Hyponatremia--risk factor in patients with chronic heart failure--clinical, evolutive and therapeutic implications.

UNLABELLED: Patients with heart failure are, by definition, hemodynamically unstable. This condition may be accentuated by medication (digitalis, diuretics, antiarrhythmics), so that they become more sensitive to electrolyte disturbances. Hyponatremia is the most common electrolyte disorder, particularly common in the intensive care unit. AIM: The evaluation of the incidence of hyponatremia in patients diagnosed with chronic heart failure in order to establish a correlation with the evolution, prognosis and therapeutic implications. MATERIAL AND METHODS: We analyzed retrospectively 120 patients diagnosed with chronic heart failure NYHA II-IV classes, admitted in the Cardiology Clinic between 2009 and 2013. We analyzed electrolytic disturbances which occurred during different strategies of therapy. RESULTS: 120 patients with heart failure were admitted in the Cardiology Clinic between 2009 and 2013, 92 males and 28 females. Diagnosis was established by classical criteria. Evaluation was very complex and included: complete clinical examination, electrocardiogram, echocardiography, chest ray examination and biochemical analyses especially hepatic, renal function and electrolyte status. CONCLUSIONS: The data obtained showed that electrolyte disturbances are frequent in patients with chronic heart failure, irrespective of NYHA class. Hyponatremia is usually associated with diuretic therapy and may play a very important role in the subsequent development of life-threatening complications. Patients with heart failure who develop hyponatremia during their evolution had a worse prognosis.

Associated factors of ejection fraction in insulin-treated patients with type 2 diabetes.

AIM OF THE STUDY: to evaluate the relation between ejection fraction (EF), diabetes characteristics and cardiovascular risk factors. MATERIAL AND METHODS: We carried out a cross-sectional study in 171 patients with insulin-treated type 2 diabetes hospitalized at the Sf. Spiridon Emergency Clinical Hospital, Iasi. All patients were evaluated for asymptomatic organ damage and cardiovascular risk factors of hypertension and diabetes metabolic control. Global ejection fraction (EF) was evaluated through 2-D echocardiography. RESULTS AND DISCUSSION: In the studied group the ejection fraction had significant negative correlations with the duration of the disease (p=0.007) and the presence of microalbuminuria (p=0.001). There were some differences between the categories realized by grouping the patients according to the presence of hypertension and/or previous myocardial infarction. In patients without personal history of cardiovascular disease EF was correlated only with LDLc levels. In the hypertensive patients without myocardial infarction it was correlated with diabetes duration, Hb A1e and LDLc, In those patients with both conditions, EF had significant correlations with Hb A1e and microalbuminuria. CONCLUSIONS: These results emphasized that the determinants associated with heart failure in patients with type 2, insulin-treated diabetes, differ according to the presence of high blood pressure and myocardial infarction.