Background and aimsPulmonary embolism (PE) is associated with a significant mortality and morbidity. We aim to study clinical profile, management and outcome of PE at Shahid Gangalal National heart Centre, Kathmandu, Nepal.MethodsIt was a retrprospective, single centre study, conducted from January 2015 to December 2016. Haemodynamics was used for risk Simplified, PESI score, predisposing factors, symptoms, clinical features at the time of admission, ECG features, echocardiogram, treatment received and the outcome were reviewed.ResultsDuring the study period 23 cases of PE were admitted. Nine were males and 14 were females. Eleven patients were diagnosed as provoked PE. High risk PE was diagnosed in four patients, Non-high risk in 19 patients. The most common clinical presentation was shortness of breath. The most common finding in ECG is sinus tachycardia followed by ST-T changes in V1-V3. Eight patient had SPO2 less than 90%. Most of the patients had a normal chest radiograph. Echocardiography revealed dilated RA and RV in 20 patients.All high risk PE patients were thrombolyzed with streptokinase. All patients who were diagnosed as Non-high risk PE were treated with LMWH. All the patients were treated with oral anticoagulants. Mean hospital stay was 9.7 ± 4.9 days. Two patients died during hospital stay. S-PESI score was 1.4 ± 0.9 respectively. Mean warfarin dose at the time of discharge was 5.9 ± 1.6 mg.ConclusionPE is an under diagnosed clinical problem world over. Suspicion is the most important part to come to the diagnosis of PE.
Background and Aims: Coronary intervention through radial artery is a preferred over femoral route. Different vasodilators are used to prevent radial artery spasm. Till date there is no study to compare the effects of various vasodilator regimes during radial coronary angiogram in Nepal. We aim to compare the efficacy of different vasodilator in our patients.Methods and Result: This is a single centre, prospective randomized trial between Verapamil, Nitroglycerine (GTN) and cocktail (Verapamil with GTN). All the patient undergoing coronary angiogram via radial approach, without the contraindication were randomized by a computer generated randomization protocol. Patient undergoing coronary procedures via the radial artery were divided into three groups. Patients in group A received intra-arterial cocktail (2.5 mg of Verapamil plus 100 mcg Nitroglycerine in 10 ml of normal saline), patients in group B received Verapamil (5mg) and patient in group C received Nitroglycerine (200mcg). Heparin of 3000U was given intravenously in all three groips. Altogether 207 patients underwent transradial coronary angiogram, 203 were randomized after exclusion. Over all Radial artery spasm was reported in 28 patients (13.79%). There was no statistically significant difference in spasm between the three regimens however when grading, there was significant higher grade of spasm in Verapamil group (13.23%, P value < 0.05). When comparing Verapamil and GTN separately there was significant higher spasm (21% vs 7%, P value < 0.05) with higher grades of spasm in verapamil group.Journal of Advances in Internal Medicine 2016;05(01):11-14
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