Dr Chandra Mani Adhikari, MD - Shahid Gangalal National Heart Centre - Dr

Dr Chandra Mani Adhikari

MD

Shahid Gangalal National Heart Centre

Dr

Kathmandu, Baghmati | Nepal

Main Specialties: Cardiovascular Disease

Additional Specialties: Cardiology

Dr Chandra Mani Adhikari, MD - Shahid Gangalal National Heart Centre - Dr

Dr Chandra Mani Adhikari

MD

Introduction

Primary Affiliation: Shahid Gangalal National Heart Centre - Kathmandu, Baghmati , Nepal

Specialties:

Additional Specialties:

Research Interests:


View Dr Chandra Mani Adhikari’s Resume / CV

Metrics

Number of Publications

29

Publications

Number of Profile Views

765

Profile Views

Number of Article Reads

7

Reads

Number of PubMed Central Citations

2

PubMed Central Citations

Top co-authors

Rajib Rajbhandari
Rajib Rajbhandari

Nepal All India Institute of Medical Sciences

3
Rabi Malla
Rabi Malla

Shahid Gangalal National Heart Centre

2
Dipankar Prajapati
Dipankar Prajapati

Department of Cardiology

1
Dipak Limbu
Dipak Limbu

Department of Cardiology

1
Yadav Kumar Bhatta
Yadav Kumar Bhatta

Norvic International Hospital

1
Suman Thapaliya
Suman Thapaliya

Department of Cardiology

1
Kc Man Bahadur
Kc Man Bahadur

Department of Cardiology

1
Prakash Gurung
Prakash Gurung

Department of Cardiology

1
Satish Singh
Satish Singh

University of Virginia

1
Arun Maskey
Arun Maskey

Department of Cardiology

1

Publications

29Publications

7Reads

2PubMed Central Citations

Clinical profile, management and outcome of pulmonary embolism in Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

The Egyptian Heart Journal

Background and aims: Pulmonary embolism (PE) is associated with a significant mortality and morbidity. We aim to study clinical profile, management and outcome of PE at Shahid Gangalal National heart Centre, Kathmandu, Nepal. Methods: It was a retrprospective, single centre study, conducted from January 2015 to December 2016. Haemodynamics was used for risk Simplified, PESI score, predisposing factors, symptoms, clinical features at the time of admission, ECG features, echocardiogram, treatment received and the outcome were reviewed. Results: During the study period 23 cases of PE were admitted. Nine were males and 14 were females. Eleven patients were diagnosed as provoked PE. High risk PE was diagnosed in four patients, Non-high risk in 19 patients. The most common clinical presentation was shortness of breath. The most common finding in ECG is sinus tachycardia followed by ST-T changes in V1-V3. Eight patient had SPO2 less than 90%. Most of the patients had a normal chest radiograph. Echocardiography revealed dilated RA and RV in 20 patients. Results: All high risk PE patients were thrombolyzed with streptokinase. All patients who were diagnosed as Non-high risk PE were treated with LMWH. All the patients were treated with oral anticoagulants. Mean hospital stay was 9.7 ± 4.9 days. Two patients died during hospital stay. S-PESI score was 1.4 ± 0.9 respectively. Mean warfarin dose at the time of discharge was 5.9 ± 1.6 mg. Conclusion: PE is an under diagnosed clinical problem world over. Suspicion is the most important part to come to the diagnosis of PE.

View Article
June 2017
2 Reads

Patterns of Valvular Involvement in Rheumatic Heart Disease patients taking Benzathine Penicillin at Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Nepalese Heart Journal 2016; 13(2): 25-27

Nepalese Heart Journal

Background and Aims: Acute rheumatic fever and rheumatic heart disease constitute an important public health problem in the developing countries. The disease results from an abnormal autoimmune response to a group A streptococcal infection in a susceptible host. We aim to describe the pattern of valvular involvement in patients taking Injection Benzathine Penicillin. Methods: All the patients, who were taking injection Benzathine penicillin during 15th April to 14th July, 2013 at our Centre, were included in this study. Demographic features like age, sex, echocardiographicdiagnosis along with any adverse effects of Benzathine penicillin were collected. Results: A total of 661 patients were included in our study, out of which female predominated in numbers. Rheumatic heart disease rather than rheumatic fever was the cause for Penicillin injection.Mitral valve was the most common valve involved and it was more common in female.Pure mitral stenosis was the most common valvular involvement. Forty two percent patients underwent intervention; among them Percutaneous transluminal mitral commisuorotomy was the most common. There was no adverse event during the study time following penicillin injection. Conclusions: Women are more commonly affected than male. Mitral valve is the most common valve involved.

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July 2016
2 Reads

Percutaneous Transluminal Mitral Commisuriotomy for Mitral Stenosis in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Nepalese Heart Journal 2016; 13(2): 15-17

Nepalese Heart Journal

Mitral stenosis (MS) is almost invariably the result of long term complication of rheumatic fever. Based upon the nature and severity of MS, patients can be managed with medical treatment, percutaneous transvenous mitral commissurotomy (PTMC) or surgery. PTMC is proven to be simple, effective and safe; it is considered as treatment of choice in the management of MS. In Shahid Gangalal NationalHeart Centre, PTMC service started in 2001. First PTMC in the centre was done on 14th April 2001.Till June2016, 6023 PTMCs were done in the centre. Multiple studies evaluated the safety and efficacyof PTMC in different groups of patients. These studies clearly demonstrated the safety and effectiveness of PTMC in our centre. This article summarizes the historical development, current status and future perspectives of PTMC procedure at Shahid Gangalal National Heart Centre, a teritary care cardiac centre in Nepal.

View Article
July 2016
5 Reads

Adherence to Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

EC Cardiology 2.3 (2016): 152-156.

EC Cardiology

Abstract Background and Aims: Heart Failure(HF) with reduced Ejection Fraction (HFrEF) is defined as the clinical diagnosis of HF and left ventricular ejection fraction (LVEF) ≤ 40% also referred to as systolic HF. Guideline-directed medical therapy (GDMT) has shown to reduce mortality for HFrEF. We aim to evaluate adherence to GDMT treatment in our Centre. Methods: Medical records of 422 with HFrEF patients discharged from our centre in between January 2014 to December 2014 were retrospectively reviewed. Performa was designed to collect patient information which included; age, gender, NYHA functional class at the time of admission, total hospital stay, Left Ventricular Internal Diameter, Left Atrial size, LVEF, Systolic, diastolic blood pressure,heart rate at the time of discharge, creatinine and the drugs used at the time of discharge were recorded. Results: Among the 422 patients included in this study, 232 (54.9%) were males and 190 (45.1%) were females. The mean age was 63.4 ± 15.5 years. Most of the patients were in NYHA class IV (65.6%), and in Sinus rhythm (78.5%). Among the discharged patients’diuretic, Angiotensin converting enzyme inhibitor (ACEI)/Angitensin receptor blocker (ARB), β-blocker, Aldosterone Antagonist, and digoxin were prescribed in 100, 86.7, 28.4, 83.9 and 47.9% patients respectively. Conclusion: ACEI/ARB, diuretic, aldosterone antagonist and digoxin used in HFrEF comparable to international studies. Use of β-blocker is not comparable to international studies. We still need some effort to increase improve our prescription rate of β-blockers.

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June 2016
4 Reads

Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis.

Cardiovasc Diagn Ther 2016 Feb;6(1):20-4

1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.

View Article
February 2016
3 Reads

Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis

Cardiovasc Diagn Ther 2016;6(1):20-24

Cardiovascular Diagnosis and Therapy

Background: Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients. Methods: It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure. Results: During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm2 to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm2 in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC. Conclusions: PTMC in JMS is safe and effective.

View Article
February 2016
2 Reads

Aldosterone Antagonists in ST Elevation Myocardial Infarction Patients with Low Left Ventricular Ejection Fraction: a Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

MAEDICA – a Journal of Clinical Medicine 2015; 10(3): 210-213

MAEDICA – a Journal of Clinical Medicine

Background: Aldosterone antagonists (AA) improve survival in ST elevation myocardial infarction (STEMI) patients with left ventricular ejection fraction(LVEF) 40% ,with either clinical heart failure or diabetes mellitus. Our aim was to assess the adherence of AA use in Shahid Gangalal National HeartCentre, Kathmandu, Nepal. Methods: Medical records of 171 STEMI patients with LVEF 40% and discharged from our centrebetween January 2012 and December 2012 were retrospectively reviewed, regarding the use of AA use. Results: Among the 171 STEMI patients with LVEF 40%, 5 patients were excluded study due tothe presence of contraindication to AA therapy. Among the remaining 166 patients, only 135 (81.2%)patients were eligible for the AA therapy (58 patients with diabetes mellitus and clinical heart failure in 77 patients). Out of 58 diabetes mellitus patients, 28 (48.2%) patients were treated with AA. Whereas 39(50.6%) out of 77 patients with clinical heart failure were treated with AA. Overall, 67(49.6%) patients among 135 eligible patients were treated with AA. Conclusions: As in the international studies AA is under-used in our patient population. We still need some more effort to improve our prescription rate.

View Article
September 2015
1 Read

Fractional Flow Reserve for Intermediate Coronary Artery Stenosis in Nepal

Nepalese Heart Journal 2015;12(2):69-72

Nepalese Heart Journal

Background and Aims: : Coronary angiogram detects anatomical lesion, however, has limited ability to assess physiological significance. Fractional flow reserve is used to determine functional significance of stenosis and is measured by the ratio of mean distal coronary pressure to mean aortic pressure during maximum hyperemia. Recently, fractional flow reserve was started in Nepal. This study intends to explore the extent of determination of hemodynamic significance of intermediate coronary stenosis by fractional flow reserve, thereby guiding revascularization. Methods: Consecutive patients with intermediate lesion undergoing fractional flow reserve from July 2014 to March 2015 were included, if fractional flow reserve ?0.80 then considered to be significant and need for revascularization determined. The study subjects were divided into two groups, one having physiologically significant stenosis and another with physiologically non significant lesion and followed up to three months. Results: Total forty four patients had fractional flow reserve done in fifty eight intermediate coronary artery lesions. The age ranged from 33 to 78 with the mean age of 58.25}10.08 years. Majority of them (75%) were male. Left anterior descending artery was commonest in 37(63.8%), followed by left circumflex 13(22.4%), then right coronary artery in 8(13.8%) target lesions. None of the patient had death, myocardial infarction or repeat revascularization during follow up. Out of 58 intermediate lesions assessed, 17(29.31%) had significant fractional flow reserve value, whereas 41(70.69%) had physiologically non significant lesion. Conclusion: Around one third (29.31%) of intermediate coronary artery stenosis are functionally significant by fractional flow reserve in the context of Nepal, thus it could be useful guide for optimal revascularization.

View Article
July 2015
1 Read

Carotid intima-media thickness (CIMT) and carotid plaques in young Nepalese patients with angiographically documented coronary artery disease.

Cardiovasc Diagn Ther 2015 Feb;5(1):1-7

Department of Cardiology, Shahid Gangalal National Heart Centre, PO Box NO 11360, Karhmandu, Nepal.

View Article
February 2015
3 Reads
1 PubMed Central Citation(source)

Carotid intima-media thickness (CIMT) and carotid plaques in young Nepalese patients with angiographically documented coronary artery disease

Cardiovasc Diagn Ther 2015;5(1):1-7

Cardiovascular Diagnosis and Therapy.

Background: Carotid intima-media thickness (CIMT) and carotid plaques are non-invasive surrogate markers of early evaluation of coronary artery disease (CAD) and sub clinical atherosclerosis. The objective of the study was to evaluate CIMT and carotid plaques in less than 45 years old Nepalese patients with angiographically proven CAD. Methods: A total of 54 patients with angiographically documented CAD at less than 45 years of age were enrolled. CAD was confirmed by coronary angiography. Demographic profile was obtained. High resolution B-mode ultrasound was used to detect the CIMT and carotid plaques. Results: The study population included 44 males and 10 females, with a mean ± SD age of 38.4±4.3 years (range, 25-44 years). Cardiovascular risks factors included smoking in 81%, Hypertension in 52%, diabetes in 19% and alcohol consumption in 78% of patients. Lipid profile (mean ± SD) was normal except for elevated triglyceride (TG) levels of 204±130.8 mg/dL. By angiography, 64.8% had single vessel disease,26% had double vessel disease and 9.2% had triple vessel disease. Ultrasound detected either thickened CIMT or presence of plaques in 46 (85.2%) cases (group-A) and 8 (14.8%) had negative (normal) carotid study (group-B). Among the 46 patients with positive findings 63% had carotid plaques and 37% had thickened CIMT only. The majority (69%) of the carotid plaques were detected at the carotid bulbs. In total population, carotid plaque was detected in 53.7% of cases. There was no statistical significant difference of age, body mass index (BMI) and lipid level between group-A and group-B. Conclusions: Increased CIMT and carotid plaques are detected in majority of the young Nepalese patients with angiographically documented CAD. The majority of carotid plaques are detected at the carotid bulbs.Routine carotid ultrasound study in young individuals with CAD risk factors appears worthwhile.

View Article
January 2015
1 Read

Immediate Outcome of Percutaneous Balloon Mitral Valvotomy in Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Nepalese Heart Journal 2015; 12 (1): 11-14

Nepalese Heart Journal

Background and Aim: Percutaneous balloon mitral valvotomy is well established as safe and effective procedure for patients with mitral stenosis due to Rheumatic Heart Disease. There are some retrospective studies on safety and efficacy of it in different subgroups of patients from our centre. Our study aims to assess the safety, efficacy and outcome of it in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Methods: A Single centre, prospective study was conducted from July 1st 2013 to June 31st 2014 in our centre. All the patients who underwent percutaneous balloon mitral valvotomy for moderate to severe mitral stenosis during the study period were included. Safety and efficacy of the procedure was analyzed. Results: There were 262 patients enrolled in the study among which 194 (74%) were females. Mean age of patients was 33.2±12.5 years. Seventy patients (26.7%) were in atrial fibrillation, six (2%) were pregnant, three (1%) had history of stroke, twelve (4.6%) underwent previous surgical or balloon commissurotomy. The mean left atrial pressure reduced from 26.8 ± 8.9 mmHg to 15.6 ± 7.2 mmHg (p < 0.05).The mean mitral valve area increased from 0.9 ± 0.17 cm2 to 1.6 ± 0.28 cm2 (p < 0.05). Forty nine patients (18.7%) developed moderate to severe mitral regurgitation. There was no mortality related to the procedure. The procedural success was achieved in 84% patients. Conclusion: Our study suggests that percutaneous balloon mitral valvotomy is a safe and effective procedure for symptomatic mitral stenosis patients.

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January 2015
2 Reads

Efficacy of enhanced external counterpulsation: our experience

Cardiometry; 2014; 5:71-77

Cardiometry

Aims Enhanced external counterpulsation therapy is a non-invasive, non-pharmacological outpatient treatment option for refractory angina pectoris. Our aim is to evaluate its efficacy in Nepalese refractory angina pectoris patients. Materials and methods It was single centre prospective study conducted from 2010 August to 2013 December. All thirty one (n=31) consecutive patients, referred for and received 35 hours of treatment were included in this study. The distance covered in six minute walk test before and after the treatment was recorded and compared. Patients were followed each with the questionnaires about their anginal symptoms before and after the treatment. Results In our study 19(61.3%) were male and 12(38.7%) female. The mean age was 65.7±9.3 years. Most patients had multi vessel disease. Twelve patients had previous history of revascularization. In 6 minute walk test there was significant difference in mean distance covered before and after the treatment. Most patients experienced decrease in the angina symptom. They had decreased in severity and frequency of angina, resulting in decreased use of sublingual nitrates. Conclusion EECP can be safe and effective treatment option for patients with RAP.

View Article
November 2014
3 Reads

Medical Management of ST elevation Myocardial infarction -Where are we?

2014 ;11(1):45-48.

Nepalese Heart journal

Background and Aims: Despite well developed guidelines in the management of ST elevation myocardial infarction, registries worldwide have demonstrated incomplete implementation of evidence-based recommendations. Our study aims to assess the adherence of our practices to the recommended clinical guidelines, which is based on the discharge prescription in Shahid Gangalal National Heart Centre. Methods: Medical records of 495 ST elevation myocardial infarction patients discharged from our centre in between January 2012 to December 2012 were retrospectively reviewed. Results: Among the 495 patients included in this study, 372 (75.1%) were males and 123 (24.9%) were females. The mean age was 56.9±12.4 years. Aspirin, Clopidrogel and statin were prescribed in more than 95% of the patients. Angiotensin Converting Enzyme inhibitor/ Angiotensin Receptor blockers was prescribed more often than β-blockers. Only a small numbers of patients were discharged without Angiotensin Converting Enzyme inhibitor /Angiotensin Receptor Blockers or β-blockers. Conclusions: Usage of Aspirin, clopidogrel, statins, beta blockers and Angiotensin Converting Enzyme inhibitor/ Angiotensin Receptor Blockers s is comparable to international studies. We still need some effort to increase improve our prescription rate of β-blockers and Angiotensin Converting Enzyme inhibitor/ Angiotensin Receptor Blockers.

View Article
August 2014
1 Read

Prevalence of Conventional Risk Factors in ST Segment Elevation Myocardial Infarction Patients in Shahid Gangalal National Heart Centre, Nepal

J Nepal Med Assoc 2014;52(195):914-19.

J Nepal Med Assoc

Introduction: Smoking, diabetes mellitus, hypertension, and dyslipidemia are labelled as conventional risk factors for coronary artery disease. Prevalence of these risk factors varies across populations. This study aimed to assess the prevalence of these conventional risk factors in patients,who were discharged from our hospital, with the diagnosis of ST elevation myocardial infarction. Methods: Medical records of 495 ST elevation myocardial infarction patients discharged from our centre in between January 2012 to December 2012 were retrospectively reviewed to evaluate the prevalence of conventional risk factors. Results: Clear dominance (75%) of male patients was seen. Inferior wall myocardial infarction (29.9%) was the most common diagnosis followed by anterior wall myocardial infarction (25.1%). Hypertension (65%), smoking (57.8%) and dyslipidemia (45.5%) were the most common risk factors.Diabetes (31.1%) was the least common. Prevalence of hypertension, dyslipidemia was similar among male and female. Smoking was statistically common in male (76.8%vs 49.5%),though diabetes was common in female (36.5%vs.29.3%) not statistically significant. Conclusions: Conventional risk factors are common among ST elevation myocardial infarction patients. Early detection and treatment of these risk factors play a vital role for the prevention of coronary artery disease. Much more focus should be stressed on preventive programs throughout the country.

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July 2014
2 Reads

Outcome of enhanced external counterpulsation in different groups of refractory angina patients.

Compr. Res. J. Biol. Sci. 2013; 1(1):32-35.

Compr. Res. J. Biological Science

View Article
December 2013
1 Read

Percutaneous Transluminal Mitral Commissurotomy in Nepalese children withRheumatic Mitral Stenosis.

Nepalese Heart Journal 2013;10(1):23-26.

Nepalese Heart Journal

View Article
November 2013
1 Read

β-blocker in Heart failure with reduced ejection fraction: A review.

Nepalese Heart Journal 2013; 10(1):38-45.

Nepalese Heart Journal

View Article
November 2013
3 Reads

Efficacy of different doses of aspirin in decreasing blood levels of inflammatory markers in patients with Cardiovascular metabolic syndrome.

. Journal of Pharmacy and Pharmacology,2009,61:1505-1510.

. Journal of Pharmacy and Pharmacology

View Article
August 2009
1 Read

Inflammation, metabolic syndrome, and inflammatory mediators.

New Chinese Medicine 2006 ;37(2):131-134

New Chinese Medicine

View Article
February 2006
1 Read

Top co-authors

Rajib Rajbhandari
Rajib Rajbhandari

Nepal All India Institute of Medical Sciences

3
Rabi Malla
Rabi Malla

Shahid Gangalal National Heart Centre

2
Dipankar Prajapati
Dipankar Prajapati

Department of Cardiology

1
Dipak Limbu
Dipak Limbu

Department of Cardiology

1
Yadav Kumar Bhatta
Yadav Kumar Bhatta

Norvic International Hospital

1
Suman Thapaliya
Suman Thapaliya

Department of Cardiology

1
Kc Man Bahadur
Kc Man Bahadur

Department of Cardiology

1
Prakash Gurung
Prakash Gurung

Department of Cardiology

1
Satish Singh
Satish Singh

University of Virginia

1
Arun Maskey
Arun Maskey

Department of Cardiology

1