ABSTRACT
Introduction: Cirrhosis liver, is characterized by diffuse destruction and regeneration of hepatic parenchymal cells leading to deposition of connective tissue with resulting disorganization of the lobular and vascular architecture. Despite the remarkable regenerative capacity of the liver, once hepatic parenchymal reserve is exceeded, clinically overt or decompensated cirrhosis ensues. Portal hypertension develops due to resistance to blood flow through the liver resulting increase in portal venous pressure leading to diversion of blood flow through low resistance portosystemic collaterals thereby bypassing the liver. The current study was designed to precisely evaluate the cardiovascular system in a group of patients with hepatic cirrhosis based on clinical examination. Aim of the study: To clinically evaluate patients with hepatic cirrhosis with respect to changes in heart rate, blood pressure, mean arterial pressure, ECG jugular venous pressure and precordial examination. Materials and Methods: 50 patients of cirrhosis liver were selected for the study. These patients were admitted in the general medical wards. All patients were subjected to routine investigations. All patients were subjected to ultrasound scan abdomen to confirm the diagnosis of cirrhosis. Patients with ascites underwent abdominal paracentesis and fluid was analyzed for protein content and cells. All patients were then subjected to electrocardiography, chest X-ray and M-mode 2-Dimensional echocardiography. Results: Out of the 50 patients studied 35 (70%) were males and 15 (30%) were females. The age of the patients ranged from 19 years to 75 years. 5 Patients (10%) were alcoholics, 14 patients (28%) had past history of jaundice or, 8 patients (16%) presented with haemetemesis. Among this 4 patients were P. Elango, G. Indumathi. Cardiac changes in hepatic cirrhosis in Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM, 2017; 4(9): 19-24. Page 20 HbsAG+ (8%) and 2 patients were diabetics 4%. All patients had sonographic evidence of cirrhosis.with portal hypertension. Out of 50 patients, 3 patients had elevated blood pressure. Previous studies show that the systolic blood pressure more than 160 mmHG and diastolic blood pressure more than 95 mmHg are the range for hypertension in cirrhotic patients. The electro cardiac gram showed an average heart rate of 82/ m. The low QRS voltage in chest leads and limb leads were found in 10 patients. T wave inversion was found in chest leads (V1 to V3 / V6) in 4 (8%) patients, in II, III avf in 7 patients (14%). The chest roentgenogram showed Hepatic Hydrothorax in 5 patients (10%). Cardio megaly was evident in chest X – ray in 11 patients (22%). Conclusion: The result of this study clearly showed that a large number of patients with hepatic cirrhosis are asymptomatic (40%) about cardiovascular system, have evidence of cardiac involvement in electrocardiography and echo cardiograph. cardiac decompensation in cirrhosis is rare despite the high output state and its presence as indicated by left ventricular systolic dysfunction.
ABSTRACT
Introducción. La insuficiencia cardíaca es un proceso de alta prevalencia en la actualidad y un problema de salud pública que alcanza proporciones de epidemia y que conduce a un deterioro progresivo y grave del paciente. Las causas de descompensación son diversas pero pueden variar con cada región. Objetivos. Determinar las causas de descompensación cardíaca en pacientes adultos. Material y métodos. Estudio observacional, descriptivo, prospectivo, de corte transversal. Se observaron pacientes con diagnóstico de insuficiencia cardíaca, internados en los servicios de Clínica Médica y Cardiología del Hospital Nacional de Itauguá (Paraguay) desde Marzo a Noviembre del 2015. Resultados. Se incluyeron 110 pacientes, la mayoría de ellos del sexo masculino con educación escolar básica incompleta. Se pudo observar que la mayor causa de descompensación de insuficiencia cardíaca fue la medicación irregular, el exceso de ingesta de sal en la dieta y el esfuerzo físico. Conclusiones. La principal causa de descompensación cardíaca fue la medicación irregular, seguida del exceso en la ingesta de sal en la dieta, como así también el esfuerzo físico. La mayoría de los pacientes presentaba un buen esquema de tratamiento previo al cuadro de descompensación, pero era administrado de manera irregular.
Background. Heart failure is a high prevalence process at present and a public health problem reaching epidemic proportions and leads to progressive and severe deterioration of the patient. Imbalance causes are various but may vary with each region. Objectives. To determine the causes of cardiac decompensation in adult patients. Material and methods. Observational, descriptive, prospective, cross-sectional study. Patients were included with a diagnosis of heart failure and hospitalized in the services of Internal Medicine and Cardiology at the National Hospital of Itauguá (Paraguay) from March to November 2015. Results. Hundred ten patients were included, most of them were males with incomplete basic education. The major cause of heart failure decompensation was irregular medication, excess salt intake in the diet and physical effort. Conclusions. The leading cause of cardiac decompensation was irregular medication, followed by excess salt intake in the diet, as well as physical effort. Most patients had a good treatment schedule before decompensation, but was administered irregularly.
Introdução. A insuficiência cardíaca é um processo de alta prevalência no presente e um problema de Saúde Pública alcançando proporções de epidemia e leva à deterioração progressiva e grave do paciente. As causas de descompensação são diversas, mas pode variar de acordo com cada região. Objetivos. Determinar as causas de descompensação cardíaca em pacientes adultos. Material e métodos. Estudo observacional, descritivo, prospectivo e transversal. Foram incluídos pacientes diagnosticados com insuficiência cardíaca internados nos Serviços de Clínica Médica e de Cardiologia no Hospital Nacional de Itauguá (Paraguai) entre Março e Novembro de 2015. Resultados. Foram incluídos 110 pacientes, a maioria deles do sexo masculino com a educação escolar básica incompleta. Observou-se que a principal causa de descompensação da insuficiência cardíaca era irregular medicação, o consumo de sal em excesso na dieta e esforço físico. Conclusões. A principal causa da descompensação cardíaca foi medicação irregular, seguido pelo consumo de excesso de sal na dieta, bem como o esforço físico. A maioria dos pacientes tinha um bom esquema de tratamento, antes de descompensação, mas foi executado de forma irregular.