Browsing by Author "Shrestha, Hemant"
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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.