Changes of Cardiac Performance in Renal Failure

Uraoka, Tadao; Sugimoto, Tsuneaki; Inasaka, Tohru; Kaseno, Kensuke; Hirasawa, Kunihiko; Kitagawa, Shunsuke; Takeuchi, Jugoro

doi:10.1536/ihj.16.489

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…can alter blood pressure. 4,8,[18][19][20][21][22][23][24][25][26] Hyperkalemia is the most commonly recognized, life-threatening problem in cats with urethral obstruction, 1-3,5,26 and its effects on cardiac electrophysiology have been well documented. 4,5 Bradycardia and atrial standstill occur because hyperkalemia reduces the myocardium resting membrane potential, causing it to be less negative and thereby decreasing the rate of sodium influx during the action potential and slowing electrical conduction.…”

Section: Discussionmentioning

confidence: 99%

“…Calcium is essential for cardiovascular smooth muscle function. 20,22 Low plasma concentrations of ionized calcium may cause cardiac mechanical 20,23,30 and electrical dysfunction, 4 and may exacerbate the effects of hyperkalemia on the heart. 4,7,31 In dogs, a 60% decrease in plasma ionized calcium resulted in decreased cardiac function, 32 peripheral vasodilatation, and decreased blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of blood pressure in cats presented with urethral obstruction

Malouin

Milligan²,

Drobatz

2007

J Vet Emergen Crit Care

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Objective: To determine the arterial blood pressure at presentation in male cats with acute urethral obstruction, and to determine whether there was any correlation between these measurements and concurrent metabolic abnormalities. Design: Prospective, single cohort, observational study. Setting: Private, small animal, after‐hours emergency clinic. Animals: Twenty‐eight client‐owned male cats with acute urethral obstruction and no other known coexisting disease. Interventions: Indirect oscillometric blood pressure measurements obtained before blood sampling and treatment. Measurements and main results: Mean arterial blood pressure (MAP) measurements, physical examination parameters, serum blood urea nitrogen (BUN), creatinine, potassium, phosphorus, total calcium and magnesium concentration, venous pH, lead II electrocardiogram, and urine volume in bladder were evaluated. No cats were hypotensive at presentation; 71% (20/28) were normotensive (median MAP=100 mmHg, range 93–140 mmHg); and 29% (8/28) were hypertensive (median MAP=153 mmHg, range 145–176 mmHg). Compared with hypertensive cats, normotensive cats had significantly lower heart rates (P=0.0201) and lower calcium (P=0.0152). For all 28 cats, MAP correlated with serum potassium and total calcium (P=0.0033). Conclusions: Though potassium and total calcium were inversely and directly correlated respectively with blood pressure in cats with urethral obstruction, none of the cats were hypotensive on presentation. Normotension on admission does not support the absence of biochemical and physical abnormalities in obstructed cats.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of blood pressure in cats presented with urethral obstruction

Malouin

Milligan²,

Drobatz

2007

J Vet Emergen Crit Care

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“…While experimental studies have shown that high concentrations of uremic compounds are capable of depressing cardiac function in vitro, the demonstration of a uremic cardiomyopathy has been lacking (1)(2)(3). Such a demonstration is hampered by the plethora of complicating diseases that prohibit the dissociation of the independent effects of uremia (4).…”

Section: Introductionmentioning

confidence: 99%

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

Nixon¹,

Mitchell²,

McPhaul³

et al. 1983

J. Clin. Invest.

100

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A B S T R A C T Prior studies of the effect of hemodialysis on left ventricular function have not distinguished between the removal of uremic toxins and the change in cardiac filling volume. To separate these effects, left ventricular function was examined by serial echocardiography in five stable hemodialysis patients before and after three different dialysis procedures: (a) hemodialysis with volume loss, (b) ultrafiltration (volume loss only), and (c) hemodialysis without volume loss. The patients were similarly studied under control conditions and after increased (50 of headdown tilt for 90 min) and decreased (lower body negative pressure) cardiac filling volume.After hemodialysis with volume loss, end-diastolic volume (EDV) decreased from 167 to 128 ml (P < 0.001) and end-systolic volume (ESV) decreased from 97 to 51 ml (P < 0.001) without a change in stroke volume (SV). Ejection fraction increased from 42 to 52% (P < 0.001) and mean velocity of circumferential fiber shortening (VCF) increased from 0.61 to 1.04 circumferences (circ)/s (P < 0.001). After ultrafiltration, EDV decreased from 167 ml to 124 ml (P < 0.001) and SV from 73 ml to 39 ml (P < 0.001), without significant changes in ESV or VCF. In contrast to the maneuvers in which volume loss occurred, after hemodialysis without volume loss ESV decreased from 95 to 66 ml (P < 0.001) and SV increased from 74 ml to 97 ml (P < 0.001) without changes in EDV. EF increased from 44 to 59% (P < 0.001) and VCF increased from 0.64 to 1.26 circ/s (P < 0.001). Ventricular function curves plotted from data obtained under conditions of altered cardiac filling volume before and after the three dialysis maneuvers demonstrate that ultrafiltration produced a pure Frank-Starling effect, while Received for publication 9 March 1982 and in revised form 23 August 1982. hemodialysis with or without volume loss produced a shift in the ventricular function curves, which demonstrated an increase in the contractile state of the left ventricle. The changes in left ventricular function produced by regular hemodialysis are the combined effects of a decrease in EDV and an increase in the contractile state of the left ventricle.

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“…[I I] and Uraokaet al [26] divided their patients whether they had clinical evidence of circulatory con gestion or not. Both groups of investigators found a lower cardiac index in those uremic patients with heart failure.…”

Section: Discussionmentioning

confidence: 99%

“…High [15,19] or normal [4,11,26] cardiac out put (CO) has been obtained in different series of patients. The left ventricular filling pressure (LVFP) which contributes importantly in the regulation of CO has seldom been reported.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Function in Terminal Uremia

Acquatella¹,

Pérez-Rojas²,

Burger³

et al. 1978

Nephron

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14 patients with advanced uremia had a mean cardiac index (CI) of 4.37 ± 0.25 liters/min/m², a mean stroke work index (SWI) of 65.6 ± 3.7 g/m/m² and a mean left ventricular filling pressure (LVFP) of 16.3 ± 2.1 mm Hg. The left ventricular performance was estimated to be normal when CI or SWI changes were correlated with simultaneous variation of the LVFP attained during peritoneal dialysis or afterload reduction. CI was high at a normal LVFP, it decreased at low or high LVFP. Guanidines retention, metabolic acidosis and hypocalcemia did not prevent the maintenance of a high CI or SWI. Out of 32 patients, left ventricular hypertrophy and pericardial effusion, conditions which may affect ventricular distensibility, were present in 25 and in 22 echocardiograms, respectively. We suggest that in uremic subjects, LVFP is primarily influenced by volume loads and by ventricular distensibility modifications.

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Changes of Cardiac Performance in Renal Failure

Cited by 8 publications

References 15 publications

Assessment of blood pressure in cats presented with urethral obstruction

Assessment of blood pressure in cats presented with urethral obstruction

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

Left Ventricular Function in Terminal Uremia

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