocardial Infarction in Women, a Study on Risk Factors, Angiographic Features and Outcomes.

Women with acute coronary syndrome are more likely to have cardiovascular disease risk factors and atypical symptoms as compared to men. In Nepal, there is a rising trend of Coronary Artery Disease and myocardial infarction in women. However, research on acute myocardial infarction in women is lacking. The aim of this study was to study the cardiac risk factors, clinical features, angiographic features, and outcome of acute myocardial infarction in Nepalese women admitted to Hospital. This was a cross sectional study done at Shahid Gangalal National Heart Center Kathmandu from September 2016 to March 2017. Female patients admitted with a diagnosis of acute ST-segment elevation myocardial infarction or non-ST segment elevation myocardial infarction, who fulfilled the inclusion criteria were included in the study. The details of the patients, demographic profile, major clinical symptoms, major coronary artery disease risk factors, angiographic features and outcomes were recorded and assessed during the study period. Coronary angiography was done in 112 patients out of 178 patients. Out of 178 patients, 85.95 % had ST-segment elevation myocardial infarction and 14.05% had non-ST segment elevation myocardial infarction. The mean patient age was 62.53 ± 12.1. 26.4% patients were of age less than 55 years. Major risk factors were central obesity (94.61%), dyslipidemia due to low HDL (78.65%). hypertension (54.49%), smoking (54.49%) and type 2 diabetes (34.83%). The most common atypical symptoms were shortness of breath (35.39 %,) , nausea and vomiting (23. 6%) and epigastric pain (6.74%), Single vessel disease was found in 36%; double vessel disease in 26.3% and triple vessel disease in 28.9% of patients. The primary outcome of in- hospital mortality was 3.37 %. Our study showed that significant number of females had Coronary Artery Disease at early age. Among women with myocardial infarction in Nepal, obesity due to high waist to hip ratio was the most common risk factor followed by dyslipidemia due to low high density lipoproteins, smoking, hypertension, and diabetes. Atypical symptoms were also common findings. Single vessel disease was the most common lesion and left anterior descending artery was the most commonly involved vessel. Mortality was seen in ST-segment elevation myocardial infarction patients only.

Prevalence and Comparision of Conventional Risk Factors of Cardiovascular Disease Between Clinical and Nonclinical Staff.

Cardiovascular disease is the leading cause of death around the globe. A number of studies have shown that hospital staff are vulnerable to cardiovascular disease due to a certain risk of shift duty. It is important to identify cardiovascular risk factors among hospital staff. The aim of this study is, to assess the prevalence of conventional risk factors of cardiovascular disease among hospital staff. A quantitative cross-sectional study was conducted among staff working at a Shahid Gangalal National Heart Center, a tertiary cardiac center in Nepal. Simple and multiple linear regression analyses were used to examine the association between independent variables and cardiovascular diseases. Statistical analysis was done using SPSS software version 20. A total of 250 hospital staff participated in this study. Among them, 137 were clinical staff and 113 were non-clinical staff. The mean age of clinical staff and the non-clinical staff was 33.69 ± 7.02 years and 38.7 ± 10.58 years respectively with a total of 66.8% females. Prevalence of hypertension, diabetes mellitus, and dyslipidaemia was less in clinical staff compared to non-clinical staff. The mean systolic, diastolic BP was high in non-clinical staff ( P-value 0.001), moreover mean HDL-C was low (1.2 ± 0.2 mmol). BMI was significantly low in clinical staff. [standardized β= -0.24; 95% CI: -2.90, -0.88]. The prevalence of cardiovascular risk factors were high in non-clinical staff compared to clinical staff.

Effect of an Educational Intervention for Nursing Personnel on Emergency Inventory and Drugs Checklist of Resuscitation Trolley in a Tertiary Cardiac Center, Kathmandu.

Background and Aims: A crash cart is a trolley with emergency medicines and equipments required for medical emergencies. Nurses often witness cardiac arrest. They should be familiar with the placement of equipments and drugs in crash cart trolleys. Thus, this study was conducted to assess the effect of an educational intervention on knowledge of crash cart drugs and equipment management among nurses. Methods: This is a pre-experimental research design conducted at Shahid Gangalal National Heart Center, Kathmandu, Nepal.A simple random sampling technique was adopted. A semi-structured questionnaire was used to identify the knowledge of nurses. A standard checklist was used to observe crash cart trolleys. Pre and post test data was taken. Outcome variables included knowledge of crash cart trolleys organization and well organized crash cart in diferent wards. Data were analyzed to compare the knowledge before and after the intervention. Chi-square test, pair t-test, and linear regression multivariable model used for statistical analysis. Results: A total of 134 nurses were recruited in this study. The overall mean score of knowledge was signifcantly higher in post-intervention. The total knowledge mean score difference among nurses was -11.07, (p<0.001), drug content difference at crash cart was -16.85, (p<0.001), equipment content at crash cart was -24.42, (p<0.001).The linear regression showed significant improvement in knowledge at post-intervention (β; 0.928, 95% CI; 10.52, 11.57, p<0.001), when adjusted for age, education, work experience, working unit and CPR training. Conclusion: Knowledge and organization of crash cart was improved after educational intervention.

Predicting Surgical Mortality After Congenital Heart Surgeries Using Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) Risk Scoring System: A Retrospective Analysis in A Single Tertiary Center

Objective: The main objective of our study was to analyze the in-hospital mortality in children who underwent surgery for congenital heart defects in a single tertiary cardiac center in Nepal using RACHS-1 risk score during 6 year period. Methods: After approval from Institutional Review Board, retrospective data analysis were performed from June 2013 to June 2019 at Shahid Gangalal National Heart Centre. Patients younger than 14 years, who underwent cardiac surgery for congenital heart defects, were enrolled. Data from patient records regarding the age, gender, weight, diagnosis, procedures performed, cardio‑pulmonary bypass (CPB) time and aortic cross‑clamp (AoX) were obtained. The operations were classifed according to the six RACHS-1 categories and patients were allotted to RACHS-1 categories retrospectively by matching the procedure of each patient with a risk category. Results: Two thousand four hundred and seventeen patients underwent surgeries for congenital heart diseases who were classifed according to the RACHS‑1 score. Among the patients, 56.1 % were male and 20.1 % were younger than one year of age. The mortality was 1.5%,13.3%, 21.7% and 73.4% for category 1, 2, 3 and 4 respectively. The overall ability of the RACHS‑1 classifcation to predict in‑hospital mortality Area under the ROC curve was 0.736 with 95% confdence interval (CI) of 0.709-0.763. Conclusion: The RACHS‑1 classification is applicable to our pediatric populations which was a useful and easily applicable tool, requiring only very few data for mortality risk in our hospital although there are other factors that have an impact on the mortality.

Antithrombotic Adherence to guideline-directed therapy and risk profile among Non-Valvular Atrial fibrillation patients

Introduction: Patients with Atrial fbrillation (AF) are at fivefold higher risk for Ischemic stroke than in the general population. Although the current therapeutic guidelines recommend the use of anticoagulants for thromboembolic prophylaxis in patients with nonvalvular AF (NVAF) with additional risk factor(s) for stroke, the global registry data show non-adherence to guidelines for the management of stroke in diferent regions of the world. The current study conducted at the tertiary referral cardiac center of Nepal for addressing the risk profle of stroke based on the current risk scores and the use of antithrombotic agents NVAF patients. Methodology: This was a descriptive observational cross sectional study conducted at Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal from December 2020 to June 2020 which included patients with Nonvalvular AF. The main objective of the study was to study the clinical characteristics, stroke risk profle based on CHA ₂DS₂-VaSc score and risk of bleeding based on HAS-BLED score and the patterns of use of antithrombotic agents in NVAF patients. Results: A total of 79 cases of NVAF were included with 48(60.8%) males and 31(39.2%) females. The mean CHA₂DS₂-VaSc and HAS-BLED score were 2.44±1.2 and 1.51±1.4 respectively. The majority patients 38% had permanent AF followed by 25.5% had paroxysmal AF. Majority of patients were symptomatic with 67.1% presented with palpitation while 32.9% presented with shortness of breath (SOB). Based on the European Heart Rhythm Association (EHRA) AF related symptoms score, 41.8% had EHRA 2a and 2b while 1.3% had EHRA 4 score. The use of anticoagulants in patients with Nonvalvular AF was 41.6%, with NOACS in 33 % and warfarin used in 8.9% cases. The majority of patients 51.8% of study population were using anti-platelet agents with aspirin in 49.3 % and clopidogrel in 2.5 % cases while no medication in 6.3% of cases. Although 70.8% patients had CHA₂DS₂-VaSc score of 2 or more but the use of anticoagulants was only 58.9% with 46.4% NOACS and 12.5% using warfarin among this group of patients. Conclusion: Although the use of anticoagulant with NOACS in patients with higher risk of stroke is increasing, it is still underused in the majority of cases .There is a need of nationwide AF registry and the need of adoption of the current recommended guidelines to increase use of Anticoagulants in patients with Nonvalvular AF patients for the prevention of stroke .

Clinical profile of patients admitted with pericardial effusion in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

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.

Patient’s Satisfaction with Healthcare Services in Out Patient Department of a Tertiary Cardiac Centre in Nepal

Background and Aims: Patient’s satisfaction with the healthcare services is important because evidence suggests that satisfied patients are more adherent to treatment guidelines and have better clinical outcomes. We aim to assess the patients’ satisfaction with healthcare services in a tertiary cardiac centre of Nepal.
 Methods: We conducted a descriptive cross sectional study to collect the data by convenience sampling method from 365 patients who attended the out-patient Department of Shahid Gangalal National Heart Centre from December 2021 to March 2022. In this study a validated tool was used after translation into Nepali language. A semi structured face to face interview schedule was used to collect data from the patients, which was then filled in Kobo Toolbox; the web based questionnaires and were analyzed.
 Results: Overall satisfaction rate of the patients with the health care services provided by a tertiary cardiac center was 91.25%. In this study, 89.86% were satisfied with physical facilities, 91.24% with registration and pharmacy services, 93.36% with physicians and nurses’ services and 90.56% with other services.
 Conclusion: In this study, most of the participants were highly satisfied with the services provided by the hospital. However, the feedback from this study can be used for the improvement of the health care services which could be beneficial for the hospital as well as cardiac patients with overall benefit in cardiovascular outcome.

Prevalence of Significant Tricuspid Regurgitation in Patients Planned for Mitral Valve Surgery in a Tertiary Center of Nepal

Background Tricuspid regurgitation is frequently present in patients with mitral valve disease and most of this tricuspid regurgitation present are significant.
 Objective To find out the prevalence of tricuspid regurgitation in adult patients present in our hospital who are planned for isolated mitral valve surgery for mitral stenosis, mitral regurgitation or both. Patients with moderate and severe tricuspid regurgitation were considered as significant.
 Method This was the retrospective cross-sectional study performed at Shahid Gangalal National Heart Center of Nepal. All cardiac surgical patients scheduled for isolated mitral valve surgery during the 3 years’ period from 2017 to 2020 were enrolled in the study and presence or absence of significant tricuspid regurgitation were recorded and analysed.
 Result Out of total patients 65% (663) of the cases with mitral valve pathology had significant tricuspid regurgitation. Out of the total mitral stenosis cases 70% were associated with significant tricuspid regurgitation, 62.6% of the cases of mitral regurgitation had significant tricuspid regurgitation and 64.8% of patients with combined mitral stenosis and regurgitation were associated with significant tricuspid regurgitation.
 Conclusion Significant tricuspid regurgitation is present in most of the cases with isolated mitral valve pathology. So routine tricuspid valve evaluation and repair if needed during mitral valve surgeries is recommended.

Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal

BackgroundCongenital heart diseases have significant effect on the growth and development of a child. Timely intervention helps a child to grow and develop to full potential. Cardiac interventionists have not long ago developed methods to cure conditions via transcatheter methods like device closures for shunt lesions. These interventions have been hugely accepted and applied all over the world. ObjectivesThe aim of this study was to determine the outcome of Transcatheter device closure in Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) in terms of improvement in echocardiographic parameters and nutritional well-being. It also outlined the immediate and long term complications of Transcatheter device closure of the shunt lesions. MethodologyA prospective study was carried out among 129 pediatric patients who underwent Transcatheter device closure of shunt lesions at Shahid Gangalal National Heart Centre from March 2019 to March 2021. Simple convenient, consecutive non-probability sampling method was used for the study.Independent sample t-test was applied to see the correlation and significance of continuous variables and Linear regression was used to find out relation between weight gain and device closure. ResultsAmong 129 pediatric patients having either ASD, PDA or VSD without other comorbidities who underwent transcatheter device closure at Shahid Gangalal National Heart Centre, there was 1 mortality (0.7 %), 3 device embolization (2.3 %), 11 (8.5 %) tiny residual leaks, 6 (4.6 %) femoral artery thrombosis, 19 (14.7 %) Left ventricular systolic dysfunction, 4 (3.1 %) new onset arrhythmia, 13(10.0 %) new onset trivial AR and 2 (1.5 %) mild obstruction to surrounding structures. There were no long term complications observed during the study period. Pulmonary artery pressures improved in most along with normalization of chamber dilatation. There was significant improvement in weight of children at the end of one year follow up (P < 0.001), however among individual shunt lesion, only patients undergoing PDA device closure demonstrated significant weight gain. ConclusionTranscatheter device closure is a promising, safe and effective means of treatment for ASD, PDA and VSD. It has significant bearing in weight gain as well as general well-being of children. Judicious selection of cases, proficient expertise and availability of suitable infrastructures are paramount for successful outcome.

Impact of COVID 19 on outcome of primary percutaneous coronary intervention in Nepal.

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.&#x0D; 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 &lt; 0.05.&#x0D; 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).&#x0D; 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.

Clinical Profile and Conventional Risk Factors of Acute Coronary Syndrome in Late Elderly Patients

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.&#x0D; 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 &gt;75 years. They were evaluated focusing their chief complaints and cardiovascular risk factors.&#x0D; 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.&#x0D; 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.

Patterns of Perception of Cardiac Symptoms by Patients Presenting with ST-Segment Elevation Myocardial Infarction and their Knowledge of Coronay Artery Disease Risk Factors.

Proper knowledge regarding Coronary Artery Disease and their risk factors is essential for the early recognition of the disease and its presentation. This study was conducted to identify pattern of clinical symptoms and knowledge regarding Coronary Artery Disease risk factors among ST-Elevation myocardial infarction (STEMI) patients. This cross-sectional, observational study was conducted among 340 ST-Elevation myocardial infarction patients in the inpatient Cardiology Department of Shahid Gangalal National Heart Centre Nepal, from November 2020 to February 2021. Baseline clinical characteristics, knowledge regarding Coronary Artery Disease risk factors, patterns of symptoms, and prehospital delay were collected and evaluated. In our study, 299 (87.9%) had typical ischemic chest pain during the symptom onset, however, only 81 (23.8%) perceived chest pain as cardiac disease, and 311 (91.5%) of the patients presented to the nearby health care center within the recommended time of less than 12 hours for the reperfusion therapy of ST-Elevation myocardial infarction. Perception of symptoms as a cardiac origin and typical chest pain were not significantly associated with earlier presentation. Also, the typical chest pain was not significantly associated with the perception of the symptom as a cardiac origin. The history of Coronary Artery Disease was considered as a Coronary Artery Disease risk factor by 184(54.1%) of the study population and 137(40.3%), 132(38.8%), 110(32.4%), 105(30.9%) and 71(20.9%) considered hypertension, smoking, age, obesity, and diabetes mellitus as a Coronary Artery Disease risk factor respectively. Though most patients presented with typical chest pain, identification of the chest pain as a cardiac origin and the awareness of the Coronary Artery Disease risk factors was low.

Effects of Prolonged Use of Face Masks among Healthcare Workers Working in a Tertiary level Hospital in Kathmandu, Nepal

COVID-19 is a pandemic threat that affects every aspect of life on the planet. Hundreds of thousands of cases werediagnosed around the world in a short period of time. Health workers are critical to the health-care system and play acritical role during global pandemics. They are also a high-risk group that must wear a face mask for extended periodsof time. The purpose of this study was to determine the effects of prolonged facemask use on healthcare workers. Adescriptive cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Theinformation from 335 healthcare personnel was collected using a self-administered questionnaire technique. This studyincluded all of the hospital’s healthcare workers from various departments. The descriptive analysis was carried out usingSPSS statistical software, version 26. Out of 355 respondents, the majority of responders (69.9%) were under 30 years old,with a mean age of 29.03 (± 4.7) years. Regarding the effects of wearing a face mask for a longer length of time, 99.70 % ofthe health workers experienced some sort of effect. The most prevalent effects were pain behind the ear (84.2%), difficultduring exertion (71.0%), headache (57.6%), and the least common was alteration in sense of smell (15.2 %). According tothe findings, almost all of the participants experienced some form of effect from wearing a face mask, hence necessaryaction by concerned authorities and participants is required to minimize these effects.

Medication Adherence in Post Myocardial Infarction Patients at Shahid Gangalal National Heart Centre

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.&#x0D; 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.&#x0D; 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.&#x0D; Conclusion: Patients were highly adherent to medication and the effect of ADR on medication adherence was not significant.

Apolipoprotein B and Lipid Profile among Patients Diagnosed with Acute Myocardial Infarction.

Background and Aims: Acute myocardial infarction (AMI) is a leading cause of death among men and women globally and often a sequelae to atherosclerotic cardiovascular disease [ASCVD]. Atherosclerosis is linked with abundance of Apolipoprotein B [ApoB] and the lipid constituents they are carrying. There are limited data of ApoB status and its usage alongside conventional lipid profile parameters among AMI patients of Nepal. The study aim estimate the blood level of ApoB and determine its usefulness alongside analysis of total cholesterol[TC], triglycerides[TG], high density lipoprotein cholesterol[HDL-C], low density lipoprotein cholesterol[LDL-C],non-HDL cholesterol, LDL/HDL ratio in AMI patients .&#x0D; Methods: This was a hospital based comparative cross-sectional study conducted in patients attending Manmohan Cardiothoracic Vascular and Transplant Centre [MCVTC] and Shahid Gangalal National Heart Centre[SGNHC] over a period of 1 year. Seventy three diagnosed AMI patients were enrolled using convenient sampling technique. Forty patients undergoing regular general health checkup in Tribhuvan University Teaching Hospital [TUTH ] were recruited as controls. Laboratory analysis was carried by turbidimetric method for Apolipoprotein B and enzymatic methods for lipid profile parameters in department of Biochemistry, TUTH. Data was analyzed using SPSS version 18.0.&#x0D; Results: AMI was seen in the mean age of 56±11 years with male predominance. Mean level and standard deviation of ApoB was 99.2±17.7mg/dl in AMI which was significantly higher than controls. ApoB showed moderate correlation with non-HDL cholesterol [r=0.378,p&lt;0.001] and HDL-C[r= -0.490,p&lt; 0.001].&#x0D; Conclusion: Our study found a significantly higher level of ApoB in AMI with moderate correlation with non HDL-C and HDL-C, necessitating its usage as a complementary marker to conventional lipid profile.

Prevalence of acute coronary syndrome among patients presenting with chest pain in a tertiary care cardiac centre

Background and aims: Chest pain is one of the common reason for hospital visit. Acute coronary syndrome is an important cause of chest pain. We aimed to study the prevalence of acute coronary syndrome among patients presenting with the chest pain and its association with common cardiovascular risk factors.&#x0D; Methods: Observational study conducted at Shahid Gangalal National Heart Centre from 20th January 2022 to 25th March 2022 enrolling 112 participants consecutively. Participants were interviewed focusing history of hypertension, diabetes, smoking and nature of chest pain. The diagnosis of participants whether it was acute coronary syndrome or not were recorded. Prevalence of acute coronary syndrome was calculated. Linear regression analysis was done to see the correlation with tested variables. &#x0D; Results: Mean age was 53.83±15.23 years. Seventy-five (66.96%) were male. Forty-two (37.5%) were hypertensive, 30 (26.78%) were diabetes and 26 (23.21%) were smoker. Fifty-six (50%) had nonspecific chest pain, 35 (31.25%) had atypical chest pain and 21 (18.75%) had typical chest pain. Among the participants 38 (33.93%) had acute coronary syndrome. Acute coronary syndrome showed positive correlation with age, gender, nature of chest pain, hypertension and smoking.&#x0D; Conclusion: Acute coronary syndrome was one of the common cause of chest pain among participants. Age, gender, nature of chest pain, hypertension and smoking showed positive correlation with it. Patients with these risk factor needs strong suspicion of acute coronary syndrome and further workup for prompt diagnosis and management.

Clinical profile and management of prosthetic valve thrombosis in Tertiary cardiac Centre of Nepal, a prospective study

Background and Aims: Prosthetic valve thrombosis is a life- threatening complication of post-valve replacement surgeries. A number of patients present with thrombotic complications mainly due to poor anticoagulation status with irregular INR checkup especially from remote areas of Nepal. Our aim was to study the clinical profile and management of prosthetic valve thrombosis in our center. Methods: A prospective observational study of 45 patients (July 2017 – Jun 2019) admitted at Shahid Gangalal National Heart Centre, with the diagnosis of prosthetic valve thrombosis were studied. The demographic profile, clinical parameters and in hospital and 1 year outcome were analyzed. Results: Out of 45 patients, majority were female (60%) with the age 11-67 years with mean age of 34.9 ± 6.7. Twenty nine patients (64.4%) presented with sub-therapeutic INR value at admission. 46.7% patient had atrial fibrillation at the time of presentation. 88% patients presented within one week of onset of symptoms with shortness of breath being primary complaint, present in 95.6% of the patients. Forty two (86.9%) were thrombolysed with streptokinase while 3 patients underwent surgery. Valve thrombosis was most common at the mitral position 39(87%) patients. In hospital mortality was 13.3% and there were no major bleeding events or new stroke noted. Conclusion: Majority of patients with prosthetic valve thrombosis presented with a sub-therapeutic INR value and poor patients' compliance. Thrombolysis is a useful option in the management of prosthetic valve thrombosis patients especially in countries like Nepal.

Trends in the number of cardiac surgical procedures after the introduction of routine catheter intervention for isolated congenital shunt lesions

Background and Aims: The study aimed to evaluate the trends in the number of cardiac surgeries after the introduction of routine catheter intervention for isolated shunt lesions.&#x0D; Methods: A retrospective observational study was conducted which studied the trends in the total number of cardiac surgeries from 2012 to 2019 with the introduction of catheter interventions for isolated shunt lesions for the same period in Shahid Gangalal National Heart Center, Kathmandu, Nepal. The change in the total number of surgeries and surgeries for isolated shunt lesions after the start of the catheter intervention was evaluated. The pre-catheter intervention era and catheter intervention era spanned from 2012 to 2015 and 2016 to 2019 respectively.&#x0D; Results: During the catheter intervention era, out of total 2590 isolated shunt lesions, 1300 were closed by catheter intervention procedure (50%). Only 44%, 11%, and 90 % of Atrial Septal Defect, Patent Ductus Arteriosus and Ventricular Septal Defect respectively were closed surgically. Interestingly, even after introduction of catheter intervention, both the total number of surgeries and surgeries for congenital heart disease (CHD) did not decrease and remained above 1200 and 500 cases per annum respectively. The expected increment in the surgical number for most of the years was achieved following the country’s population growth remained at 1.8%, even though a large portion of isolated shunt lesions were closed by catheter intervention procedure.&#x0D; Conclusion: Though a significant number of isolated shunt lesions were closed by catheter intervention procedure, the number of surgical procedures for congenital as well as total cardiac surgeries did not decrease in number.