Background and Aims: As in other developing countries, Rheumatic Heart Disease (RHD) remains a major public health problem in Nepal. The most commonly affected people are children and adults in their productive years of age.

Background and Aims: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF presentations to the emergency department of a tertiary cardiac center in Nepal1. Present study evaluated the prevalence and characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG). Methods: In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing CAG, at Shahid Gangalal National Heart Centre, were evaluated. Results: The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%) with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years, smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter (iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which, smoking was the independent predictor of CAD. Conclusion: Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries, which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.

Background: The prevalence of stage 2 hypertension approaches one-third in adult Nepalis and despite inexpensive effective treatment, long-term compliance is poor. World-wide, a major impediment is the incongruity between hypertension and patients’ symptom-based illness representations. The Common-Sense Model of Self-regulation was used to investigate Nepali illness representations through open-ended interviews of patients with hypertension.Methods: In a tertiary hospital setting, 50 self-identified hypertensive patients were interviewed about their representations of health, hypertension, and hypertensive treatment. Responses were analyzed with a modified Interpretative Phenomenological Analysis.Results: An Ayurvedic-influenced health model appeared in illness identity and coping responses. Hypertension was identified as a serious disease having observable, wide-ranging symptoms with chronic and intermittent timelines. Concerns included side-effects and barriers to treatment. Conclusions: Further confirmation and investigation of Nepali common-sense hypertension models in a sample size sufficient for factor analysis is warranted for effective adherence interventions.Keywords: Common-sense model; hypertension adherence; illness representations; Nepal

Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT. Results: Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56 years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong correlation between MLS index and MVA by planimetry ( r = 0.89, p<0.001) and MVA by PHT (r=0.95, p<0.001). MLS index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT. Conclusion: MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.

Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation. Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1st July 2018 to 30th June 2019. Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e’(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively. Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e’ ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.