No abstract

A 42-year-old woman presented herself to the emergency services in cardiogenic shock. She had a history of progressively worsening breathlessness for the past year; however, no medical evaluation had been performed earlier. At presentation, her pulse rate was 110 beats per minute, regular, and low volume, and her blood pressure was 90/70 mm Hg. On auscultation, third heart sound was present, but no murmurs were heard. Soon after presentation, she had an asystolic cardiac arrest. However, she was resuscitated successfully and mechanically ventilated, and she required inotropic support with dopamine and noradrenaline for maintaining blood pressure.Her ECG showed normal sinus rhythm and nonspecific ST-T changes, and chest radiograph showed cardiomegaly with features of pulmonary venous hypertension (Figure 1). Her echocardiogram showed severe left-ventricular systolic dysfunction with a left-ventricular ejection fraction of 20% ( Figure 2). Her routine blood biochemistry, including liver and renal function tests, was within normal limits, except for mild anemia with hemoglobin of 9.5 g/dl. A diagnosis of dilated cardiomyopathy with cardiogenic shock was made, and the patient was treated accordingly. Subsequently, she was weaned off the ventilator, but she continued to require inotropic support.She remained markedly symptomatic with fatigue and complained of blackouts on getting up. There was a postural drop of 25 mm Hg in systolic blood pressure on sitting up. Furthermore, it was noticed that her heart rates did not go beyond 110 beats per minute, despite being on high doses of inotropes and remaining hypotensive. On close scrutiny, patchy pigmentation of face was noticed along with loss of axillary and pubic hair.Further inquiry into her past history revealed that she had nearly bled to death in her last pregnancy 14 years ago. Since then, she had no menstruation and lactation. In light of this, she was investigated for endocrine disorder and was found to be having panhypopituitarism (Table)-thus a case of Sheehan syndrome. The diagnosis remarkably changed her management because along with cardiogenic shock, she also had additional hypoadrenal shock. She was started on glucocorticoids, thyroxine, and fludrocortisone, and within 2 days she was weaned off inotropes. Her blood pressure by guest on

No abstract

Background: Chronic kidney disease (CKD) patients have 20–30 times greater risk of cardiovascular morbidity and mortality. Echocardiography is quintessential in cardiovascular evaluation and monitoring in CKD patients. This study was designed to determine the echocardiographic manifestations in patients on renal replacement therapy (RRT) and recipients of renal transplantation. Materials and Methods: An observational cross-sectional study was undertaken in a tertiary care hospital. All CKD patients on RRT or post renal transplant were included. Patients with known cardiac disease, malignancy were excluded. Demographic details, thorough history, physical examination and 2D echocardiography were performed for the patients. Results: Of the 51 patients, 60% were on dialysis and remaining were post renal transplant recipients. The mean age of study population was 44.16±13.66 years, with 64.7% males. 47% of patients were of age group of 41 years to 60 years. The most common etiology of CKD was hypertension in 16 (31.4%) followed by diabetes in 11 (21.6%). Only 8 patients (15.7%) had normal echocardiograms. LVH (80.4%) was most common abnormality, followed by diastolic dysfunction (74.5%), systolic dysfunction (13.7%), mitral regurgitation (13.7%) and pericardial effusion (5.8%). Around 95.2% had concentric hypertrophy. Diastolic dysfunction was observed in 90.2% and 80.9% of cases with LVH and hypertension respectively and was significantly associated with both (p=0.001, p=0.003 respectively). Conclusions: Left ventricular hypertrophy was the most common abnormality in CKD patients and renal transplant recipients. Diastolic function was affected in majority of patients. Early identification of cardiac abnormalities by echocardiography prior to manifestation of cardiac complications may result in better prognosis for this patient population.

No abstract