NepMed Repository :: Browsing by Author "Poudel, Chandra M"

Browsing by Author "Poudel, Chandra M"

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Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal
(Institute of Medicine, 2020) Sharma, Manju; Jha, Sunil C; Sayami, Arun; Gajurel, Ratna M; Poudel, Chandra M; Khanal, Rajaram; Pathak, Surya R; Thapa, Shovit; Adhikari, Suman; Yadav, Vijay
ABSTRACT Introduction: Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation. Methods: This was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed. Results: A total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7). Conclusion: Temporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented. Keywords: Complete heart block, myocardial infarction, temporary transvenous pacemaker
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 R
ABSTRACT 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, thrombolysis
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 M
ABSTRACT 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 disease
Frequency of ABO Blood Group and its Association with Acute Coronary Syndrome in Patients Presenting in a Tertiary Care Center of Nepal
(Institute of Medicine, 2020) Pathak, Surya R; Jha, Sunil C; Gajurel, Ratna M; Poudel, Chandra M; Shrestha, Hemant; Thapa, Sanjeev; Sahi, Ravi; Thapa, Shovit; Koirala, Paras
ABSTRACT Introduction: Coronary artery disease is the major cause of death all over the world. There are studies suggesting association between blood group and coronary artery disease. We attempted to study the frequency of ABO blood group and its association with acute coronary syndrome (ACS) in our hospital. Methods: This is a retrospective, cross sectional study carried out in Manmohan Cardiothoracic Vascular and Transplant Centre from March 2018 to February 2019. Patients who were admitted with diagnosis of ACS were enrolled in the study. Data were recorded and analyzed using SPSS 20. Association between blood group and ACS was analyzed using chi square test and logistic regression. Results: Total 430 patients were admitted with diagnosis of ACS during the study period, of which 307 (71.4 %) were male and Mean age was 61.22 years (±10.75). Blood group O was the most common type of blood group observed in 207 (48%) patients. ACS was significantly higher in blood group O compared to other groups after adjusting for normal ABO blood group prevalence in general population: blood group O vs. A (OR: 3.45, 95% CI: 2.48- 4.79, p- <0.001), blood group O vs. B (OR: 5.08, 95% CI: 3.53-7.33, p- <0.001), blood group AB vs. O (OR: 0.65, 95% CI: 0.41- 1.02, p- 0.064). Individuals with blood group O and B had increased risk of having STEMI and NSTEMI where as those with blood group A had increased risk of having unstable angina. Conclusion: There was association between ABO blood group and coronary artery disease. Individuals with blood group O have increased incidence of ACS. Keywords: ABO blood group, acute coronary syndrome, coronary artery disease
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, Vijay
ABSTRACT 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, prevalence
Short Term Outcome of Acute ST Elevation Myocardial Infarction in a Tertiary Care Cardiac Center
(Institute of Medicine, 2020) Shrestha, Hemant; Gajurel, Ratna M; Poudel, Chandra M; Thapa, Sanjeev; Sayami, Arun
ABSTRACT Introduction: Acute ST Elevation Myocardial infarction (STEMI) is a cardiovascular emergency and is associated with significant adverse short and long-term outcome. The objective of this study was to determine the short-term outcome in terms of heart failure, myocardial reinfarction, stroke, hospital readmission and mortality in patients admitted with STEMI Methods: It was a prospective observational study conducted at Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu from May 2014 to April 2015. All patients admitted with diagnosis of STEMI during study period were enrolled. Patients were treated on the basis of existing guidelines. Mode of management, adverse outcomes and mortality of patients during the study period were evaluated. The discharged patients were followed up for 30 days. Statistical analysis was performed with SPSS version 20. Ethical approval was taken from the Institutional Review Committee of Institute of Medicine. Results: The median duration of presentation was 20 hours, and only 40% of the patients presented within 12 hours of symptom onset. Primary PCI was performed in 50 (33%), thrombolysis was performed in 29(19%) and conservative medical management was done in 72 (48%) patients. Overall outcome occurred in 52 (37.7%) patients. In hospital and 30 day mortality was 14 (9.2%) and 17 (11%) respectively. Heart failure was present in 28(18.5%), myocardial reinfarction 8 (5%), stroke 4 (2.6%), and hospital readmission was 18 (12%). Conservatively treated patients had significantly more adverse outcomes (p=0.02). More patients in conservatively managed group had hospital readmission. (p=0.04) Conclusion: There were more overall adverse outcomes in conservatitley managed group which is mainly due to more hospital readmission. Keywords: Primary PCI, short term outcome, STEMI, thrombolysis

Browsing by Author "Poudel, Chandra M"

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