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Background- Cardiovascular disease is the second most common non-communicable disease in Nepal but we do not yet have data for the upper karnali region. This paper documents the various types of cardiac diseases presenting in the sole tertiary level hospital serving the catchment area of the upper Karnali region. Methods- This is a single center, descriptive, cross sectional study of 1 year duration from july 2019 to august 2020 involving a total of 284 patients who underwent echocardiograpy in this center. Results- Total of 284 patients are included from all the 5 districts of the upper karnali region. Cor-pulmonale is seen in 90 patients, Diastolic dysfunction in 26 patients, Valvular heart disease in 21 patients, Cardiomyopathy in 11 patients, Myocardial infarction in 9 patients and Congenital heart disease in 7 patients. Conclusions- This study highlights the need to develop infrastructure to provide domiciliary oxygen for patients in the upper Karnali region. Also, the difference in result from other studies showing rheumatic heart disease as the most common cardiac problem suggests the need for rheumatic heart disease screening campaigns in the upper Karnali region.