ABSTRACT
Background: The heart and liver are organs that are closely related in both health and disease. Due to the limited number of human studies, the management of cirrhotic cardiomyopathy remains largely empirical. Material and methods: 30 Patients included in the study were recruited from the Department of Medical Gastroenterology, Narayana Medical College Hospital, Nellore. Consecutive patients diagnosed to have cirrhosis of nonalcoholic etiology formed the study group. The parameters that were assessed in echocardiography are E/A ratio, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction. QTc interval more than 440 msec and E/A ratio less than 1 were considered diagnostic of cirrhotic cardiomyopathy in this study. Results: In 9 cases, cirrhosis was due to hepatic B viral infection, 4 due to due to hepatities C and in 17 patients it was cryptogenic. Of the 30 cases included in the study. Results: In 9 cases, cirrhosis was due to hepatic B viral infection, 4 due to hepatitis C and in 17 patients it was cryptogenic. Of the 30 cases included in the study, 7 cases (23.3%) had Class A CTP. 16 cases (53.3%) had Class B CTP, 7 cases had Class C CTP. Of the 30 patients included in this study, 21 patients had end diastolic volume above 90. 2 patients had end systolic volume above 38. 29 patients had ejection fraction above 60%. Out of the 30 cases, 23 showed features of cirrhotic cardiomyopathy. 7 patients had CTP Class A. 16 patients had CTP Class B.7 patients had CTP Class C. 12 patients with cirrhotic cardiomyopathy had CTP Class B. 7 patients with cirrhotic cardiomyopathy had CTP Class C. 3 patients with CTP Class A and 4 patients with CTP Class B did not have cirrhotic cardiomyopathy. The QTc was prolonged in 16 (53.3%) of patients in this study. 29 cases had ejection fraction above 60. Of the 23 cases that had cirrhotic cardiomyopathy 21 cases had ascites. 27 of the 30 cases had varices. 70.0% of the cases had end diastolic volume above 90. 76.2% of the cases with EDV above 90 had E/A ratio below 1. Conclusion: Cirrhotic patients with non alcoholic etiology do have evidence of cirrhotic cardiomyopathy. The presence of cirrhotic cardiomyopathy was independent of the etiology. Some degree of diastolic dysfunction is seen in most of the cirrhotics. Prolongation of QTc interval correlates with severity of cirrhosis. Ventricular end diastolic volume, end systolic volume and ejection fraction do not correlate with severity of cirrhosis.
ABSTRACT
A 50 year female presented with dysphagia for 2 months and she denied pain during swallowing, retrosternal pain, drooling of saliva, nasal regurgitation, cough, breathlessness, hoarseness of voice abdominal pain, vomiting, loss of weight or loss of appetite. Upper gastrointestinal (UGI) endoscopy revealed a web at 17 cm from incisors. Post endoscopy patient developed pain over the upper abdomen which worsened during swallowing and breathing. Because of rapid development of these symptoms we suspected esophageal perforation/dissection. Complete blood picture suggestive of neutrophilic leukocytosis and other parameters were normal. Thin barium study showed pseudo lumen in esophagus and confirmed the diagnosis of esophageal web with esophageal dissection. Patient was treated conservatively with nil per oral and parenteral fluids and antibiotics. Web was dilated after 2 weeks with Salivary-Gilliard dilators and procedure was uneventful and oral feeding was initiated.