Browsing by Author "Thapa, Shovit"
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Publication Atropine and Kounis syndrome, a rare association mimicking ST segment elevation myocardial infarction in a young patient: A Case Report(Nepalese Respiratory Society, 2023) Hussain, Asraf; Regmi, Shyam Raj; Dhital, Bishnu Mani; Thapa, Shovit; Dhungana, Tirth; Khan, Amir; Thapa, Sagar; Murarka, Rohit; Shrestha, Ashok; Chaudhary, Ramgobind; Kurmi, RamnarayanAbstract: Kounis syndrome is a hypersensitivity acute coronary disorder which occurs with allergic reaction with drugs, food and insect bite. Atropine is rarely found to be reported with such allergic reactions in the literatures. In this report, we describe a case of a 25 years old male, with a background history of psychotic disorder and cannabis dependent syndrome with persistent bradycardia. When challenged with atropine he developed chest pain, shortness of breath and urticarial rash. ECG showed ST segment changes which settled after symptomatic management. Coronary angiogram revealed normal coronary arteries. Though uncommonly reported, it is one of the confusing and underdiagnosed serious conditions for treating physicians which can potentially mimic ST segment elevation myocardial infarction.Publication 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, VijayABSTRACT 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 pacemakerPublication 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 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, ParasABSTRACT 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 diseasePublication 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.Publication Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity: A Single Centre Study(Institute of Medicine, 2019) Pant, Pankaj; Thapa, Shovit; Das, Santa K; Bam, NirajABSTRACT Introduction Chronic obstructive pulmonary disease (COPD) is a public health problem of epidemic proportion. Several studies have shown low serum vitamin D levels in patients with COPD. The aim of this study was to compare serum vitamin D level in patients with Global Initiative for Chronic Obstructive Lung Diseases (GOLD) COPD stage II, III and IV with controls and correlate serum vitamin D level with severity of COPD. Methods A cross sectional study was conducted from June 2014 to November 2015 at Tribhuvan University Teaching Hospital (TUTH). A total of 154 subjects were enrolled for study that consisted of 77 cases of COPD and 77 controls for comparison. Participants were taken from medical wards and outpatient department. COPD staging was done as per GOLD guidelines and stage II, III and IV were labeled as advanced COPD cases. Both descriptive and inferential statistics were performed in SPSS version 20. ResultsStage II, III and IV COPD were 30%, 36% and 34% respectively. Mean serum vitamin D level was 15.16±7.19 ng/ml in COPD cases and 33.99±12.37 ng/ml in healthy controls showing statistically significant relation of low serum vitamin D in patients with advanced COPD (p <0.0001). Serum vitamin D was found to be in decreasing trend with increasing severity of COPD. Conclusion Patients with advanced COPD (GOLD stage II, III and IV) had low serum vitamin D levels compared to normal population and serum vitamin D level correlated with GOLD severity in Nepalese patients with COPD. Keywords: Chronic obstructive pulmonary disease; global initiative for chronic obstructive lung diseases; vitamin D