Cardiac Function in Malnourished Children

Phornphatkul, Chalie; Pongprot, Yupada; Suskind, Robert M.; George, Varghese; Fuchs, George J.

doi:10.1177/000992289403300304

Cited by 43 publications

(50 citation statements)

References 15 publications

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“…Also, Phornphatkul et al (1994) concluded that the children with primary third-degree malnutrition not only have cardiac wasting, but also inherent ventricular dysfunction as the result of severe malnutrition that responds to nutritional therapy.…”

Section: Discussionmentioning

confidence: 99%

“…These may variably influence the cardiac function (Kothari et al, 1992). In addition, Phornphatkul et al (1994) reported that children with malnutrition not only have cardiac muscle wasting but also have inherent ventricular dysfunction as a result of severe malnutrition that responds to nutritional therapy. It has been reported that myocardial dysfunction either in the form of cardiac arrhythmia or heart failure are among the causes of death in kwashiorkor (Olowonyo et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

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Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

et al. 2005

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Background and objectives: The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. Patients and methods: The present study was carried out on 30 PEM infants (16 nonedematous -14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were reevaluated using the same preinterventional parameters. Results: The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. Conclusion: We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

et al. 2005

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“…All these pathological changes lead to disturbed cardiac functions in the electrical activity of the heart that may be reflected in the electrocardiogram (ECG). 5 However, studies on electrocardiographic and echocardiographic changes in Malnutrition are scant. To a great extent, SAM is one of the leading causes of mortality and morbidity in the pediatric population in developing countries.…”

Section: Introductionmentioning

confidence: 99%

What affect heart in SAM: structure or function

Sharma

Gaur

Agrawal

2017

Int J Contemp Pediatr

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Background: Objective of present study was to assess structural and functional cardiac changes in children with severe acute malnutrition between the age of 6 month to 59 months. Setting: The study conducted in Department of paediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior. A prospective case control study. Participants: 100 cases and 100 controls enrolled based on the selection criteria, Control group was selected from patient came in Out Patient Department. Children from 6 months to 59 months of age with weight for height ranging <-3SD and/or Mid Upper Arm Circumference (MUAC) <11.5 cm and/or edematous malnutrition and/or visible severe wasting). Selection of cases and control were done through random sampling method.Methods: All enrolled admitted children were stabilised after admission as per WHO protocol of management. After that they undergone echocardiographic and electrocardiographic evaluation and data were collected and Analysed.Results: In this study, study group show decrease in dimension of heart i.e. IVSd (p-value-0.02413), LVEDd (p-value-0.0000017), PLVWd (p-value-0.01493), LVEDs (p-value-0.0000263), PLVWs (p-value-0.0000254) more affected during diastole than systole, increased HR (p-value-0.0044), shorten PR intervals (p-value-0.0001) and shorten P wave(p-value-0.000385), QT (p-value-0.044) and QTc (p-value-0.00968) as compared to control group. Pericardial effusion found in 16 cases in study group (8 mild and 8 trace).Conclusions: Early evaluation of cardiac function in malnourished child will significantly affect the management of Severe Acute Malnutrition to prevent deaths from Severe Acute Malnutrition.

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“…It remain unresolved, however, if these abnormalities are primary phenomenon of malnutrition or secondary to other abnormalities commonly associated with severe malnutrition, such as sepsis. [3][4][5] The heart atrophies during starvation, but controversy persist as to whether the atrophic heart with PEM functions normally or demonstrates left ventricular dysfunction.…”

Section: Introductionmentioning

confidence: 99%