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  • 1
    In: Indian Heart Journal, Elsevier BV, Vol. 70 ( 2018-12), p. S309-S312
    Type of Medium: Online Resource
    ISSN: 0019-4832
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
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  • 2
    In: Indian Heart Journal, Elsevier BV, Vol. 68, No. 6 ( 2016-11), p. 788-791
    Type of Medium: Online Resource
    ISSN: 0019-4832
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
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  • 3
    In: Journal of Advances in Internal Medicine, Nepal Journals Online (JOL), Vol. 5, No. 1 ( 2017-03-30), p. 11-14
    Abstract: Background and Aims: Coronary intervention through radial artery is a preferred over femoral route. Different vasodilators are used to prevent radial artery spasm. Till date there is no study to compare the effects of various vasodilator regimes during radial coronary angiogram in Nepal. We aim to compare the efficacy of different vasodilator in our patients.Methods and Result: This is a single centre, prospective randomized trial between Verapamil, Nitroglycerine (GTN) and cocktail (Verapamil with GTN). All the patient undergoing coronary angiogram via radial approach, without the contraindication were randomized by a computer generated randomization protocol. Patient undergoing coronary procedures via the radial artery were divided into three groups. Patients in group A received intra-arterial cocktail (2.5 mg of Verapamil plus 100 mcg Nitroglycerine in 10 ml of normal saline), patients in group B received Verapamil (5mg) and patient in group C received Nitroglycerine (200mcg). Heparin of 3000U was given intravenously in all three groips. Altogether 207 patients underwent transradial coronary angiogram, 203 were randomized after exclusion. Over all Radial artery spasm was reported in 28 patients (13.79%). There was no statistically significant difference in spasm between the three regimens however when grading, there was significant higher grade of spasm in Verapamil group (13.23%, P value 〈 0.05). When comparing Verapamil and GTN separately there was significant higher spasm (21% vs 7%, P value 〈 0.05) with higher grades of spasm in verapamil group.Journal of Advances in Internal Medicine 2016;05(01):11-14
    Type of Medium: Online Resource
    ISSN: 2091-1440 , 2091-1432
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2017
    detail.hit.zdb_id: 2895109-8
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  • 4
    In: Nepalese Heart Journal, Nepal Journals Online (JOL), Vol. 16, No. 1 ( 2019-04-30), p. 11-13
    Abstract:    Background and Aims: Atrial septal defect (ASD) device closure has been accepted worldwide as an alternative to surgical closure with the excellent results. This interventional, non-surgical technique plays an important role in the treatment of ASD. This audit aims to report our experience of ASD device closure in our centre. Methods: This cross sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal. All patients who were attempted for ASD device closure from February 2016 to January 2018 were included. ASD size, device size, procedural approach, and device implantation success rates were retrospectively analyzed from our hospital records. Result: During the study period, 566 cases were attempted for device closure. Among them device was successfully implanted in 557(98.4% of cases). In nine cases ASD device could not be implanted. Among the 557 successful cases, 401 (71.9%) were female. Age ranged from 5 to 72 years with the mean of 30.9 years. In five patients, transcatheter closure cases, was done under general anesthesia with the guidance of transesophgeal echocardiogram. In all other patients, device closure was done in local anesthesia under transthoracic echocardiography guidance. ASD size ranged from 7mm to 37mm with the mean of 20.8mm. ASD device ranged from 8 to 42mm with the mean of 26.5mm. Four different devices were used with the Amplatzer septal occluder used in 527 (94.6%) patients, hyperion( Comed) device in 10 (1.7%) patients, Memopart (Lepu) device in 19 (3.4%) patients and Cera (Life tech) device in 1(0.1%) patients. Discussion: ASD device closure is a safe and effective procedure.
    Type of Medium: Online Resource
    ISSN: 2382-5464 , 2091-2978
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2019
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  • 5
    In: Nepalese Heart Journal, Nepal Journals Online (JOL), Vol. 17, No. 1 ( 2020-05-06), p. 7-16
    Abstract: Background and Aims: Incidence of ST-elevation myocardial infarction (STEMI) is increasing in Nepal. We aim to describe the presentation, management, complications, and outcomes of patients admitted with a diagnosis of STEMI in Shahid Gangalal National Heart Centre (SGNHC), Nepal. Methods: Shahid Gangalal National Heart Centre-ST-elevation registry (SGNHC-STEMI) registry was a cross sectional, observational, registry. All the patients who were admitted with the diagnosis of STEMI from January 2018 to December 2018 were included. Results: In this registry, 1460 patients out of 1486 patients who attended emergency were included. The mean age of patients was 60.8±13.4 years (range: 20 years to 98 years) with 70.3% male patients. Most of the patients (83.2%) were referred from other hospitals and 16.8% of patients directly attended the SGNHC emergency. During the presentation, smoking (54%) was the most common risk factor, followed by hypertension (36.6%), diabetes mellitus (25.3%), and dyslipidemia (7.8%). After admission, new cases of dyslipidemia, HTN, Impaired Fasting Glucose (IFG), and Type 2 DM were diagnosed in 682 (51.3%), 182 (20.1%), 148 (10.3%) and 95 (8.9%) respectively. At the time of presentation, 73.3% were in Killip class I and 26.3% were above Killip class II with 5.1% in cardiogenic shock. Thirty-one percent of the cases received reperfusion therapy (Primary percutaneous intervention in 25.2% and fibrinolysis in 5.8%). Inferior wall MI was the most common type of STEMI. Among the patients who underwent invasive therapy, the multi-vessel disease was noted in 46.2% cases and left main coronary artery involvement in 0.7% cases. In-hospital mortality was 6.2% with cardiogenic shock being the most common cause. Aspirin (97.8%), clopidogrel (96.2%), statin (96.4%), ACEI/ARB (76.8%) and beta-blocker (76.8%) were prescribed during discharge. Conclusion: The SGNHC-STEMI registry provides valuable information on the overall aspect of STEMI in Nepal. In general, the SGNHC-STEMI registry findings are consistent with other international data.
    Type of Medium: Online Resource
    ISSN: 2382-5464 , 2091-2978
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2020
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  • 6
    In: Nepalese Heart Journal, Nepal Journals Online (JOL), Vol. 16, No. 2 ( 2019-11-14), p. 11-15
    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. 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.
    Type of Medium: Online Resource
    ISSN: 2382-5464 , 2091-2978
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2019
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  • 7
    In: Nepalese Heart Journal, Nepal Journals Online (JOL), Vol. 17, No. 2 ( 2020-11-05), p. 33-37
    Abstract: Background and Aims: Among the various biomarkers, high sensitivity C-Reactive Protein (hs-CRP) has been widely studied and is easy to use in the prognostication of patients with acute ST elevation myocardial infarction (STEMI). This study aimed to associate serum level of hs-CRP with in-hospital mortality in patients presented with acute STEMI. Methods: This was a hospital-based prospective observational study conducted in Shahid Gangalal National Heart Centre among patients presented to the emergency department with chest pain of less than 24 hours duration, who were diagnosed subsequently to have STEMI. Patients who had known chronic inflammatory diseases, septic foci and chest pain of over 24 hours were excluded from the study. Blood sample for Hs-CRP was sent from the emergency department and was measured with Finecare TM FIA system; Model number: FS-112. The study was conducted from April 2019 to March 2020. Patient outcomes were stratified as per the four groups of serum level of hs-CRP and among them the relationship between mortality and hs-CRP level was tested with chi-square test. The p-value across the groups was again tested for inter-group significance using the Bonferroni adjusted significance level. Results: 140 patients (112 males and 28 females) with mean age of 58.1±14.86 years were enrolled in the study. There was no increased in-hospital mortality in acute STEMI patients who had serum level of hs-CRP below 3 mg/l. In-hospital mortality showed an increasing trend above this level but it reached statistical significance beyond 10 mg/l only. Thirty five percent of our patients of acute STEMI were found to have serum level of hs-CRP above this threshold. The total in-hospital mortality was 13 (9.28%). Conclusion: The increased serum level of hs-CRP was associated with increased in-hospital mortality in patients with acute STEMI.
    Type of Medium: Online Resource
    ISSN: 2382-5464 , 2091-2978
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2020
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  • 8
    Online Resource
    Online Resource
    Nepal Journals Online (JOL) ; 2004
    In:  Nepalese Heart Journal Vol. 3, No. 3 ( 2004-12-30), p. 17-18
    In: Nepalese Heart Journal, Nepal Journals Online (JOL), Vol. 3, No. 3 ( 2004-12-30), p. 17-18
    Abstract: Limited knowledge of heart attack symptoms causes patients’ delay for early time Dependant thrombolytic therapy, which offers impressive survival benefit. Previous studies carried out in developed countries demonstrated the deficient of knowledge about wide range of heart attack symptoms. This study first reveals public awareness and knowledge of heart attack symptoms in developing country Like Nepal,
    Type of Medium: Online Resource
    ISSN: 2382-5464 , 2091-2978
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2004
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  • 9
    In: Nepalese Heart Journal, Nepal Journals Online (JOL), Vol. 18, No. 2 ( 2021-11-23), p. 21-25
    Abstract: Background and Aims: Frontal QRS-T angle has been previously correlated with long term mortality in ST-segment elevation myocardial infarction patients. This study aimed to investigate the prognostic value of frontal QRS-T angle and in-hospital outcomes in the setting of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Methods: We evaluated 97 consecutive patients presenting to the emergency department of Shahid Gangalal National Heart Centre with chest pain of less than 12 hours duration, who were subsequently diagnosed as ST-segment elevation myocardial infarction in a prospective observational study. The study was conducted from July 2020 to June 2021.The data evaluation included demographics, clinical variables, electrocardiogram, length of hospital stay and in hospital mortality. Patient outcomes were stratified into three groups according to frontal QRS-T angle. The relationship between mortality and frontal QRS-T angle was tested with chi-square test. The p-value across the groups was again tested for inter-group significance. Results: Out of 97 patients 67 (69.07%) were male and 30 (30.92%) were female., The mean age of study population was 55.8±11.8 years. The patients under study were divided into three groups based on the calculation of fQRST angle as Group 1 (0-45°) being 46(47.4%), Group 2(46-90°) being 20(20.6%) and Group 3 ( 〉 90°) with 31(32%) cases. Diabetes and Congestive heart failure (CHF) patients were more likely to have increase in frontal QRST angle (P value 0.029, 0.012 respectively). Atrial fibrillation (AF) was higher among patients in group 3( 〉 90° frontal QRST angle) which was statistically significant (0.012). Although the mean length of hospital stay was higher among patients with highest frontal QRST angle, it was statistically insignificant (p Value 0.062) however, the chance of hospital stay durations significantly increases across three groups at a 5% significance level (p-value: 0.018). In hospital mortality increased with increase in frontal QRST angle with 8.7%, 15% and 22.6% in group 1, 2 and 3 respectively however it was statistically insignificant. Conclusion:  Diabetes, CHF and AF patients were more likely to have increase in frontal QRST angle. The chance of hospital stay duration significantly increases with increase in frontal QRST angle Although the in hospital mortality increased with increase in the frontal QRST angle, it was statistically insignificant. A prospective study with larger sample size will help to clarify its association.
    Type of Medium: Online Resource
    ISSN: 2382-5464 , 2091-2978
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2021
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  • 10
    In: Journal of Advances in Internal Medicine, Nepal Journals Online (JOL), Vol. 2, No. 1 ( 2013-02-15), p. 6-9
    Abstract: Background and Aims- Reperfusion therapy is indicated for patient with acute ST Elevation Myocardial Infarction. Several randomized trials and meta-analyses have shown that Primary Percutaneous Coronary Intervention is better than thrombolysis. Our aim was to determine the outcomes of Primary Percutaneous Coronary Intervention in Shahid Gangalal National Heart Centre, Nepal. Methods- Medical records of 212 Primary Percutaneous Coronary Intervention from March 2007 to March 2012 were retrospectively reviewed. The primary end point was in-hospital mortality and secondary end points were 30 day mortality and long term mortality. Results- In the patients presenting to emergency with acute ST elevation myocardial infarction, inferior wall Myocardial Infarction 64 (30%) was the most common. Single vessel disease 168 (79%) predominated in emergency coronary angiogram. In majority of the patients Right Coronary Artery 103 (48.7%) was the culprit vessel. Cardiogenic shock was present in 28 (13.2%) patients. There were 11 deaths (39.2%) in cardiogenic shock group where as only 5 deaths (2.7%) among 184 non cardiogenic shock patients, resulting in in hospital mortality rate of 7.5%. Among the 196 patients who were successfully discharged from the hospital, 21 patients lost to follow up. There was one death reported within a month, non within three months and four within a year post discharge from the hospital. Conclusions- The result of this study is comparable to the findings elsewhere in the world. Primary Percutaneous Coronary Intervention should be the treatment of choice in treating acute myocardial infarction where the facilities and the expertise are available. Journal of Advances in Internal Medicine 2013;02(01):6-9 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7629
    Type of Medium: Online Resource
    ISSN: 2091-1440 , 2091-1432
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2013
    detail.hit.zdb_id: 2895109-8
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