Background and Aims: : Chronic obstructive pulmonary disease (COPD) is highly prevalent in the Nepalese population. It is associated with significant extrapulmonary effects among which cardiovascular complications are most common . Echocardiography evaluation mainly focused on effects on the right heart function is a salient tool to evaluate the presence of degree of pulmonary hypertension and also identify those group of patients who need more early aggressive therapy for the underling lung disease . We aimed to prospectively study the patients with diagnosed COPD with echocardiogram for evaluating the right heart . Methods: An observational , cross sectional study was done on 50 patients with COPD who were admitted at Bir Hospital and underwent echocardiographic evaluation from Dec 2015 -Dec 2016 . All echocardiogaphic parameters focused on right heart and its function were assessed . Results: Out of total 50 COPD patients studied , majority of them were female (32 patients ,64%). The mean age group of the studied patients was 60.9 ±11.4 years . Pulmonary hypertension defined as sPAP>30 mmHg was evident in all of the patients ; with 30 patients (60% ), 14 (28 %) and 6(12 %) patients having severe, moderate and mild pulmonary hypertension respectively . RV dysfunction was evident with reduced average TAPSE values (1.59± 0.38 cm) and elevated RIMP values (0.58±0.16). Conclusion: Majority of COPD patients had evidence of pulmonary hypertension. Echocardiogram can be a helpful tool to assess early changes on the right heart size and function in patients with COPD and also monitor these patients for rapid progression of the illness .

Background and Aims: Heart failure is a major global health problem, but studies on prevalence of heart disease in Nepal are sparse. The aim of this study is to describe the etiology of heart failure patients in emergency department of Shahid Gangalal National Heart Centre.Methods: This was a single centre, prospective, observational study, conducted in the Emergency Department of National Heart Centre, from 1st May to 30th August 2016. All (n=591) consecutive patients with clinical diagnosis of heart failure were evaluated.Results: The mean age of the patients was 56.48 ±19.44 years, with 45.9% males. 31.3% had atrial fibrillation. The commonest cause of heart failure was rheumatic heart disease (25.1%), followed by dilated cardiomyopathy (22.8%), and coronary artery disease (18.1%). The commonest causes in the age group ≤44 years were rheumatic heart disease (61.9%), and congenital heart disease (11.0%). Commonest causes in the age groups 45 – 64 years and ≥ 65 years were dilated cardiomyopathy (29.0% and 26.4%, respectively) and coronary artery disease (22.3% and 24.3%, respectively). The commonest causes in male was dilated cardiomyopathy (26.9%) and in female it was rheumatic heart disease (31.6%).Conclusion: Rheumatic heart disease, dilated cardiomyopathy and coronary artery disease are the commonest cause of heart failure. Appropriate prevention strategies focused at these causes of heart failure are required to decrease the burden of heart failure in Nepal.Nepalese Heart Journal 2017; Vol 14(2), 1-4

Background: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. Methods: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. Results: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). Conclusions: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal. Keywords: Femoral; percutaneous coronary intervention; radial

Background and Aims: Abnormal Right Ventricular (RV) function affects the long term outcome and clinical symptoms in patients with mitral stenosis (MS). This study evaluates the immediate effect of Percutaneous Transmitral Commisurotomy (PTMC) on RV function. Methods: An observational, cross sectional study was done on 50 patients with rheumatic MS who underwent PTMC at Shahid Gangalal National Heart Center from Dec 2015 -Dec 2016. All underwent clinical evaluation and echocardiogram before and immediately after PTMC. Results: There was female preponderance with 66% being female. The mean age was 37.26 ± 10.63 years. There was immediate increase in the mitral valve area (MVA) from 0.87 ± 0.12cm2 to 1.54 ± 0.27cm2(p< 0.001). There was significant decrease in mean mitral diastolic gradient from 16.4 ± 8.8mmHg to 5 ± 1.5mmHg (p< 0.001), in the pulmonary artery systolic pressure 53.6 ± 21.83mmHg to 39.5 ± 14.67mmHg (p< 0.001), in the RV Tei index from 0.56 ± 0.08 to 0.40 ± 0.08 (p< 0.001). There was significant increase in TAPSE from 16.0 ± 1.50 to 18.6 ± 1.70 mm, (p<0.001) and the longitudinal velocity of excursion of the RV at the tricuspid annulus (RV S') from 13.69 ± 3.33 cm/sec to 15.31 ± 3.07 cm/sec (p< 0.001) Conclusions: Successful PTMC can improve RV function as shown by the improvement in PASP, RV Tei index, TAPSE and RV S'. Further larger population studies are required to confirm the findings. Long term studies are important to determine the prognostic significance of improvement in RV function.