The Heart in Kwashiorkor

Smythe, P. M.; Swanepoel, A.; Campbell, J. A.

doi:10.1136/bmj.1.5271.67

Cited by 88 publications

(30 citation statements)

References 10 publications

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“…Similar results were recorded by Olowonyo et al (1993). Smythe et al (1962) also documented the prolongation of QTc in his study on malnourished children. Moreover, Isner et al (1979) confirmed this observation and further implicated QT prolongation as a factor predisposing for sudden death, but they could not show this consistently in their patients who subsequently died.…”

Section: Discussionsupporting

confidence: 85%

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: Discussionsupporting

confidence: 85%

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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“…Similar results were recorded by Olowonyo et al 6 Smythe et al also documented the prolongation of QTc in his study on malnourished children. 10 Moreover, Isner et al confirmed this observation and further implicated QT prolongation as a factor predisposing for sudden death, but they could not show this consistently in their patients who subsequently died.…”

Section: Discussionsupporting

confidence: 50%

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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“…Patients with anorexia strated marked histologic abnormalities, including vacuolation and fragmentation of myofibrils, replacement fibrosis, and considerable loss of muscle fibers that would provide a substrate for left ventricular dysfunction. [8][9][10][11][12][13][14][15][16][17][18][19][20] We studied patients with anorexia nervosa prospectlively to assess the physiologic consequences of marked reduction of left ventricular mass on (1) left ventricular architecture and its remodeling, (2) left ventricular afterload, (3) left ventricular stress-shortening relations, (4) resting pump function, and (5) exercise performance during treadmill testing to assess cardiac reserve.…”

mentioning

confidence: 99%