Browsing by Author "Gajurel, Ratna Mani"
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Publication Aspirin Desensitization and Percutaneous Coronary Intervention in a Patient with Aspirin Hypersensitivity and Acute Coronary Syndrome: A Case Report(Nepal Medical Association, 2024) Acharya, Suman; Gyawali, Siddinath; Kharel, Sanjeev; Upreti, Dinesh; Bhusal, Khem Raj; Maharjan, Silvia; Shrestha, Hemanta; Gajurel, Ratna ManiAbstract Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.Publication Clinical Correlation between Symptoms and Risk Factors with Cardiac Arrhythmias on 24-Hour Holter Monitoring(Institute of Medicine, Tribhuvan University, 2025) Shrestha, Hemant; Chhetri, Surendra Bahadur; Bashyal, Bibhav; Bastakoti, Sudip; Gajurel, Ratna ManiAbstract: Introduction Ambulatory ECG Holter monitoring is necessary for the diagnosis of intermittent arrhythmias. The study aimed to study the clinical profile of symptomatic patients and association between symptoms and risk factors with specific arrhythmia. Methods This was a prospective observational study conducted to study the clinical profile of symptomatic patients who presented with unexplained palpitation, dizziness, syncope, or unexplained neurological events and who underwent 24-hour Holter monitoring for suspected cardiac arrhythmias. Results Overall, 265 patients were enrolled, of which 127 (47.9%) were male and 138 (52.1%) were female. The mean age of the study population was 55.5 ± 16.7. The most common indication was palpitation (58.5%), followed by dizziness (20%), unexplained neurological events (10.2%), and syncope (9.1%). The most common finding was Ventrical premature contractions (VPCs) seen in 195 (73.6%), followed by Atrial premature contractions (APCs) in 176 (66.4%), Supravenricular tachycardias (SVTs) in 33 (12.5%), and ventricular arrhythmias in 7 (2.6%). Sinus bradycardia was seen in 6 (2.3%), while sinus pause was seen in 10 (3.8%) patients. SVTs significatntly presented with palpitation (p-0.008) while sinus pause and sinus bradycardia presented with syncope (p-<0.001). Sinus pause was exclusively associated with syncope in all 10 patients (100 %). Conclusion Increasing age, smoking, hypertension, and pre-existing cardiac disease were significantly associated with abnormal Holter reports. Syncope was the only symptom that was associated with a higher prevalence of clinically significant arrhythmias. Only supraventricular tachycardias, sinus bradycardia, and sinus pause were associated with specific symptoms.Publication Impact of Thrombus Burden in Patients with Acute Coronary Syndrome during the Hospital Stay: A Cross-Sectional Study at a Tertiary Center in Nepal(Institute of Medicine, Tribhuvan University, 2025) Bhusal, Khem Raj; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Raja Ram; Shakya, Smriti; Thapa, Shovit; Jha, Suchit; Miya, Madeena; Sah, Sangam; Upadhayaya, Prajjwal; Gajurel, Ratna ManiAbstract: Introduction Acute coronary syndrome (ACS) is the leading cardiovascular (CV) cause of mortality and necessitates prompt diagnosis and treatment. Luminal thrombus secondary to coronary plaque rupture is considered as the underlying mechanism for ACS. Intracoronary thrombus burden was a strong predictor for adverse outcomes including stent thrombosis, myocardial re-infarction, and mortality. Methods This study was done in consecutively taken 72 patients presenting with acute coronary syndrome. Angiographic grading of intracoronary thrombus was done according to TIMI thrombus grading. Information on Cardiovascular risk factors and comorbidities was obtained and analysis was done with respect to Thrombus Grade. Adverse cardiovascular outcomes during hospital stay, length of hospital stay and in-hospital mortality were analyzed with respect to thrombus grade. Results Among 72 patients studied, the mean age was 58.93 (± 14.22 years) ranging from 30 years to 91 years. Males were 36.1% while 63.9% were females. Regarding the comorbidities, 62.5% were Hypertensive, 34.7% were Diabetic, 6.9% had hypothyroidism, 2.8% had chronic kidney disease and 5.6% had chronic obstructive pulmonary diseas, 38.9% were active smokers, 15.3% were former smokers, 34.7% were alcohol consumer, 5.6% were tobacco consumer and 1.4% were substance abuser. Among the participants, 6.9% had prior history of MI and 4.2% had prior history of stroke. High thrombus burden was associated with longer duration of hospital stay (p-value=0.026). Conclusion High Thrombus burden was significantly associated with longer duration of hospital stay because of being sicker due to higher cardiovascular events in high thrombus group. Cardiovascular complications were significantly higher in high thrombus burden group.Publication Occluded Coronary Artery among Non-ST Elevation Myocardial Infarction Patients in Department of Cardiology of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Sharma, Manju; Khanal, Raja Ram; Shah, Sangam; Gajurel, Ratna Mani; Poudel, Chandra Mani; Adhikari, Suman; Yadav, Vijay; Devkota, Surya; Thapa, ShovitAbstract Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient’s clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Among 126 non-ST elevation myocardial infarction patients included in the study, the prevalence of occluded coronary artery was 41 (32.54%) (24.36-40.72, 95% Confidence Interval). Conclusions: The prevalence of occluded coronary arteries was similar to the studies done in similar settings.