prevalence of hepatopulmonary syndrome in cirrhotic patients due to hepatitis C

Hepatopulmonary syndrome is defined as the triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. It complicates a substantial percent of cirrhotic patients and has an impact on survival. Hepatitis C virus is the most common cause of cirrhosis in Egypt. The aim of this study: was to explore the prevalence of hepatopulmonary syndrome in HCV- induced cirrhotic patients and the risk factors associated with it. Patients and Thirty HCV- induced cirrhotic patients were studied. They underwent careful history taking, through clinical examination, chest X-ray,a complete blood count, prothrombin time, serum albumin, bilirubin, hepatitis markers, abdominal ultrasound, upper gastrointestinal endoscopy, arterial blood gases and transthoracic contrast echocardiography. Results' Four patients [13.3%] were found to have HPS. Patients with Hepatopulmonary syndrome had significantly higher Child-Pugh score compared with patients without Hepatopulmonary syndrome. The prevalence of HPS was significantly higher in ChildPugh class C compared with Child-Pugh A. Hepatopulmonary syndrome was not uncommon in HCV- induced cirrhotic patients [13.3. [% The study showed a significant correlation between the severity of liver disease and Hepatopulmonary syndrome

Towards more appropriate evaluation of blood pressure

Both systolic and diastolic blood pressures are instantaneous pressures as the arterial blood pressure is continuously changing during the cardiac cycle. In such a situation using the mean arterial blood pressure seems to be more appropriate. The mean arterial blood pressure should be calculated according to the definition of the mean:- Sum of the data = mean x number of the data. The pressure curve tracing is recorded from a randomly selected patient during cardiac catheterization. The time of one cardiac cycle is divided into many millions small equal segments by a set of vertical lines that intersect with the pressure curve. These vertical lines will be very closely adjacent to each other so that the sum of their lengths [pressure values] will be equal to the area under the pressure curve. Then the mean arterial blood pressure could be represented by the length of a rectangle in which the width is represented by the time of one cardiac cycle and its area is equal to the area under the pressure curve. the mean arterial blood pressure [mBP] is equal to :- mBP= diastolic pressure +1/3PP x [1+Ta/T] where PP is the pulse pressure, Ta is the time of the ascending limb of the pressure curve and T is the time of one cardiac cycle. 1. The time factor should be considered during calculation of mean arterial blood pressure. 2. Mean arterial blood pressure is almost always underestimated when calculated as the sum of diastolic and one third of pulse pressure. 3. The correlation between elevated pulse pressure and mean pressure after considering the time factor should be clarified by further studies. In hypertensive patients assessment of blood pressure using the mean pressure instead of the instantaneous systolic or diastolic pressures alone may be more appropriate. An important research work is needed to study if this statement is correct

Cardiac abnormalities associated with liver cirrhosis

The occurrence of unexpected deaths due to heart failure following liver transplantation and major surgery in cirrhocic patients and the studies that shown evidence of cardiac dysfunction in patients with cirrhosis have led to the introduction of the new clinical entity, [cirrhotic cardiomyopatby]. This study explores the cardiac abnormalities in cirrhotic patients and its correlation with aetiology and severity of cirrhosis and degree of portal hypertension. 40 cirrhocic patients with no history of cardiac disease and 20 age- and sex-matched healthy individuals were studied. They underwent: [1]Laboratory analysis: including liver function tests and hepatitis markers [2]Abdominal ultrasound [3]Upper gastrointestinal endoscopy [4] Trans-thoracic echocardiographic examination to assess left ventricular systolic and diastolic chamber dimensions, interventricular septal thickness, left ventricular posterior wall thickness and systolic and diastolic function. Cirrhotic patients had significantly increased interventricular septal thickness [P= 0.017] and Left atrial size [P= 0.03]. The ejection fraction was significantly higher in cirrhotic patients compared with the controls [P < 0.05]. The isovolumic relaxation time was significantly prolonged in cirrhotic patients [P= 0.04] and the deceleration time was significantly increased in cirrhotic patients [P< 0.05]. Cirrhotic patients with advanced liver disease [Child-Pugh class C] had a significantly smaller left ventricular diameter at the end of diastole compared with the controls [P= 0.03]. The E/A ratio was also significantly reduced in this group [P< 0.05]. The deceleration time was increased in all cirrhotic groups, and significantly so in the class C cirrhotic patients [P= 0.03]. The aetiology of cirrhosis and degree of portal hypertension has no effect on the cardiac abnormalities in cirrhotic patients. Cirrhosis is associated with changes in cardiac structure and function. There is thickening of interventricular septum and increased Left atrial size associated with diastolic dysfunction, as demonstrated by prolongation of the isovolumic relaxation time and increased the deceleration time. The ejection fraction was significantly higher in cirrhotic patients compared with the controls. The severity of liver disease is associated with more severe diastolic dysfunction. Child-Pugh class C cirrhotic patients had a significantly smaller left ventricular diameter at the end of diastole and the E/A ratio was also significantly reduced compared with the controls. The deceleration time was significantly increased in the class C cirrhotic patients compared with class A and B. The aetiology of cirrhosis and degree of portal hypertension has no effect on the cardiac abnormalities in cirrhotic patients