Carotid Plaque Burden in Patient who Underwent Coronary Angiogram at Dhulikhel Hospital.

Background Coronary artery disease (CAD) is a leading cause of death worldwide and is primarily caused by atherosclerosis. Carotid plaque and coronary artery disease share a common pathogenesis and risk factor. Carotid arteries are accessible through noninvasive imaging method. By characterizing the carotid arteries, it becomes possible to estimate the total burden of atherosclerosis, including that of coronary artery disease. According European Society of Cardiology (ESC) ultrasound of the carotid arteries should be considered, and be performed to detect plaque in patients with suspected chronic coronary syndrome. Objective To establish a relationship between coronary artery disease and carotid plaque. Method It is a cross sectional analytical study. Patients who underwent coronary angiogram at Dhulikhel Hospital from 1st April 2022 till 31st March 2023 were assessed for carotid plaque using carotid ultrasound. Chi square test was done to find the relationship between presence of carotid plaque and coronary artery stenosis of more than 50%. Positive predictive value and negative predictive value was calculated. Result Total number patient was 254 and the mean age was 61± 4.7 years. Out of which 85(33.5) had normal coronary artery, 143(56.3) had ≥ 50% stenosis and 120 (47.2) had ≥ 70% stenosis. Eight patients also had significant left main disease with ≥ 50 % stenosis. Carotid plaque was present in 121(47.6) patients. Out of 143 patients who had ≥ 50% stenosis in coronary angiogram, 104(72.7) patients also had carotid plaque which is statistically significant as p < 0.05. Positive predictive value (PPV) was 72.7% and negative predictive value was 84.7%. Conclusion This study establishes a relationship between coronary artery disease and carotid plaque, suggesting that the presence of carotid plaque may serve as an indicator of underlying coronary artery disease.

Prevalence of Microalbuminuria in Patients of Essential Hypertension and its Correlation with Left Ventricular Hypertrophy and Carotid Artery Intima­media Thickness.

Background Urinary albumin excretion has been associated to cardiovascular events and increased mortality in hypertensive patients. There is limited information among Nepalese patients about the implications of microalbuminuria (MA) in the setting of hypertension and potential cardiovascular morbidity. Objective To investigate the prevalence of microalbuminuria in patients with essential hypertension and its connection with left ventricular hypertrophy (LVH) and carotid artery intima-media thickness (cIMT). Method The study involved 80 hypertension individuals in total. All patients in the study had basic biochemical tests, routine urine evaluations, echocardiography, and carotid artery intima-media thickness measurements performed, and the data were analyzed. Result The prevalence of microalbuminuria was present in 37.5% cases of essential hypertension. The mean left ventricular mass index (LVMI) was significantly higher in patients with increased microalbuminuria as compared to patient with normal microalbuminuria. In addition, a significant positive correlation between microalbuminuria and left ventricular hypertrophy was also observed. Furthermore, mean carotid artery intima-media thickness was found to be higher in patients with microalbuminuria (p < 0.001), with 76.7% of the patients with microalbuminuria having elevated mean carotid artery intima-media thickness. The carotid artery intima-media thickness had a positive correlation with both microalbuminuria and left ventricular hypertrophy. Conclusion Microalbuminuria assessment in hypertensive patients is an important test for the evaluation of target organ damage. This study shows that microalbuminuria is common in hypertension patients, particularly those with left ventricular hypertrophy. Microalbuminuria was found to be associated with left ventricular hypertrophy and carotid artery intima-media thickness.

Study of Echocardiographic Measurements to Estimate the Physiological Cardiac Efficiency in Apparently Healthy Patients Visiting University Hospital for Cardiac Evaluation.

Background Healthy cardiac function is evaluated by echocardiography in the non-invasive cardiology department. Cardiac functional and structural evaluation is assessed by cardiologists based on a physiologically defined normal range. We want to compute the physiological value of variables in the healthy population. Objective To compute and compare the recorded echocardiographic parameters among apparently healthy patients. Method This is a retrospective study and a total of 544 subjects whose standard reference range was within the normal limit are included for computational study. 268 males (52.8%) and 240 females (47.2%) were studied for the size of the aortic root, size of the left atrium, left ventricular internal diameter during diastole (LVIDd) and systole (LVIDs), interventricular septum during diastole and systole (IVSd and IVSs), left ventricular posterior wall during diastole (LVPWd) and systole (LVPWs) and ejection fraction (EF). Result Ejection fraction (EF) is not significantly different (p=0.14) between genders, Mean±SD; 70.45±6.7 for females and Mean±SD; 68.34±7.18 for males. The mean age of examined female patients is Mean±SD; 36.88±12.6 which is not significantly different with male patients age Mean±SD; 38.28±12.5. Males have larger left ventricular internal diameter in diastole, Mean±SD; 43.90±6.4 than females Mean±SD; 41.37±8.08. Ejection fraction for females is Mean±SD; 70.45±6.7, for males is Mean±SD; 68.34±7.18 with p=0.14. Conclusion Absolute echocardiographic measurements vary physiologically between apparently healthy genders yet the ejection fraction is not significantly different between both the genders in the examined Nepali population.

Neonatal Arrhythmia.

Arrhythmias are seldom observed in the newborn period and rarely lead to serious consequences. Because they may be a continuation of fetal arrhythmias, newborn arrhythmias are different from those occurring at later ages. Here we describe a case of a newborn presented with tachycardia at birth. A female baby of 1950 grams born by emergency cesarean section for fetal distress at 36 weeks of gestation. Fetal tachycardia of 251 bpm was detected prenatally. Electrocardiography showed supraventricular tachycardia (SVT). Hematological and biochemical tests done were within normal limits. Echocardiography revealed normal anatomy with severe tachycardia, dilated chambers with moderate to severe TR with moderately reduced ventricle function. For persisting SVT intravenous adenosine was administered with no significant decrease in heart rate, then continuous intravenous amiodarone infusion was started resulting in a transient decrease in heart rate, however again increased, hence baby was started on intravenous digoxin which responded well. Repeated echocardiography showed normal cardiac chambers and function. Baby was discharged on maintenance oral digoxin and was gradually weaned and stopped after 12 months of age. Neonatal arrhythmias is not an uncommon condition in newborns, however it should be early recognized and evaluated for a better outcome of the baby. Although the frequency of arrhythmias in the newborn period is not high, SVT are the most frequently observed arrhythmias in this period.

Radiation Exposure to the Patient During Diagnostic Coronary Angiogram at Dhulikhel Hospital.

BACKGROUND: Radiation is a necessary evil in Coronary Angiogram. The Interventional Cardiology procedure provides huge benefit to the patient but at the cost of radiation. There is evidence of cumulative effect of radiation. Therefore it is essential to keep the radiation dose as minimum as possible. OBJECTIVE: The aim of this study is to find out radiation exposed to the patient undergoing diagnostic coronary angiogram. METHOD: A retrospective study was done. Those patients who underwent diagnostic coronary angiogram were selected for the study. There were total of 166 patients. Radiation exposure in terms of fluoroscopy time in minute and dose area product (DAP) in Gy.cm2 was recorded. RESULT: Out 166 patients 92 were male and 74 female. Age range was from 39 to 79 years with mean age 58.13±9.14. Amount of contrast used was in range of 30 to 100 ml with mean of 45.54±14.06. Range of fluoroscopy time was 2.60 to 37.00 minutes with mean 11.38±6.80. Mean fluoroscopy time in male was 10.92±5.82 minutes and in females it was 11.92±7.68 minutes, with p 0.331. The range of DAP was 11.00 Gy.cm2 to 106.00 Gy.cm2 with mean 40.73±23.58 Gy.cm2. The mean DAP in male and female was 38.77±23.26 Gy.cm2 and 43.16±23.90 Gy.cm2 respectively with p 0.234. CONCLUSION: From this study we can conclude that the radiation exposure to our patient undergoing coronary angiogram is similar to the international values in terms DAP but more in terms of fluoroscopy time. When males and females compared there is no difference.

Efficacy of Different Antihypertensive Drugs among newly Diagnosed Hypertensive Patient in Dhulikhel Hospital.

Background Cardiovascular disease represents the largest burden on global health, important modifiable risk factor being hypertension. Difference in response to antihypertensive medication depending on ethnic group is well recognized. There is very few data regarding this difference in the South Asian population especially from Nepal. Objective The aim of this study is to find out which antihypertensive medication has better efficacy in our population. Method One seventy two newly diagnosed hypertensive patients who presented to cardiology OPD were included. Blood Pressure (BP) was recorded in both arms at least three times. Patients were counseled for lifestyle and dietary modification and were prescribed one of the three drugs Hydrochlorthiazide 25 mg or Amlodipine 5 mg or Enalapril 5 mg. Patients were called back in 4-6 weeks time and Blood Pressure was recorded in similar manner. Result Out of 172 patients, 97 were male and 75 female. The mean age was 55.49±1.03 years. Mean Systolic BP before treatment was 156.2±10.6 mm of Hg and Mean Diastolic BP before treatment was 100.5 ±6.8 with no statistically significant difference among different groups. However Systolic BP reduction was 14.6 ±5.1, 21.9±5.9 and 21.8±7.4 by Hydrochlorthiazide , Amlodipine and Enalapril respectively. Diastolic BP reduction was 8.8±2.5, 14.2±2.8 and 14.3±2.9 by Hydrochlorthiazide, Amlodipine and Enalapril respectively. Conclusion Amlodipine and Enalapril are equally effective in controlling BP in our population. Hydrochlorthiazide is less effective than both Amlodipine and Enalapril.

Association of cardiovascular risk factors and coronary artery lesion among coronary artery disease patients.

BACKGROUND: Coronary artery disease (CAD) is associated with the numbers of risk factors causing coronary atherosclerosis. Coronary artery stenosis is mostly caused by coronary atherosclerosis. OBJECTIVE: This study aims to analyze the association between coronary artery stenosis and cardiovascular risk factors. METHODS: An observational study was conducted among CAD patients. The diagnostic coronary angiogram was performed from femoral approach using standard catheters and techniques to find out any abnormalities. RESULT: A total 73 patients (44 male and 29 female) with coronary artery disease undergoing diagnostic coronary angiography was included with the documented cardiovascular risk factors. The coronary stenosis was found in 40 patients on the basis of stenosis grading. Among the established cardiovascular risk factors, sex, diabetes mellitus and smokers show are significantly associated with coronary stenosis among CAD patients. The present study shows the significant association of coronary stenosis among male CAD patients (OR 2.47; CI 0.94-6.48, p<0.05) and similar association has been observed in diabetes mellitus (OR 3.32; CI 1.12-9.84, p<0.05) and smoking (OR 4.10; CI 1.45-11.61, p<0.01). CONCLUSION: The prevalence of CAD is increased with numbers of presence of cardiovascular risk factors. Male gender, diabetes mellitus and smoking are significantly associated with coronary stenosis among CAD patients. However, hypertension and dyslipidemia are comparable between coronary stenosis and no significant stenosis group.

Prevalence and associated risk factors of hypertension among people aged 50 years and more in Banepa Municipality, Nepal.

BACKGROUND: Hypertension is a cardiovascular disorder rapidly emerging as a major public health problem in developing countries and is the most widely recognized modifiable risk factor for cardiovascular diseases. OBJECTIVE: The objective of this study was to find out the prevalence and associated risk factors with hypertension among people aged 50 years and more in Banepa Municipality, Kavre, Nepal. METHODS: It is a cross- sectional, population based study which was carried out in Banepa Municipality from May 15 to June 15, 2009. Among total 11 wards of Banepa municipally, wards number 1, 3, 5, 6, 7, and 10 were selected by using Simple Random Sampling Technique and 405 subjects of people aged 50 years and more were selected for study from the selected wards by using Cluster Sampling. The structured interview method was used for collection of data. Mercury sphygmomanometers with standard cuff were used to measure the indirect auscultatory arterial blood pressure. Two consecutive blood pressure readings were taken and average of them was calculated to determine single value of blood pressure. RESULTS: The prevalence of hypertension was 44.9 percent (47.75% in male and 42.73% in females). Among them, only 32.9 percent (60/182) were previously diagnosed as hypertension. The higher proportion of hypertensive cases were in age > 65 years (55.49%) than in the age group < 65 years (36.32%). The prevalence of hypertension was seen positively associated with non vegetarian eating habits, alcohol consumption, and > 25 Body max index. Taking green leafy vegetable at least once a week was negatively associated with the prevalence of the hypertension. CONCLUSION: These findings provide important information on the prevalence, associated factors of hypertension in Banepa Municipality. Effective public health measures and strategies are needed to improve prevention, diagnosis and access to treatment of these 50 years and above population.