Study of cardiac involvement in liver cirrhosis patients

Authors

  • Ranjith Kumar G. K. Department of General Medicine, Shimoga Institute of Medical Sciences (SIMS), Shimoga, Karnataka, India
  • Manjunath F. V. Department of General Medicine, Shimoga Institute of Medical Sciences (SIMS), Shimoga, Karnataka, India
  • Parameshwar . Department of Cardiology, Shimoga Institute of Medical Sciences (SIMS), Shimoga, Karnataka, India
  • Nagabhushana S. Department of General Medicine, Shimoga Institute of Medical Sciences (SIMS), Shimoga, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20212405

Keywords:

Cirrhosis of liver, Echocardiography, Pleural effusion, Arrhythmias, Anemia

Abstract

Background: Cirrhosis liver is characterized by diffuse destruction and regeneration of hepatic parenchymal cells. Various studies have been carried out over the years to evaluate the cardiac and hemodynamic changes in cirrhosis of the liver.

Methods: Study is conducted on 50 consecutive patients with cirrhosis liver admitted in various medical wards of the Mc Gann Hospital attached to Shimoga institute of medical sciences, Shimoga from January, 2020 to September 2020. Detailed history was taken and a through physical examination was done. Blood investigations are done. Echocardiography, Chest radiography done. All patients were subjected to USG abdomen to confirm the diagnosis of cirrhosis.

Results: There were 35 males and 15 females. Average age is 54±6.6 years. Alcoholism (64%) and idiopathic (16%) are commonest associations. Commonest symptom is anaemia (88%) followed by pedal oedema (80%) followed by fatigue (66%), ascites (60%) and jaundice (60%). Pleural effusion seen in 38%, diastolic dysfunction 32%, pericardial effusion 16%, wall motion abnormality in 11%. Hypertension, arrhythmias and LVF is seen in 8%. Cardiomyopathy in 6%. ECG changes are Hemiblock in 4 (8%), QTc prolongation in 34%. LVH in 12%, Low voltage complex are seen in 24%. cardiomegaly seen in 20%.

Conclusions: Study shows that, there was significant incidence of subclinical cardiac abnormalities observed in chronic liver disease patients which increase with duration of illness. Early detection of subclinical cardiac changes is important to reduce morbidity and mortality in chronic liver disease patients.

Author Biography

Manjunath F. V., Department of General Medicine, Shimoga Institute of Medical Sciences (SIMS), Shimoga, Karnataka, India

ASSISTANT PROFESSOR

Department of General Medicine, Shimoga Institute of Medical Sciences (SIMS), Shimoga. Karnataka. India.

References

Sahn DJ, De Maria A, Kisslo J, Weyman A. recommendations regarding quantitation in M-Mode echocardiography results of a survey of echocardiographic measurements. Circulation. 1978;58:1072-83.

Herry VL, DE Maria A, Gramiak R, King DL, Kisslo J, Popp RL, Sahn DJ, et al. Report of the American Society of Echocardiography, nomenclature and standards in two-dimensional echocardiography. Circulation. 1980;62:212-7.

Ma Z, Lee SS. Cirrhotic cardiomyopathy getting to the heart of the matter. Hepatology. 1996;24:451-9.

Shah A, Variyam E. Pericardial effusion and left ventricular dysfunction associated with ascites secondary to hepatic cirrhosis. Arch Int Med. 1988;148:585-688.

Moller S, Weinberg N, Henriksen JH. Non-invasive 25 –Hour ambulatory arterial blood pressure monitoring. Hepatology. 1995;22:88-95.

Moller S, Bendtsen F, Henriksen JH. Splanchnic and systemic hemodynamic derangement in decompensated cirrhosis. Can J Gastroenterol. 2001;15(2):94-106.

P. Punekar, Thakur DK. Echocardiographic changes in chronic liver disease. International Journal of Contemporary Medical Research. 2018;5(3):C1-4.

Sukhwani N, Nayak OP, Kumbhkar T. Cardiac changes in patients with chronic liver disease: A prospective descriptive study. Int J Med Res Rev. 2016;4(4):569-74.

Sharma N, Chaudhary A. A Comparative Study to Assess the Cardiovascular Complications in Patients of Liver Cirrhosis. Int J Sci Stud. 2021;8(11):78-81.

Selvamani S, Vignesh C. Cardiac Changes in Hepatic Cirrhosis: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2016;15(7):01-4.

P. Elango, G. Indumathi. Cardiac changes in hepatic cirrhosis in Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM. 2017; 4(9):19-24.

Ahmed SS, Howard M, ten Hove W, Leevy CM, Regan TJ. Cardiac function in alcoholics with cirrhosis: absence of overt cardiomyopathy--myth or fact? J Am Coll Cardiol. 1984;3(3):696-702.

Møller S, Søndergaard L, Møgelvang J, Henriksen O, Henriksen JH. Decreased right heart blood volume determined by magnetic resonance imaging: evidence of central underfilling in cirrhosis. Hepatology. 1995;22(2):472-8.

Friedman HS, Fernando H. Ascites as a marker for the hyperdynamic heart of Laennec's cirrhosis. Alcohol Clin Exp Res. 1992;16(5):968-70.

Wong F, Liu P, Lilly L, Bomzon A, Blendis L. Role of cardiac structural and functional abnormalities in the pathogenesis of hyperdynamic circulation and renal sodium retention in cirrhosis. Clin Sci (Lond). 1999;97(3):259-67.

Perello A, Inserte J, Godoy A. Cardiac structure and function in experimental intra-hepatic portal hypertension. J Hepatol. 2000;32:65.

Mota, Gomes V, Filho M, Brivaldo. Echocardiography in chronic liver disease: systematic review. Arquivos Brasileiros de Cardiologia. 2013;100:376-785.

Bhardwaj A, Joshi S, Sharma R, Bhardwaj S, Agrawal R, Gupta N. QTc prolongation in patients of cirrhosis and its relation with disease severity: An observational study from a rural teaching hospital. J Family Med Prim Care. 2020;9:3020-4.

Ring – Larsen H, Henriksen JH, Wilken C, Clausen J, Pals H, Christensen NJ. Diuretic treatment in decamp cirrhosis and congestive heart failure; effect of posture. Br Med J. 1986;292:1361-53.

Tsiompanidis E, Siakavellas SI, Tentolouris A, Eleftheriadou I, Chorepsima S, Manolakis A, et al. Liver cirrhosis-effect on QT interval and cardiac autonomic nervous system activity. World J Gastrointest Pathophysiol. 2018;9:28-36.

Bal JS, Thuluvath PJ. Prolongation of QTc interval: Relationship with etiology and severity of liver disease, mortality and liver transplantation. Liver Int. 2003;23:243-8.

Kim SM, George B, Alcivar-Franco D, Campbell CL, Charnigo R, Delisle B, et al. QT prolongation is associated with increased mortality in end stage liver disease. World J Cardiol. 2017;9:347-54.

Jaue DN, Ma Z, Lee SS. Cardiac muscarinic receptor function in rats with cirrhotic cardiomyopathy. Hepatol. 1997;25:1361-5.

Downloads

Published

2021-06-23

Issue

Section

Original Research Articles