ABSTRACT
We used echocardiography (ECHO) to detect pericardial effusions and assess left ventricular (LV) function in 39 patients with end-stage renal disease (ESRD). Pericardial effusions were present in 24 patients (62%). Thirty-one patients (79%) had concentric hypertrophy and 20 patients (51%) had decreased LV compliance. The majority of patients with concentric hypertrophy and decreased LV compliance had normal LV internal dimensions and contractility. Six patients (15%) had ECHO results compatible with congestive cardiomyopathy. An echocardiographic distinction between congestive heart failure, decreased LV compliance, and salt and water overload in ESRD has allowed an appropriate therapeutic decision as to whether to administer cardiac glycosides or increase ultrafiltration as a treatment for pulmonary congestion. ECHO is a safe, convenient, and noninvasive method of assessing serial LV function, and it can be used to document progressive deterioration of LV function in ESRD.
Subject(s)
Echocardiography , Heart Ventricles/physiopathology , Kidney Diseases/physiopathology , Adolescent , Adult , Aged , Cardiac Output , Cardiomegaly/diagnostic imaging , Cardiomegaly/etiology , Electrocardiography , Female , Humans , Kidney Diseases/complications , Kidney Diseases/diagnostic imaging , Male , Middle Aged , Myocardial Contraction , Pericardial Effusion/diagnosis , Pericardial Effusion/etiology , RadiographyABSTRACT
In 16 patients with end-stage renal disease (ESRD), 24-hour electrocardiographic recordings showed an incidence of supraventricular and ventricular arrhythmias similar to that in patients who had had myocardial infarction and in low-risk subjects. Eight patients (50%) with ESRD had supraventricular complexes. This incidence was significantly higher than that after myocardial infarction (P < .001). Fifteen ESRD patients (94%) had premature ventricular complexes (PVCs), including nine (56%) with complex PVCs (multiform PVCs, couplets, or runs). The incidence of PVCs as well as complex PVCs in patients with ESRD was comparable to that of the patients who had had myocardial infarction but was significantly higher than that found in low-risk subjects (P less than .005 for PVCs and P less than .05 for complex PVCs). The high incidence of complex PVCs in patients with ESRD may predispose them to increased cardiovascular death, and further investigation of this finding is indicated.
Subject(s)
Arrhythmias, Cardiac/etiology , Kidney Failure, Chronic/complications , Adolescent , Adult , Electrocardiography , Female , Humans , Kidney Failure, Chronic/metabolism , Male , Middle Aged , Renal DialysisABSTRACT
We studied the in-hospital mortality and morbidity of 745 patients who had suffered a first myocardial infarction. One hundred twenty-four patients (16.6%) had nontransmural infarction and 621 (83.4%) had transmural infarction. Both groups of patients were similar in the distribution of age, sex, and coronary risk factors. Patients with nontransmural infarction had a significantly lower mortality (3% vs 11%, p less than 0.01) and a lower prevalence of premature ventricular complexes (81% vs 88%, p less than 0.05). The patients with transmural infarction were distributed evenly among the three subgroups with peak SGOT levels less than 120 units, 120-240 units and more than 240 units (31%, 34% and 35%, respectively), while most patients with nontransmural infarction (60%) had peak SGOT levels less than 120 units (p less than 0.0001). When the in-hospital mortality and morbidity were compared between the parallel subgroups, the prognosis of patients with the two types of infarctions was similar. This study shows that the peak SGOT level is more important than the type of infarction in determining the acute mortality and morbidity of first myocardial infarction.
