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Rheumatic heart disease is the most important consequence of acute rheumatic fever. Both are common cardiovascular problems in Nepal. Echocardiographic detection of rheumatic heart disease is important to establish the diagnosis. The involvement of valves and their severity guides the therapeutic options. A total of 133 valvular heart disease cases attended in Dhulikhel Hospital between July 2008 to June 2009 were analyzed. Fifty-one patients, in whom the problems were rheumatic in origin were studied. Among them, 12% (6) had isolated aortic valve involvement, 35%(18) had isolated mitral valve and 53%(27) ahd mixed involvement. Severe mitral stenosis accounts for 24% of all mitral stenosis and severe aortic stenosis is 20% fo all aortic stenosis. The rates for severe mitral regurgitation and severe aortic regurgitaiton are 30% and 28% respectively. Although the study population has a high number of female patients, the differences in the rates of involvement of aortic or mitral valve in both genders are statistically insignificant. The study, although small, confirms that in this population, females are more commonly affected, that the mitral valve is the most commonly damaged valve and that disease affecting multiple valves is marginally more common than isolated valve disease. The detection of valvular involvement at different stages can guide the therapeutic options.

Background and Aim : Echocardiograph is an important diagnostic tool to evaluate cardiac disease and is indispensible for management. So it is important to know the spectrum of cardiac abnormalities that can be detected by echocardiograph and the frequency of these findings may vary depending on where the echocardiogram is performed. Aim of this study was to find out the spectrum of echocardiographic finding in different age group in a medical college hospital. Methods and materials : A retrospective observational study was done to at Dhulikhel Hospital to review Echocardiographic profile of 3310 patients who were indicated for echocardiogram over a period of 3 years. Data collected from echocardiograph report registry. Data analysis was done using SPSS 17. Result : Congenital Heart Disease(CHD) (37.74%),Normal finding( 21.19%), Pericardial Heart Disease(19.21%) and Rheumatic Heart Disease(RHD)(17.88%) were the echocardiographic finding in children. In adolescents and young adults Rheumatic Heart Disease (49.90%), Hypertensive Heart Disease (13.34%), Congenital Heart Disease (6.58%), and Pericardial Disease (4.38%) were found. Most common finding in middle age was cor-pulmonale (34.76%) followed by Diastolic Dysfunction (20.60%), Hypertensive Heart Disease(17.06%),Ischemic Heart Disease(IHD) (12.80%). In elderly age most common finding was Diastolic Dysfunction (57.14%). Conclusion : The spectrum of echocardiograph finding in a medical college hospital ranges from Congenital Heart Disease, Rheumatic Heart Disease, Ischemic Heart Disease ,Pericardial disease, Corpulmonale, Diastolic Dysfunction, systolic dysfunction and degenerative valve disease. Streptococcal sore throat leading to Rheumatic Heart Disease and complication of tuberculosis and parasitic infestation leading to pericardial diseases, as well as Hypertensive Heart Disease, and Ischemic Heart Disease constitutes burden in Nepal. Cor-pulmonale and ) Sanjaya Humagain, Ramsundar Twayana, Rajendra Koju. DOI: http://dx.doi.org/10.3126/njh.v11i1.10976 Nepalese Heart Journal 2014;11(1): 13-17

Hypertension is one of the major cardiovascular problems in middle and low income countries. There are few studies conducted in Nepal which shows significant number of hypertensive popu­lation in suburban area. Systematic random sampling from voter lists of all the members more than 18 years of age of Dhulikhel Municipality was done. 796 among 1150 sampled population were interviewed and their blood pressure was measured twice using mercury sphygmomanom­eter in standard method in their home. The average blood pressure was taken for study. Hyper­tension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or on antihypertensive treatment. Total number of study population was 796. Among them 490 (61.6%) were female and 306 (38.4%) were male with age ranging from 18 years to 88 years (mean 48.41±17.38). Overall prevalence of hypertension was 28.9% (male 28.8%, female 29%). The prevalence was increasing with age (11.1% in 70 years). Ac­cording to JNC 7, 29.1% were in Pre-hypertensive group. This study shows that Hypertension is significant in suburban area of Nepal. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 35-39 DOI: http://dx.doi.org/10.3126/njh.v7i1.8500

A stroke is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. It is a medical emergency that requires rapid diagnosis and treatment. The availability of CT Scan has made it easier for early diagnosis and intervention. The aim of this study was to identify the risk factors (eg. hypertension, diabetes mellitus and cigarette smoking) commonly seen in patients admitted in the hospital with stroke along with age group, sex distribution, duration of stay in the hospital and the occupancy of stroke patients admitted in medical ward. A total of 51 stroke patient were admitted in medical ward in the review period. CT scan was used to dif­ferentiate hemorrhagic from ischemic stroke. Patients were analyzed in terms of risk factors (like hypertension, diabetes mellitus and cigarette smoking) along with age and sex. In case of ischemic stroke along with CT Scan, ECG, Echocardiography, Carotid Doppler was done accordingly. Out of 2307 total admissions in medical ward, 51 cases (2.2%) were stroke patients. Among the stroke cases, 59% constituted male and 41% female. Similarly around 25% of the total cases were Dia­betic / Hypertensive both or alone, 35% of the total cases were smokers, 48.6% of the cases were in the 51-70 age groups. 61% stayed in the hospital for 5 days or less. Cerebrovascular disease carries a lot of financial, physical, social and emotional implications. If we can address the modifiable risk factors, we can reduce the incidence of stroke. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 40-43 DOI: http://dx.doi.org/10.3126/njh.v7i1.8501

The ischaemic heart disease is one of the most common cause of preventable deaths. The number of deaths due to ischaemic heart disease has been reported to be on the rise in the low and mid­dle income countries. Data on the prevalence and risk profile of ischaemic heart disease is scarce in Nepal. The aim of this study was to analyze the demographic and risk profile of patients with ischaemic heart disease admitted at Dhulikhel hospital. 115 patients in the period between 2008 to 2009 with the diagnosis of ischaemic heart disease were identified and analyzed. The mean age of patients with IHD was 62.9+/- 12.79 years and the youngest was aged 34 years. The number of male patients was greater (54.8%) than the females (45.2%). Among the risk factors hypertension and diabetes were more common in females, where­as smoking was more common in males. The study also showed more people with IHD came from rural than urban areas. In conclusion, the ischaemic heart disease is a rising public health problem affecting even the younger age groups and people from lower socioeconomic strata. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 1-4 DOI: http://dx.doi.org/10.3126/njh.v7i1.8493

Background Coronary Artery Diseases (CAD), one of the the leading causes of death, is increasing globally. The number of CAD is also increasing in Nepal. Dhulikhel Hospital is also providing cardiovascular services to populations from semiurban and rural population of mid region of country. It started coronary angiography services from April 2012. This paper aims to analyze pattern of coronary artery occlusion in patients undergoing coronary angiography during April to September months of 2012. Methods There were a total of 36 cases of diagnostic angiography and coronary interventions done in Dhulikhel Hospital from April to September 2012. Among them 32 cases of coronary angiography done for Acute Coronary Syndrome and Stable Angina, were analyzed using SPSS 17. Results Males were higher in number than females and majority of the patients were above 55 years. Out of 32 cases, 13 (40.6%) had Acute Coronary Syndrome (ACS) and 19(59.4%) had Stable Angina. Six out of 32 were found to have normal coronaries. One patient with ACS had normal coronary. Out of all the patients with coronary stenosis, four had left main disease, 14 had LAD stenosis, 7 had LCX stenosis and 12 patients had RCA stenosis. Thirteen had severe coronary stenosis. Nine out of 12 ACS patients had more than one coronary artery involved, which is significantly higher than the stable angina group ( P

Background Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults. Though declined and almost non-existent in developed nations, RHD is still one of the leading cause for premature death and disability in developing countries. Prevalence of RHD is high in both rural as well as urban area of Nepal. Present study is designed to look at the pattern of valvular involvement and demographic features in RHD. Methods 326 Patients indicated for inj. Benzathine penicillin were selected and echocardiograph performed to see the pattern of vavular involvement. Data analysis was done using SPSS 17. Result The most common type of lesion was mixed type with mitral valve involvement. MR was the most common isolated lesion. MS was more commonly seen in females whereas AS was more common in males. Secondary prophylaxis was more common than primary prophylaxis. Conclusion RHD still being a major problem and a preventable disease so extensive screening program is required to identify them early and prevent the complication. DOI: http://dx.doi.org/10.3126/njh.v9i1.8342 Nepalese Heart Journal Vol.9(1) 2012 pp.16-19

Background Hypertension is the leading cause of morbidity and mortality worldwide. Because hypertension is usually asymptomatic yet requires long term therapy, consideration of potential of undesirable effects of drugs used for its treatment is important for making the appropriate choice. In this context, a precise understanding typical adverse reaction profile of the different drugs is essential. Objective This study was done to assess the side effects profile of different antihypertensive drugs (calcium channel blocker, beta blocker, ACE inhibitor) among the hypertensive patient. Methods A mixed retrospective & prospective cross sectional study of 61 patients was done at Medical Out Patient Department of Dhulikhel Hospital KUTH were included in the study. Result Dry cough was experienced by most of the patients (66.7%) and both dry cough and dizziness was reported by only one patient (6.7%) taking enalapril. In case of atenolol, bradycardia, dizziness and insomnia were experienced by same number of patients (14.3%) separately. Among amlodipine users, side effects experienced were peripheral edema (23%), flushing (2.6%), dyspnoea (2.6%), headache (5.1%), dizziness (2.6%), palpitation (2.6%) and insomnia (2.6%).Patients on enalapril had significantly more complaints regarding side effects (73.3%) compared to those taking amlodipine (41%) (OR=4, p =0.033) and atenolol (42.9%).There was no significant difference in the occurrence of side effects between enalapril- atenolol ( p >0.05) and amlodipine- atenolol ( p >0.05). Conclusion Although all three drugs were well tolerated, more side effects were seen in case of enalapril. Enalapril has 4 times higher rate of side effects than amlodipine. DOI: http://dx.doi.org/10.3126/njh.v9i1.8344 Nepalese Heart Journal Vol.9(1) 2012 pp.25-29

Background Chronic Obstructive Pulmonary Disease (COPD) is a common global problem and most common medical problem in Nepal having significant morbidity and mortality. One of the pathogenesis of COPD in long run is the elevation of Pulmonary Artery Systolic Pressure (PASP) leading to right heart failure. A simple investigation - an Electrocardiograph (ECG) is assessed to co-relate with elevated PASP measured by Echocardiography in COPD patients of Dhulikhel Hospital. Methods and Materials A retrospective case control study of 342 COPD patients was done with assessment of ECG to co-relate with elevated PASP and with normal PASP. Data were analyzed using SPSS 17. Result There was significant difference in mean age, P amplitude in Lead II, III and aVF, QRS axis and R wave in V1 and S in V6 between two groups. Conclusion ECG changes are fairly sensitive and specific for elevation of PASP. DOI: http://dx.doi.org/10.3126/njh.v8i1.8330 Nepalese Heart Journal Vol.8(1) 2011 pp.12-15

Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality throughout the world including Nepal. The assessment of risk factors responsible for CVD can predict 10 year risk of CVD. World Health Organization (WHO) risk assessment chart, specially designed for South East Asia Sub-region D can predict the risk of CVD in Nepal. Method and Materials A total 532 study population from Panauti, Banepa and Dhulikhel were calculated their 10 year risk of CVD using WHO/ISH risk prediction chart on the basis of risk factors: age, gender, smoking status, diabetes, systolic blood pressure and total cholesterol. Result Ten year risk of developing cardiovascular disease is less than 10% among the population less than 50 years, irrespective of gender. 5% of male population had more than 10% chance of developing cardiovascular events in next ten years. One third of 60 – 69 years people had more than 10% chance of developing cardiovascular disease whereas it increased to 50% among 70 years and older group. Conclusion The assessment of risk factors is quite easy and cheap tool to predict the cardiovascular event, which support to practice the good clinical management to prevent the cardiovascular morbidity and mortality. DOI: http://dx.doi.org/10.3126/njh.v8i1.8328 Nepalese Heart Journal Vol.8(1) 2011 pp.3-7