Background and Amis: Rheumatic Heart Disease (RHD) is among the commonest diseases of young adults in low-income countries like Nepal. Mitral and aortic valves are more commonly affected than others in RHD. Echocardiography is simple and cost effective tool to identify the patterns of valvular involvement that helps in diagnosis and determines the timing of surgery. This study aimed at determining the pattern of RHD in patients who underwent Echocardiography in a tertiary care hospital of western Nepal.Methods: A retrospective analysis of trans-thoracic echocardiographic record of patients from January 2009 to December 2015 was done. Data were collected in a pre-structured proforma and analyzed.Results: Among 12567 echocardiography, 609 (4.84%) were recorded to have RHD including post valve replacement patients. Females predominated with male to female ratio of 1:2.8. Most patients, 308 (50%) belonged to age group of 21-40 years. The commonest isolated lesion was mitral regurgitation (MR) in 119 (26.21%) patients followed by mitral stenosis (MS) in 31(6.82%) patients. The commonest mixed lesion was MS with MR and aortic regurgitation (AR) seen in 99 (21.8%). The frequency of atrial fibrillation (AF) and stroke was 18% and 3% respectively in RHD patientsConclusions: The proportion of RHD was high in our study. Majority of RHD patients were females of reproductive age group. The commonest lesion was MR followed by mixed valvular lesions.Nepalese Heart Journal 2016; 13(2): 29-31

Introduction: Acute coronary syndrome is associated with high mortality and morbidity. The incidence of acute coronary events in young is increasing.Objectives: This study aimed at evaluating the profile of acute coronary syndrome in young people in the western part of Nepal.Methodology: A retrospective study was designed. All patients admitted for acute coronary syndromes were taken and data of acute coronary syndrome involving patients aged less than 45 years from April 2015 through December 2017 were collected in a pre-structured proforma and analyzed.Results: There were 712 (489 males and 223 females with M:F=2.19:1) acute coronary syndrome patients admitted during the study period. Only 79 (12.9%) patients were patients <45 years of age. Commonest risk factor of acute coronary syndrome was smoking (69%) followed by dyslipidemia (46.8%), hypertension (45.5%) and diabetes (14%). Out of 79 patients of young acute coronary syndrome, 37 (46.8%) presented with ST elevated myocardial infarction, 16 (20.2%) with non-ST elevated myocardial infarction and 26 (32.9%) with unstable angina. Most common finding in coronary angiography was single vessel disease (35%) –left anterior descending artery being the commonest (53% of single vessel disease), double vessel disease (17.7%), non-critical coronary artery disease (16.4%), triple vessel disease (7.6%) and left main (1.2%). Myocardial bridging was seen in 1.2% and 20% had normal coronaries. Comparison of males and females in different categories of acute coronary showed that males predominate significantly in ST elevated myocardial infarction (odds ratio: 2.99; p=0.03) but there was no significant difference between the males and females presenting either with Non ST elevated myocardial infarction or unstable angina.Conclusion: Acute coronary syndrome in young people was common (12.9%) particularly males with Non ST elevated myocardial infarction. Smoking was the commonest risk factor. Public awareness regarding stoppage of cigarette smoking should be focused to prevent such events especially in the young population. BJHS 2018;3(1)5 : 361-365

Background: Coronary dominance is associated with adverse peri-procedural events during coronary interventions. There are limited data regarding events during coronary angiography in Nepal.

Introduction: Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Timely restoration of myocardial blood flow with reperfusion therapy is crucial. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function. Methods: A prospective study was carried in cardiology unit of a medical college from August 2013 to December 2017. Cases of acute ST segment elevation myocardial infarction that have undergone thrombolysis were recruited. Results: Out of 450 patients with ST Elevation Myocardial Infection (STEMI), delayed presentation was seen in 288 (64%) for >6 hrs and 108 (24%) patients for >12 hrs. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 12.66 hrs (SD=14.19, range = 30 min to 72 hrs). The door to needle time was 54 min (SD=24) The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation problems (31%). Conclusion: Misinterpretation of symptoms remain the most common cause of delayed presentation. Health education for public awareness can reduce the delay. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy.

Background & Objectives:Stroke is a major public health burden worldwide leading to long-term morbidity and even mortality. Atrial fibrillation (AF) is the most common sustained arrhythmia and is an independent factor to increase risk of ischemic stroke. The risk of stroke further enhanced in rheumatic atrial fibrillation and affects younger population of developing countries. The study has aimed to find out frequency of co-existence of stroke in AF and secondarily to look for age distribution of stroke and risk factors of AF. Materials & Methods: A retrospective analysis of trans-thoracic echocardiographic records of patients from 1 st June 2009 to 31 st June 2016 was done. Data were collected in a pre-structured proforma and analyzed. Results: Among 15767 echocardiographies, 577 (3.65%) cases were recorded to have atrial fibrillation. Mean age 65(±15) years ranging from 14 to 100 years. Rheumatic heart disease was the second most common cause of atrial fibrillation after hypertension. The co-existence of ischemic stroke was seen in 87(15.07%) cases with male to female ratio of 1:1.3. The proportion of stroke in rheumatic Atrial fibrillation was 21(18.75%) which was higher than in non-Rheumatic atrial fibrillation 66(14.2%). Conclusion: Rheumatic heart disease is contributing as second most common cause of atrial fibrillation after hypertension, nearly one fourth of total stroke and most common (93%) cause of stroke below the age of 45 years. Preventive strategies aimed at health awareness about rheumatic fever, screening programs at community level, early detection and treatment for hypertension and Rheumatic heart disease can contribute in reduction of stroke burden.Key words: Atrial Fibrillation; risk factors; rheumatic heart disease; stroke Citation: Kafle RC, Jha GS, Paudel N, Alurkar VM. Co-existence of ischemic stroke in Rheumatic and nonrheumatic atrial Fibrillation in a tertiary care teaching hospital of Western Nepal. JCMS Nepal. 2017;13 (4):318-22.