Background and Aims: Percutaneous Coronary Intervention (PCI) is the preferred method of revascularization in Acute ST Elevation Myocardial Infarction (STEMI). Our aim was to study the clinical profile and outcomes of patients who underwent PCI for STEMI at tertiary cardiac centre of Nepal. Methods: It is a retrospective, single centre study, performed at Tribhuvan University, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal. All patients who underwent PCI for STEMI from November 2015 to July 2018 were enrolled in this study. All the data were collected from hospital registry and cath lab records. Results: The Study showed that out of 232 patients who presented with STEMI, 74.5% were male with average age of 57.39 years. The mean time of presentation after onset of symptom/s was 17.5 hours. About 66% patients presented in less than 12 hours of symptoms onset, 21% presented at 12-24 hours of symptoms onset and 13% patients presented late. Primary PCI was done in 87% of patients. Almost all patients (98.2%) underwent coronary artery stenting with drug eluting stents. Multivessel PCI during index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% cases. Average LVEF at discharge was 44.73%. There were 8 deaths, all after Primary PCI. In-hospital mortality rates for patients presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%. Conclusion: This study has reemphasized that PCI is effective in the management of STEMI cases in Nepal with improving mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one of the prime focuses for effective management of STEMI.

Background and Aims: Although pacemaker implantation has been done regularly in Nepal for the last 20 years, there is no large scale published data of pacemaker implantations. Manmohan Cardiothoracic Vascular and Transplant Centre (MCVTC) have been providing uninterrupted permanent pacemaker implantation services since its inception. This led us an opportunity to report the data regarding permanent pacemaker implantations in MCVTC. Methods: Hospital records of all patients who had undergone PPI at MCVTC between Shrawan 2070 – Ashad 2075/ July 2013- June 2018 (5 years) were searched for and all available data were retrospectively analyzed. Results: A total of 277 cases underwent PPI at MCVTC in 5 years. Out of these 165 (59.5%) were male with male to female ratio of 1.47. The mean age was 65.82±16.10 years with 3 (1.1%) cases of <20 years of age and almost 70% of cases aged >60 years. Dual chamber units were implanted in 49 (17.7%) cases. Only 13 women (11.6%) received dual chamber pacemaker compared with 36 men (21.8%) (P = 0.029). The most common indication for PPI was complete atrioventricular block 165 (59.6%) followed by sick sinus syndrome 65 (23.5%). Hypertension 84 (30.3%) was the most common co morbidity present. Complication occurred in 5.4% of cases with wound infection as commonest complication and single mortality due to postoperative complications post-RV repair. Conclusion: Single chamber pacemaker was the most commonly used pacemaker. Dual chamber pacemaker was more common in younger patients. Complete heart block was the most common indication. Permanent pacemaker insertion was effective and relatively safe procedure in MCVTC with few complications.

Background Electrocardiographic (ECG) changes are frequently reported findings in patients with subarachnoid hemorrhage (SAH). We conducted a retrospective descriptive study to assess the prevalence of electrocardiographic changes in patients with non-traumatic SAH. Methods In this single-center retrospective cross-sectional study, ECG recordings of 45 patients who presented to Tribhuvan University Teaching Hospital in the year 2019 with SAH were collected and analyzed to detect any abnormalities. Results In our study, 88.8% of patients had some form of ECG abnormality. The most common ECG abnormalities associated with SAH were QTc prolongation, T-wave abnormalities, and bradycardia, which were found, respectively, in 35.5%, 24.4%, and 24.4% of the patients. Other ECG changes we observed include ST depression, large U-waves, atrial fibrillation, and premature ventricular contractions. Conclusion Morphological and rhythm abnormalities are frequently observed in patients with SAH, which may cause diagnostic dilemmas and unnecessary workups. Further studies are required to evaluate their significance and correlate ECG changes with clinical outcomes.

The overall incidence of embolic complications in infective endocarditis (IE) ranges from 20 to 50%. It is very uncommon for a treating physician to encounter a patient having multiple manifestations of systemic embolisation.Acute coronary syndrome complicating infective endocarditis is an uncommon finding and the incidence has been found to be upto 10%.Cerebral embolism should be suspected in patients with infective endocarditis and neurological sign and symptoms. Neurologic manifestations can sometimes be the first presentation of infective endocarditis. We present the scenario of a 51-year-old diabetic male with chronic kidney disease, rheumatic heart disease with infective endocarditis leading to multiple embolic complications. Our case is notable because the patient had evidence of coronary, cerebral, splenic, hepatic and musculoskeletal manifestations due to embolic complications of IE within a duration of one year. Our case was primarily managed by multidiscipliniary approach. It is an impossible task for a cardiologist to treat such cases with showering complications where a multidisciplinary team approach is the only treatment option.