Use of Statin and Target Low-density lipoprotein cholesterol attainment among post-ST elevation myocardial infarction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

BACKGROUND: and objective: Lipid-lowering is an important intervention to reduce cardiovascular morbidity and mortality in the secondary prevention of STEMI. There is no study to analyze the use of statin and LDL-C treatment target attainment among STEMI patients in Nepal. This study aims to assess the use of statin and LDL-C treatment target attainment among STEMI patients. METHODS: It was a prospective observational single-center study conducted at the Shahid Gangalal National Heart Centre, Kathmandu, Nepal outpatient department. An outpatient department-based survey was conducted among STEMI patients who have lipid profile levels at the time of admission for STEMI and after 4-13 weeks of the index event. Lipid profile levels, diagnosis, and risk factors were collected during the outpatient follow-up. RESULTS: Our study included 280 post-STEMI patients; the mean age was 57.5±11.7 years with the majority being male. The mean duration of follow-up was 6.7 ± 0.1 weeks. Rosuvastatin was the preferred statin with 82.1%. The most common dose of statin used was Rosuvastatin 20mg (70%), followed by Atorvastatin 40mg (12.5%). LDL-C levels of <1.4mmol/l were achieved in 44.6% of cases and LDL levels of <1.8mmol/l in 71.8% of cases. In 36.8% of the study population, there was a greater than 50% decline in LDL-C levels. Diabetic patients (55.1% and 83.1%) only have the significant achievement of LDL goal of both <1.4mmol/l and <1.8mmol/l respectively, when compared to those without diabetes (44.9% and 16.9%). CONCLUSIONS: Most of the post-STEMI patients were treated with high doses of statins and achieved the target LDL-C levels.

The Yentl Syndrome: A Case Report.

Cardiovascular disease, including ischemic heart disease, is one of the most common causes of death and disability in both sexes. The traditional concept of ischemic heart disease as a "man's disease" is debunked. Yentl syndrome is used to describe the underdiagnosis of ischemic heart disease in females and its associated effects. This article reports a 48-year-old female presented to the emergency department with acute epigastric discomfort. Her initial diagnostic tests did not reveal any abnormalities, and she was discharged. Subsequently, after four days, she again visited the emergency department with chest pain, the evaluation of which furthermore revealed no abnormalities. However, we admitted her. After 40 hours of hospitalization, her evaluation revealed anterior wall ST elevation myocardial infarction, and she underwent emergent reperfusion via coronary catheterization. This combination of atypical signs and symptoms and chances of delayed manifestations in the diagnostic investigations provides evidence for a need for thorough assessment in a female with chest pain.