Echocardiographic Profile of Patients in Dhulikhel Hospital , A Medical College Hospital in Nepal

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. Citation Sanjaya Humagain, Ramsundar Twayana, Rajendra Koju. Echocardiographic profile of patients in Dhulikhel Hospital, A Medical College Hospital in Nepal. Nepalese Heart Journal 2014;11(1): 13-17.

Cardiovascular Disease is the leading cause of mortality worldwide.Developing countries contributed to 80 percent of CVD deaths.There is considerable variation in CVD mortality rates across world [5][6] .A developing country like Nepal has to deal with communicable disease as well increasing burden of non communicable heart disease 7 .In both conditions echocardiography is an important evaluation tool.In the last decade echocardiography has become more popular and available in different parts of the country.In Nepal Echocardiography is mostly restricted to cardiologists, however other specialties frequently refer patients for echocardiographic evalulation.

reSult
The age range of patients was from 1 st day of life to 98 years with mean (SD) age 51+/-7.2years.Out of total number of 3310 patients 1680(50.75%)were male and 1630(49.25%)were females with no statistically significant difference, p being 0.44.However there was some statistically significant difference between male and female in some age groups as shown in table

diScuSSiOn
There was almost equal number of male and female patients in this study.However in some study there is predominant number of male patient 9 and some shows predominant female patient.CHD is the most common finding in children similar to other studies 9,10 .ASD was the most common CHD in our study similar to Ejim EC et al. but most of the studies shows VSD to be the most common finding [11][12][13][14] .This is probably because we did not screen all the children for CHD and also we referred many cases to the pediatric cardiologist in other center when it was difficult for us to give our opinion.RHD is the most common finding in adolescents and young adults which is similar to the other studies from developing nations 9,10 but different from those of developed nations 1,2 .This is a known fact that RHD is common in developing countries but almost nonexistent in developed countries 5,15 .Cor-pulmonale is the most common finding in middle age group in our study.
We could not find this in other studies 9,10 , this is probably because our study is based on general hospital with multiple discipline rather than cardiac center and cor-pulmonale is a complication of respiratory disease which is common problem in Nepal 5,6 .Diastolic Dysfunction, Hypertensive heart disease, Degenerative valve disease, Ischemic heart disease, Systolic Dysfunction are all commonly found in elderly similar to other studies 9,10 .

cOncluSiOn
From this study we can conclude there is a large spectrum of echocardiograph finding in a medical college hospital.
In a developing country like Nepl, streptococcal sore throat leading to rheumatic heart disease and complication of tuberculosis and parasitic infestation leading to pericardial diseases, as well as the non-communicable diseases like hypertensive heart disease, and ischemic IHD still constitutes a huge burden.Cor-pulmonale and right heart failure are also common in our country and will definitely require more focus and evaluation in the future.

Fig 1 :Fig 2 :Fig 3 :
Fig 1 : Common Echocardiograph findings in adolescents and young adults (age 11-40) Common echocardiographic findings may vary depending on which setting it is performed.It may be different in private clinic or in cardiac center in comparison to general hospital with multiple disciplines.So in this study, the aim was to find out the echocardiographic profile of patients at Dhulikhel Hospital, Kathmandu University Hospital.Dhulikhel Hospital is located 30 kilometer east of Kathmandu and is a medical college hospital where echocardiography is indicated by cardiologists, physicians, pediatricians and other specialists.

et al. : Echocardiographic profile of patients in Dhulikhel Hospital. Original Article
1.The highest number of patient was in age group 51-60.Normal echocardiographic finding was rare in elderly patients.The most common echocardiographic finding in children was congenital heart disease (CHD), 57 out of 151(37.74%)as given in table 2. Followed by normal finding 32(21.19%), Common echocardiographic findings according to different age group are shown in table 3.Sanjaya Humagain, | NHJ | July 2014 | Volume 11 | No. 1 | 15

Table 1 :
Distribution according to age and sex