RESUMEN

Diabetes Ketoacidosis in association with acute myocardial infarction is quite frequent but is also associated with higher morbidity and mortality. These two can trigger each other, different hypothesis have been proposed to explain this phenomenon but still it is difficult to know which one appears first. We report a referred case to our centre with acute Myocardial Infarction and diabetic ketoacidosis promptly initiated treatment of diabetic ketoacidosis along with primary PCI. Keywords: Cardiogenic shock; diabetic ketoacidosis; metabolic acidosis; myocardial Infarction.

Asunto(s)

RESUMEN

MV repair in the rheumatic population is feasible with acceptable long-term results. Incidence of mitral stenosis (MS) following mitral valve (MV) repair for severe rheumatic mitral regurgitation (MR) and usefulness of percutaneous transluminal mitral valvuloplasty in these patients is not described in literature. We report a case of successful PTMC in severe MS following MV repair for severe rheumatic MR.

RESUMEN

BACKGROUND: Door-to-balloon (DTB) time of 90 min during primary angioplasty is considered as the benchmark duration. Shorter DTB time is preferable, and longer duration can have poor clinical outcomes. METHODS: A cross-sectional observational study of three months in Shahid Gangalal National Heart Center was conducted in which all patients undergoing primary angioplasty were included. The DTB time was calculated, and the different determining factors were studied. RESULTS: Seventy-nine patients undergoing primary percutaneous intervention were studied. The median DTB time was 79 minutes (Interquartile range [IQR] 59-115 min). Forty-six (58.2%) patients had a DTB time of less than 90 min. DTB time varied significantly with direct visit vs transfer (p = 0.029) and office time visit (9 am-5 pm) vs off time (5 pm-9 am) (p = 0.012). DTB time did not differ between any infarct-related vessels (p = 0.471), number of vessels involved (p = 0.638), and the added procedures (defibrillation, thrombosuction, and temporary pacemaker insertion) (p = 0.682) during angioplasty. No significant differences were recorded according to age (p = 0.330), gender (p = 0.254), hypertension (p = 0.073), diabetes (p = 0.487), heart failure (p = 0.316), and baseline left ventricular ejection fraction (LVEF) (p = 0.819). CONCLUSION: The median DTB time in primary angioplasty was less than 90 minutes. The significant determining factors were timing of hospital visit (office vs off time) and type of visit (direct vs transfer). There can be improvement in factors determining DTB time to lower it further.

Asunto(s)

RESUMEN

INTRODUCTION: Pre-hospital delay includes time from onset of symptoms of myocardial infarction till arrival to emergency room of the hospital. This defines time from symptom onset to first medical contact and first medical contact to emergency room. This study aims to study the prehospital events and determining factors in patients undergoing primary angioplasty. METHODS: This was a cross sectional study in Shahid Gangalal National Heart Centre for three months. Timings of chest pain, first medical contact time, transfer time to hospital and overall pre-hospital time for PCI and risk factors were analysed. RESULTS: There were 79 cases with 66 (83.5%) males and 13 (16.5%) females with mean age 56±11.2 years. Risk factors were 60 (75.9%), smoking, 47 (59.5%) hypertension, 25 (31.6%) diabetes, 22 (27.8%) dyslipidaemia and 16 (20.3%) heart failure. Chest pain was maximum in 5 to 9 AM. The median prehospital delay was 300 minutes (5.0 hours) of which symptom to first medical contact was 165 minutes and first medical contact to hospital was 80 minutes. The longer median prehospital delay for hypertension, diabetes, female and age ≥50 years and the shorter for male, age less than 50 years, dyslipidemia and heart failure, though not statistically significant. Private transport was the preferred from symptom to first medical contact and ambulance for first medical contact to emergency room. Patients received in ER had aspirin 72 (91.1%), atorvastatin 54 (68.4%) and double anti-platelets 45 (57%). CONCLUSIONS: Chest pain was common in morning and the prehospital delay can be minimized by improving time from symptom to first medical contact and first medical contact to Emergency room.

Asunto(s)

RESUMEN

BACKGROUND: Renovascular hypertension due to fibromuscular dysplasia is an uncommon cause of secondary hypertension and is more common in females. This entity is an important treatable cause of secondary hypertension. CASE PRESENTATION: We report the case of a 21-year-old asymptomatic male found to have high blood pressure on routine checkup. Renal angiogram revealed fibromuscular dysplasia involving the right renal artery. He underwent percutaneous angioplasty with complete recovery. The single antihypertensive which he was on was stopped next month. CONCLUSION: Fibromuscular dysplasia causing stenosis of renal artery is uncommon. High degree of suspicion is required for the timely diagnosis and treatment of this potentially treatable cause of secondary hypertension.

RESUMEN

BACKGROUND: The percutaneous transvenous mitral commissurotomy is an important procedure for the treatment of mitral stenosis. A lot of mitral stenosis cases have left atrial appendage clot which precludes the patient from the benefit of this procedure. The aim of the study was to study the feasibility and safety of the procedure in a patient with appendage clot in the setup of certain urgent conditions. METHOD: All cases of mitral stenosis with significant dyspnea and mitral valve area <1.5cm2 with left atrial appendage clot and a condition which would preclude the patient from continuing on anticoagulation and needed urgent intervention were included in the study. From January 2011 to December 2013, twenty patients coming to Shahid Gangalal National Heart Centre, Kathmandu were selected for the procedure with conventional sampling technique. Informed written consent was obtained from the patients explaining all possible complications. The approval of the study was taken from the ethical committee of the hospital. RESULT: Mean mitral valve area increased from 0.90cm2 (SD±0.14) to 1.5cm2 (SD±0.21) (p=0.02). Left atrial mean pressure decreased from mean of 20 to 10mmHg. Subjective improvement was reported in all. All of the patients had fulfilled criteria for successful PTMC. There was no mortality during hospital stay or in one-week follow-up period. There were no neurological complications or any need for emergency surgery. CONCLUSION: The immediate result of percutaneous transvenous mitral commissurotomy in selected cases of mitral stenosis with left atrial appendage clot is safe and acceptable in certain urgent situations in experienced hands.

Asunto(s)

RESUMEN

BACKGROUND: Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients. METHODS: It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure. RESULTS: During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and 61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm(2) to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm(2) in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC. CONCLUSIONS: PTMC in JMS is safe and effective.

RESUMEN

INTRODUCTION: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid alternative to surgical therapy in selected patients with mitral stenosis. Though its efficacy in children and young adults is already established, its role in elderly patients is not well reported. We aimed to evaluate the efficacy of PTMC in elderly patients (≥60 years). METHODS: All elderly patients who underwent PTMC from March 2008 to March 2013 were retrospectively reviewed. Mitral valve area and mean left atrial pressure before and after the procedure were compared. RESULTS: During the study period 49 elderly patients underwent PTMC. Thirty eight were female and 11 male. Age ranged from 60 to 77 years with the mean age of 64.5±4.0 years. The mean mitral valve area increased from 0.9±0.1 cm(2) to 1.6±0.3 cm(2) whereas mean left atrial pressure decreased from 25.4±6.6 mmHg to 12.9±4.5. Successful results were observed in 41 (83.6%) patients. Unsuccessful results were due to suboptimal mitral valve area <1.5 cm(2) in 7 (14.25%) patients and post-procedure MR of more than moderate MR in 1(2%) patients. Unsuccessful PTMC was much more common in severe than in moderate mitral stenosis. CONCLUSIONS: Our study suggests that PTMC in elderly is a safe and effective procedure when performed in experienced centre by experienced operators.

RESUMEN

BACKGROUND: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7~10% of patients. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Large thrombolytic trials demonstrate 60% mortality with most effective thrombolytic agent. METHODS: In between September 2005 to August 2008 total PCI in Shahid Gangalal National Heart Center (SGNHC) in Nepal was 452. Among them primary PCI (PPCI) in AMI with cardiogenic shock was done in only 16 patients (3.5%). RESULTS: This study showed in-hospital mortality of 50% (n = 8). Of 50% (n = 8) alive patients with cardiogenic shock who underwent PPCI, 6 patients are in routine follow-up over 12 months and 2 were doing well in subsequent 6 months but not in follow up after that. CONCLUSION: Primary PCI in AMI complicated by cardiogenic shock has lower mortality and improved outcome. High cost, high in-hospital mortality and lack of trained personnel are major limitations.

RESUMEN

OBJECTIVE: Limited knowledge of heart attack symptoms may prevent patients from seeking time-dependent thrombolytic therapy, an intervention that offers impressive survival benefit. Previous studies carried out in developed countries demonstrated a deficit of knowledge about a wide range of heart attack symptoms. The aim of this study was to describe knowledge of heart attack, knowledge of heart attack symptoms, and anticipated first response to symptoms among the lay public in Nepal. METHODS: A total of 1192 participants (657 men and 535 women age 16 to 88 years old) were interviewed in a cross-sectional manner. Those <16 years of age, all health professionals, and individuals with a history of heart attack were excluded. RESULTS: A total of 862 (72.3%) participants had heard of heart attack. Significantly more male than female participants had heard of heart attack (P <.001). Of the respondents, 91.7% with >or=10 years of education (ED-2) had heard of heart of attack, whereas only 54% respondents with <10 years of education or who were illiterate (unable to read and write) (ED-1) had heard of heart attack, and in both the male and female populations, a higher percentage of the ED-2 group had heard of heart attack than the ED-1 group (92.6% vs. 60% and 85.6% vs. 49.6%, respectively). A significantly higher number of respondents from 31 to 50 years of age (AGE-2) had heard of heart attack than those 16 to 30 years of age (AGE-1) and those >50 years of age (AGE-3) (P <.001). Among 862 respondents who had heard of heart attack, 21.3% could not name any heart attack symptoms. A total of 16 different heart attack symptoms were named. Fainting or collapsing (48%), chest pain (22.4%), shortness of breath (9%), dizziness (8.4%), palpitations (7.4%), and sweating (7.4%) were the leading symptoms named by respondents. Fainting or collapsing and chest pain and shortness of breath were named more frequently among the ED-2 group respondents and the AGE-3 group men. Only 3.7% could name >or=2 typical heart attack symptoms. A significantly larger number of the ED-2 group named >or=2 typical symptoms than their counterparts (P <0.001). A large number (77.6%) of respondents preferred immediate hospital referral and/or doctor consultation after a heart attack. CONCLUSIONS: In Nepal, better-educated men are more aware of heart attack. Fainting or collapsing and chest pain and shortness of breath were leading heart attack symptoms named by the general population. Public heart attack awareness is not adequate and knowledge of wide range of heart attack symptoms is deficient in the Nepalese general population.

Asunto(s)

RESUMEN

Two hundred patients underwent Percutaneous transvenous mitral commissurotomy (PTMC) from January 2003 to July 2004. Seventy four percent of the patients were female. Age ranged from 10 years old to 61 years and mean age was 29 years. Twenty three percent of the patients were under 21 years of age. Atrial fibrillation was present in 32.0% of the cases. Mean mitral valve area increased from 0.90cm2 (+/- 0.14) to 1.82cm2 (+/- 0.21) (p = 0.018). Left atrial mean pressure decreased from 21 mmHg mean to 7 mmHg. Subjective improvement was reported in 98.0% of the patients immediately after the procedure. There was no mortality during the hospital stay or within the first month of the procedure. Significant mitral regurgitation of grade 3 was noted in 5 patients. Two developed severe mitral regurgitation. The complications were negligible. One had systemic embolisation during the procedure which recovered over a period of time. One developed deep vein thrombosis which recovered after treatment.

Asunto(s)

RESUMEN

UNLABELLED: Assessment of carotid artery lumen diameter and intima-media thickness is becoming as a surrogate marker of early evaluation of cardiovascular disease. Present study aims to describe the normal carotid dimensions in healthy adults of both sexes. A total of 123 healthy volunteers including 65 men and 58 women, aged 21 to 60 years (mean +/- SD; 35.66 +/- 8.84 years) were studied. Ultrasound study of both carotid arteries were performed with a 7.5 MHz linear array transducer. Common carotid artery lumen diameter ranged from 4.3 mm to 7.7 mm. Difference was not noted between left and right common carotid artery lumen diameter (5.78 +/- 0.57 mm and 5.86 +/- 0.66 mm), and internal and external carotid artery lumen diameter as well. Both left and right common carotid artery, internal and external carotid artery lumen diameter tended to be larger (p < 0.05) in men than women. Common carotid artery intima-media thickness ranged from 0.4 mm to 0.8 mm. Difference was not noted between left and right common carotid intima-media thickness when separately analyzed among men, women and the entire population. Difference was also not noted in comparison between men and women. CONCLUSION: Common carotid artery and internal and external carotid artery lumen diameter tends to be larger in men than women among young adults. There is no difference between left and right carotid artery lumen diameter. Common carotid artery intima-media thickness is similar in comparison between left and right and both sexes.

Asunto(s)

RESUMEN

BACKGROUND, In the context of rapidly raising occurrence of cardiovascular diseases in the developing countries, it becomes imperative to study the scenario in its various aspects. The present study in Nepal deals with the hypertension as it is one of the major risk factors of cardiovascular diseases. METHODS AND RESULTS, A house-to-house survey was conducted in a suburban area of Kathmandu valley from February to June 2005 in adult population (age >/=18 years) to estimate the prevalence, awareness, treatment, and control rates of hypertension. Blood pressure was measured twice using standardized mercury sphygmomanometer, and an average of the two readings was taken. Total number of subjects were 1114 (men:541; women: 573; mean age: 37.8 -/+ 16.3 years). Overall prevalence of hypertension was 19.7% (22.2% in men and 17.3% in women, p < 0.05).Prevalence of hypertension in age group of >/=40 years was 36%.Awareness, treatment, and control rates were 41.1%, 26%, and 6%, respectively. CONCLUSION, Our study indicates that prevalence of hypertension is significant in Nepal and is comparable with other developing countries of this region. Awareness, treatment, and control rates are poor.