Browsing by Author "Khanal, Rajaram"
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Publication Clinical Profile and In-Hospital Outcome of COVID-19 Infection among Patients with Cardiovascular Disease: A Cross-Sectional Study(Institute of Medicine, 2022) Ghimire, Roshan; Gajurel, Ratna M; Paudel, Chandra M; Shrestha, Hemant; Khanal, Rajaram; Manandhar, Bhawani; Shakya, Smriti; Shakya, Samir; Yadav, Vijay; Sharma, Manju; Yadav, Sutap; Shah, Nischal; Thapa, SanjeevABSTRACT Introduction: Coronary heart disease, hypertension, heart failure, diabetes, and other cardiovascular diseases (CVDs) increase the disease severity and in-hospital mortality among patients with COVID-19. Methods: This is a hospital-based study assessing the effects of CVD on the in-hospital outcomes in patients admitted with COVID-19. Clinical characteristics and in-hospital outcomes were studied in patients with cardiovascular risk factors and underlying CVD. Results: A total of 108 covid positive patients had an underlying cardiovascular disease/s in various forms with a mean age of 60.69±16.24 years and 55.6% were male. Hypertension and diabetes mellitus were the commonest cardiovascular risk factors. Among these patients, acute decompensated heart failure and cardiac arrhythmia commonly atrial fibrillation were the common cardiac complications. The in-hospital mortality rate was 16.67%. Those who died due to cardiac involvement was 18.2% in comparison to 14.3% of the patients who did not have cardiac involvement, although this could not reach statistical significance. The most common cause of death was multiorgan failure resulting in 44.5% of all cause of death followed by acute respiratory distress syndrome accounting 27.8% and refractory cardiogenic shock with 22.2% involvement. Among those who died vs those who survived length of hospital stay was significantly longer in death group (13.6 days vs 9.11 days, p=0.002) Conclusion: In patients hospitalized with COVID-19, pre-existing established cardiovascular risk factors and CVD appear to be important contributors to mortality. The involvement of multiorgan predisposes COVID-19 patients to accentuated risk of mortality. Keywords: Cardiovascular diseases, COVID-19, in-hospital mortalityPublication Clinical Profile, Management and Outcome of Patients Presenting with Acute Pulmonary Embolism at Tertiary Level Cardiac Centre in Nepal(Institute of Medicine, 2021) Poudel, Chandra M; Shakya, Smriti; Khanal, Rajaram; Gajurel, Ratna M; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Pathak, Surya RABSTRACT Introduction: Pulmonary embolism (PE) is a common, under diagnosed and potentially lethal clinical condition. The aim of our study was to find out the clinical profile, management and outcome of patients with acute PE. Methods: It was a retrospective study. The participants included patients admitted and diagnosed to have acute PE from January 2014 to December 2019. Patients with high clinical probability and positive D-dimer in low and intermediate clinical probability were diagnosed as acute PE clinically. Data were obtained from the records section of the hospital. Results: The most common risk factor was found to be smoking. Only two patients were found to have protein C and protein S deficiency (4.4%) and one patient had hyperhomocysteinemia (2.2%). The most common symptom was found to be shortness of breath (97.8%). The most common sign was sinus tachycardia. Right ventricular dysfunction was found in 35.5% of the patients on echocardiogram. Computerized tomography pulmonary angiogram (CTPA) was done in 60% of the patients. The most common CT finding was presence of thrombus in main pulmonary artery in 13.3% of patients. Troponin I was positive in 26.7% of patients and D-dimer was positive in 66.7%. Only 42.2% had evidence of deep vein thrombosis. Only 13.3% were thrombolysed. All the patients received low molecular weight heparin or unfractionated heparin followed by warfarin or dabigatran. The in-hospital mortality rate was 15.6% where the rest of the patients were discharged. Conclusion: The most common symptom and sign was found to be shortness of breath and sinus tachycardia. Single investigation was not conclusive so multiple investigations were done to reach the diagnosis. Though all the patients received anticoagulation, only few of them were thrombolysed. The in-hospital mortality was found to be 15.6%. Keywords: High clinical probability, pulmonary embolism, thrombolysisPublication Dimensions of Normal Coronary Arteries in a Tertiary Cardiac Center Kathmandu(Institute of Medicine, 2023) Sharma, Padam PD; Poudel, Chandra M; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Rajaram; Shakya, Smriti; Thapa, Shovit; Gajurel, Ratna MABSTRACT Introduction: Coronary artery disease is the major cause of morbidity and mortality worldwide. The knowledge of normal coronary artery dimensions is fundamental during the percutaneous coronary intervention for appropriate sizing of the coronary balloons and stents. The dimensions of the coronary arteries differs among individuals of various countries, even among the different ethnicities. So, this study wass done to find out the normal coronary artery dimensions. Methods: This study was done in randomly selected 100 normal coronary angiograms. The diameter and the length of different segments of coronary artery were measured with the use of software as quantitative coronary angiography. Results: Diameter of left main (LM) coronary artery was 4.06±0.68 mm. Similarly, diameters of prox-left anterior descending (LAD) artery, mid-LAD, dist-LAD, prox-left circumflex (LCx) artery and dist-LCx were 3.26±0.48 mm, 2.67±0.49 mm, 2.01±0.44 mm, 2.91±0.48 mm and 2.38±0.44 mm respectively. The diameters of prox-right coronary artery (RCA), mid-RCA and dist-RCA were 3.2±0.51 mm, 2.89±0.5 mm and 2.43±0.51 mm respectively. The lengths of LM, proximal/mid and distal LAD were 10.06±3.12 mm, 17.91±6.09 mm, 18.28±6.81 mm, 67.94±15.57 mm respectively. The lengths of proximal and distal LCX were 18.95±10.13 mm, and 52.1±17.78 mm respectively. Similarly, the lengths of proximal, mid, and distal RCA were 17.2±4.74 mm, 33.82±9.4 mm, 33.43±12.01 mm respectively. The diameter and length of ramus intermedius (RI) was 2.32±0.56 mm and 70.77±19.75 mm. Conclusion: LM artery and p-RI had the largest and the smallest diameters respectively. LAD and RI had the longest and the shortest courses respectively. Keywords: Coronary angiography, coronary artery dimension, coronary artery diseasePublication Prevalence and Patterns of Coronary Artery Anomalies in a Tertiary Cardiac Center of Nepal: A Coronary Angiographic Study(Institute of Medicine, 2022) Poudel, Chandra M; Shakya, Smriti; Gajurel, Ratna M; Shrestha, Hemant; Devkota, Surya; Manandhar, Bhawani; Thapa, Sanjeev; Khanal, Rajaram; Sharma, Manju; Yadav, VijayABSTRACT Introduction: The prevalence of coronary artery anomalies (CAAs), though rare, is nonetheless globally found in 0.2% to 1.3% of patients undergoing coronary angiography (CAG). We aimed to investigate the prevalence and patterns of CAAs. Methods: The data was collected retrospectively by analyzing the coronary angiographic data of 6000 consecutive adult patients undergoing coronary angiography between January 2016 to December 2020 at the Manmohan Cardiothoracic Vascular and Transplant Center. Results: Among 6000 patients, 89 (1.4%) had CAAs, with anomalies in the right coronary artery (RCA) being the most common (73%). The presence of a dominant RCA was found in 48 (53.9%) patients. The anomalous origin of RCA arising from the left sinus of valsalva was present in 33 (37.1%) patients. The left main (LM) anomaly was present in 49 (55%) patients with absent LM in 29 (32.6%) and a short LM in 20 (22.5%) patients, respectively. The left anterior descending (LAD) artery anomalies were present in 42 (47.2%) patients - out of which 29 (32.6%) had a separate origin of LAD from the left coronary sinus and 13 (14.6%) had a dual LAD. The left circumflex artery (LCx) anomalies were evident in 32 (35.9%) patients including separate origin from left coronary sinus in 29 (32.6%) and anomalous origin from the right coronary sinus in 3 (3.4%) patients, respectively. Two patients (2.2%) had coronary artery fistulas, both arising from LAD. Conclusion: Though rare, our study did discover the prevalence of CAAs to be 1.4%. Keywords: Coronary angiogram, coronary artery anomaly, prevalencePublication Rheumatic Heart Disease among Patients with Valvular Heart Disease Admitted to the In-patient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Basnet, Kriti; Bhattarai, Shreeyash Raj; Shah, Sangam; Joshi, Amir; Sah, Sanjit Kumar; Gami, Roshan; Khanal, RajaramAbstract Introduction: Valvular heart disease continues to cause significant morbidity and mortality around the world, with rheumatic heart disease accounting for the bulk of cases in developing nations. The aim of this study is to find out the prevalence of rheumatic heart disease among patients with valvular heart disease admitted to the in-patient department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from December, 2018 to December, 2020 at a tertiary care centre after receiving ethical approval from the Institutional Review [Reference number: 395 (6-11) e2 077/078]. Patients of age ≥18 years presenting with valvular manifestations of any disease diagnosed by transthoracic echocardiography were included and patients other than Nepalese nationals were excluded. Convenience sampling was done and a sample size of 327 was taken. Data were collected, entered and analyzed using the Statistical Package for the Social Sciences version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 327 patients, the prevalence of rheumatic heart disease was found to be 237 (72.47%) (67.63-77.31 at 95% Confidence Interval). Conclusions: The prevalence of rheumatic heart disease was similar to the other similar studies conducted in similar settings.