https://nepjol.info/index.php/NHJ/issue/feed Nepalese Heart Journal 2023-11-05T00:00:00+00:00 Dr Apurb Sharma nhjournal@hotmail.com Open Journal Systems <p>Nepalese Heart Journal (NHJ) is a biannual, peer-reviewed, open-access, international medical journal. NHJ publishes original research and critical reviews dealing with all disciplines of cardiovascular Medicine. It is the official journal of the Cardiac Society of Nepal and is published twice a year (May and November). Each issue of NHJ publishes Original Articles, Review Articles, Case Reports, Editorials and Letters to the Editor. From time to time invited articles, editorials and review of selected topics will be published. Authors do not have to pay for the submission, processing or publication of articles in NHJ.</p> <p>The Nepalese Heart Journal aims to facilitate a common portal for publication of wide ranging topics in cardiovascular research and clinical works. It aims to provide easy dissemination of research works to a variety of health workers and researchers.</p> <p>The journal can also be viewed on its own website at <a title="NHJ" href="http://www.nhjournal.info/" target="_self">http://www.nhjournal.info/</a></p> https://nepjol.info/index.php/NHJ/article/view/59446 Takotsubo Cardiomyopathy in the setting of Urosepsis 2023-10-24T08:37:30+00:00 Awin Saraf awinsaraf@gmail.com Anish Hirachan awinsaraf@gmail.com Ranjit Sharma awinsaraf@gmail.com <p>Takotsubo cardiomyopathy is a rare cardiac condition associated with transient left ventricular apical wall motion abnormalities in association with stress but without any signifcant coronary artery disease. We present a case of takotsubo cardiomyopathy presenting as acute pulmonary edema in the background of urosepsis.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59484 Spontaneous Epidural Hematoma: A rare neurological complication in a patient following routine coronary angiography 2023-10-29T01:45:40+00:00 Smriti Shakya drsmritishakya@gmail.com Ratna Mani Gajurel drsmritishakya@gmail.com Chandra Mani Poudel drsmritishakya@gmail.com Hemant Shrestha drsmritishakya@gmail.com Surya Devkota drsmritishakya@gmail.com Sanjeev Thapa drsmritishakya@gmail.com Bhawani Manandhar drsmritishakya@gmail.com Rajaram Khanal drsmritishakya@gmail.com Sutap Yadav drsmritishakya@gmail.com Ashmita KC drsmritishakya@gmail.com <p>Spinal epidural hematoma is an uncommon but potentially devastating complication associated with various medical interventions. We present a case report of this rare neurological complication following a routine coronary angiography. A 69-year-old male with Aortic Stenosis presented for a scheduled coronary angiography to assess his cardiac status before valve replacement. The procedure was uneventful but approximately 15 minutes after the angiography, he developed sudden-onset of rapidly progressing weakness and numbness in bilateral lower extremities. An urgent neurologic evaluation revealed signs of spinal cord compression, prompting a magnetic resonance imaging (MRI) scan which showed an extensive spinal epidural hematoma spanning multiple levels within the cervicothoracic spine. This case highlights the importance of recognizing this rare but a potential complication following routine coronary angiography even in the absence of signifcant procedural complications. Timely diagnosis and prompt surgical intervention are crucial for achieving favorable outcomes and minimizing morbidity associated with this condition.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59442 Hyper-dominant Left Anterior Descending Artery in the coronary circulation as a rare coronary anomaly 2023-10-24T07:02:56+00:00 Brijesh Pandey bp73160@gmail.com Prahlad Karki bp73160@gmail.com Naveen Kumar Pandey bp73160@gmail.com Jeet Prasad Ghimire bp73160@gmail.com Biplave Karki bp73160@gmail.com Achyut Gyawali bp73160@gmail.com Shikha Pandey bp73160@gmail.com <p>Hyper-dominant left anterior descending artery is rarely seen in the coronary distribution. Its involvement in ACS can often be detrimental as it supplies most of the anterior and inferior part of the right and left ventricles in compared to other variants of LAD artery. It is required to be recognized earlier and management strategies should be ascertained. Our report here describes such a case of anomalous coronary artery which is less commonly encountered during Coronary Angiography. This was case of a 60 year old hypertensive male who presented with atypical chest pain had normal ECG, echocardiography and cardiac biomarkers but TMT was positive, subsequent Coronary angiographic evaluation came up with LAD artery which was going beyond apex in the posterior interventricular groove up to crux forming PDA with 20 to 30% stenosis in proximal to distal part. Such a large LAD running into the interventricular groove forming PDA is known as “Hyper-dominant” LAD artery. The Right Coronary artery was non-dominant. Fortunately, there was no signifcant coronary artery disease to explain the cause of his chest pain, but the artery had unusual distribution provided that it has sole territorial supply to larger part of the myocardium which can worsen the clinical status if coronary artery disease progresses. He was kept under medical management and was doing good. The “Take away” lesson is that there are very few subjects with Hyper-dominant LAD artery till date and most other cases with this anatomy had presented with myocardial infarction and thus such anatomical variant of LAD artery ought to be matter of concern and further research in the feld of cardiology.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59514 Patient blood management for cardiovascular surgery: Clinical practice consensus statement 2023-10-29T14:52:32+00:00 Ashish Govinda Amatya amatyaashish151@gmail.com Apurb Sharma amatyaashish151@gmail.com Battu Kumar Shrestha amatyaashish151@gmail.com Bipin Nepal amatyaashish151@gmail.com Hem Raj Paneru amatyaashish151@gmail.com Amit Shrestha amatyaashish151@gmail.com Ravi Baral amatyaashish151@gmail.com Arjun Gurung amatyaashish151@gmail.com Nirmal Panthee amatyaashish151@gmail.com Ajay Gandhi amatyaashish151@gmail.com Klaus Goerlinger amatyaashish151@gmail.com Diptesh Aryal amatyaashish151@gmail.com Lalita Shakya amatyaashish151@gmail.com Chandra Mani Adhikari amatyaashish151@gmail.com Bishesh Poudel amatyaashish151@gmail.com Bijoy G Rajbanshi amatyaashish151@gmail.com <p>Anemia, blood loss and transfusion related issues following cardiovascular surgery are detrimental to patient outcomes. This document provides a concise overview of the Patient Blood Management for Cardiovascular Surgical Practice in Nepal. The consensus aims to optimize patient outcomes and enhance the quality of care in cardiovascular surgery by emphasizing evidence-based approaches to blood management. The document covers a range of topics, including preoperative assessment, intraoperative strategies, and postoperative care, with a focus on minimizing unnecessary blood transfusions, promoting hemostasis, and reducing the risk of complications. By adhering to this consensus, healthcare professionals can contribute to improved patient safety and overall clinical effectiveness in the field of cardiovascular surgery.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59515 Screening for Hypertension in Asymptomatic Individuals in Nepal: An Expert Consensus Statement 2023-10-29T15:26:45+00:00 Prakash Raj Regmi pregmi68@gmail.com Sanjib Kumar Sharma pregmi68@gmail.com Yadav Kumar Deo Bhatt pregmi68@gmail.com Rabi Malla pregmi68@gmail.com Arun Maskey pregmi68@gmail.com Yubaraj Limbu pregmi68@gmail.com Rajesh Nepal pregmi68@gmail.com Achutanand Lal Karn pregmi68@gmail.com Sahadeb Prasad Dhungana pregmi68@gmail.com Mani Prasad Gautam pregmi68@gmail.com Mukunda Prasad Kafle pregmi68@gmail.com Robin Maskey pregmi68@gmail.com Subhash Saurav pregmi68@gmail.com Uttar Kumar Mainali pregmi68@gmail.com Kunjang Sherpa pregmi68@gmail.com <p>Hypertension affects a substantial proportion of the general population in Nepal with prevalence ranging from 20 to 30 percent. Early diagnosis and treatment are essential for undiagnosed hypertension and is possible through hypertension screening. The aim of this paper is to provide unified consensus recommendations for the effective screening of hypertension in Nepal. In<strong>&nbsp;</strong>two National Advisory expert consensus meetings, a total of 42 experts participated, discussed and voted on the key statements for formulating the consensus. Each key statement was scored on a Likert scale ranging from 1 to 9 and a mean score was calculated. The consensus statement was accepted if the mean score was seven or more with the voting of more than two-thirds of the experts. The main consensus recommendations are the following. First, screening for hypertension should start among adults from 18 years of age. Second, effective screening of hypertension can aid in the early diagnosis, control, and improve the cardiovascular disease outcomes. Third, in asymptomatic adults, re-screening is necessary every 3 to 6 months and every 3 to 5 years for initial blood pressure levels of 130-139/80-89 mmHg and &lt;130/85 mmHg, respectively. Fourth, hypertension screening is cost-effective in a resource-limited setting. The use of consensus recommendations will help in a unified community screening of hypertension among the asymptomatic adult population of Nepal. Screening of hypertension should be promoted by all the stakeholders in healthcare services. &nbsp;</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59444 A Randomized Comparison of Two Doses of Tranexamic Acid in High-Risk Open-Heart Surgery 2023-10-24T07:37:59+00:00 Battu Kumar Shrestha battushrestha@gmail.com Rima Khadka battushrestha@gmail.com Surendra Bhusal battushrestha@gmail.com Rabin Baidya battushrestha@gmail.com Sandip Bhandari battushrestha@gmail.com Suraj KC battushrestha@gmail.com <p><strong>Background and aims:</strong> Tranexamic acid is commonly used in cardiac surgery to minimize perioperative bleeding. There are wide variations in dose of this drug. This study aims to find out the minimal effective dose of tranexamic acid.</p> <p><strong>Methods:</strong> Patients were randomized into low dose group receiving 10 mg/kg and high dose group receiving 30 mg/kg bolus of tranexamic acid each followed by an infusion of 1mg/kg/hr until the end of surgery. Primary objective was to compare blood loss during the first postoperative day. Secondary objectives were to compare total blood products transfused during 24 hours post-operative period, to compare the incidence of re-explorations and to compare the adverse drug reactions between the groups.</p> <p><strong>Results:</strong> There were sixty patients in each group. There was a signifcant difference in blood loss (435.17± 299.91 ml vs 528.64 ±254.04 ml) between the low dose group and dose group (p=0.010). Transfusion of packed red blood cell, re-exploration and adverse drug reactions were higher in high dose group however these were not statistically signifcant.</p> <p><strong>Conclusion:</strong> Higher dose of tranexamic acid is not effective in reducing blood loss in open heart surgery in first postoperative day.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59447 Cardiovascular Disease Risk Profiling among First-Degree Relatives of Premature Coronary Artery Disease Patients 2023-10-24T08:46:13+00:00 Nischal Shah naz.nepali@gmail.com Ratna Mani Gajurel naz.nepali@gmail.com Chandra Mani Poudel naz.nepali@gmail.com Roshan Ghimire naz.nepali@gmail.com Sutap Yadav naz.nepali@gmail.com <p><strong>Background and Aims:</strong> First-degree relatives of patients with premature coronary artery disease are at heightened risk of cardiovascular events due to the synergy of genetic and environmental factors. The aim of this study was to assess the cardiovascular disease (CVD) risk factors and to estimate cardiovascular risk in first-degree relatives of patients with premature CAD.</p> <p><strong>Methods:</strong> The study was conducted among first-degree relatives of patients with coronary artery disease in a tertiary care hospital in Kathmandu. A total of 144 first-degree relatives aged 18 years or older participated in this study. Age and gender matched subjects with no clinical evidence of CAD and no history of premature CAD in frst degree relatives were recruited as controls. The cardiovascular risk of study participants was assessed using the American Heart Association (AHA) Cardiovascular Risk Assessment Tool.</p> <p><strong>Result:</strong> The study age group was between 18 to 59 years. The mean age of the subjects was 35.54 ± 10.57 years and 63.19% of subjects were men. A statistically significant number of first-degree relatives of premature CAD were found to be hypertensive and had metabolic syndrome. CVD risk factors like physical inactivity, smoking, diabetes, and dyslipidemia were found in 46.5%, 47.22%, 13.2%, and 52.01%, of the study participants, respectively.</p> <p><strong>Conclusion:</strong> The study highlights the widespread presence of risk factors and underlying medical conditions among young study participants both with and without a family history of premature CAD. Appropriate direction based on opportunistic screening programs and risk stratifcation should be initiated which can play an important role in the primary prevention of early CAD.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59445 Antithrombotic Adherence to guideline-directed therapy and risk profile among Non-Valvular Atrial fibrillation patients 2023-10-24T07:38:13+00:00 Kunjang Sherpa sherpakunjang7@gmail.com Chandra Mani Adhikari sherpakunjang7@gmail.com Dipanker Prajapati sherpakunjang7@gmail.com Reeju Manandhar sherpakunjang7@gmail.com Nripesh Adhikari sherpakunjang7@gmail.com Roshan Raut sherpakunjang7@gmail.com Murari Dhungana sherpakunjang7@gmail.com Prashant Bajracharya sherpakunjang7@gmail.com Surakshya Joshi sherpakunjang7@gmail.com Birat K Timilsena sherpakunjang7@gmail.com Amrit Bogati sherpakunjang7@gmail.com Santosh Yadav sherpakunjang7@gmail.com Ojaswee Sherchand sherpakunjang7@gmail.com Madhu Roka sherpakunjang7@gmail.com Sujeeb Rajbhandari sherpakunjang7@gmail.com <p><strong>Introduction:</strong> 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.</p> <p><strong>Methodology:</strong> 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.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> 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 .</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59448 Effect of an Educational Intervention for Nursing Personnel on Emergency Inventory and Drugs Checklist of Resuscitation Trolley in a Tertiary Cardiac Center, Kathmandu. 2023-10-24T09:09:47+00:00 Sunita Khadka khadkathsunta@gmail.com Battu Kumar Shrestha khadkathsunta@gmail.com Reshma Thapa khadkathsunta@gmail.com Deoki Saru khadkathsunta@gmail.com Nita Devi Dangol khadkathsunta@gmail.com Dipanker Prajapati khadkathsunta@gmail.com Suraksha Dhungana khadkathsunta@gmail.com Murari Dhungana khadkathsunta@gmail.com Chandra Mani Adhikari khadkathsunta@gmail.com <p><strong>Background and Aims:</strong> 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.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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&lt;0.001), drug content difference at crash cart was -16.85, (p&lt;0.001), equipment content at crash cart was -24.42, (p&lt;0.001).The linear regression showed significant improvement in knowledge at post-intervention (β; 0.928, 95% CI; 10.52, 11.57, p&lt;0.001), when adjusted for age, education, work experience, working unit and CPR training.</p> <p><strong>Conclusion:</strong> Knowledge and organization of crash cart was improved after educational intervention. </p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal https://nepjol.info/index.php/NHJ/article/view/59449 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 2023-10-24T09:09:55+00:00 Smriti Mahaju Bajracharya smriti.mahaju@gmail.com Dikshya Joshi smriti.mahaju@gmail.com Sidhartha Pradhan smriti.mahaju@gmail.com <p><strong>Objective</strong>: 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.</p> <p><strong>Methods</strong>: 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.</p> <p><strong>Results</strong>: 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.</p> <p><strong>Conclusion</strong>: 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.</p> 2023-11-05T00:00:00+00:00 Copyright (c) 2023 Nepalese Heart Journal