Laxman Dubey

CLINICAL PROFILE OF PATIENTS HOSPITALIZED WITH HEART FAILURE IN BHARATPUR, NEPAL

INTRODUCTION Heart failure (HF) is a common cardiovascular condition whose incidence and prevalence are increasing. Being a common reason for urgent hospital admission, it is a major cause of morbidity and mortality for the patients. In the developed countries coronary artery disease remains the leading cause of HF, whereas, in the underdeveloped countries, rheumatic heart disease leading to valvular lesion still remains the commonest causes of HF admission.The current study was designed to evaluate the clinical profile and medications prescribed reflecting the extent to which evidence based medicine is being practiced at our community. METHODS Clinical profile and prescribed medications of patients with diagnosis of HF who were admitted in the cardiology department of College of Medical Sciences & Teaching Hospital (CMS-TH), Bharatpur, Nepal, April 2010 to May 2012, were analyzed. A total of 255 patients presented with HF during the studied period were included. RESULTS Coronary artery disease, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart failure, cor-pulmonale, and congenital heart disease leading to HF were found in 93 (36.5%), 65 (25.5%), 37 (14.5%), 22 (8.6%), 31 (12.2%),and 7 (2.7%) patients respectively. The commonest presenting symptom was shortness of breath (81%) and the commonest sign was bilateral basal crepitations (68%). From all patients, 89%, 64%, 51%, 16%, 48%, and 32% received loop diuretics, angiotensin-converting enzyme inhibitor, digoxin, angiotensin receptor blocker, spironolactone, and beta-blocking agents respectively. CONCLUSION Coronary artery disease leading to HF was the commonest cause of HF admission in our centre. Despite current guidelines suggesting the use of beta-blocking agent in patients with HF, only 32% of our patients received this class of medications. Thus, many patients were not being managed fully in accordance with the evidence-based guidelines.

Unruptured left ventricular pseudoaneurysm following inferior wall myocardial infarction.

Left ventricular (LV) pseudoaneurysm is a rare but potentially lethal complication of acute myocardial infarction (MI). We report a very rare case of a 60 year-old woman with a ruptured myocardial wall, and a non-ruptured LV pseudoaneurysm. The patient presented with acutely worsening shortness of breath and exertional dyspnea of one months duration, and palpitation. She had an inferior wall MI nine months previously. Coronary angiography showed severe stenosis at right coronary artery. Echocardiography, LV angiography, and computed tomography angiography revealed a large pseudoaneurysm postero-inferior to the LV. Surgical resection of the pseudoaneurysm was performed and repair of the ruptured LV wall done, with good results.

Ventricular Septal Rupture Complicating Acute Myocardial Infarction in a Tertiary Care Hospital of Nepal

Background: Ventricular septal rupture is a rare but fatal mechanical complication of acute myocardial infarction. Although the incidence has decreased, the mortality rate from ventricular septal rupture has remained extremely high.

Simultaneous Left Ventricle and Left Atrial Appendage Thrombi in a Patient with Dilated Cardiomyopathy

A 24-year-old male, diagnosed with post myocarditis dilated cardiomyopathy (DCM), presented with dyspnea and body swelling. On examination, he was ill-looking. Blood pressure was 90/60 mm Hg and his heart rate was 110 beats per minutes. Upon physical examination, pitting edema was noted in bilateral lower extremities and a S3 gallop sound was audible. Jugular venous pulse was raised. Chest X-ray showed cardiomegaly with pulmonary congestion. Electrocardiography showed sinus tachycardia. The cardiac enzymes were within the normal range. What is the echocardio graphic diagnosis based on the Figure 1 and videos 1,2?

Percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease

Left main coronary artery disease is associated with poor clinical outcomes. Coronary artery bypass graft surgery has been the standard treatment for unprotected left main coronary artery disease. However, with the introduction of drug-eluting stents and advances in catheter techniques, together with advances in periprocedural adjunctive pharmacotherapies, percutaneous coronary intervention has become a viable alternative to coronary artery bypass graft for the management of this complex coronary lesion. The authors describe percutaneous coronary intervention in the treatment of unprotected left main coronary artery disease and briefly review its role in the management of patients with the condition.