Electrocardiographic and Echocardiographic Findings in Malnourished Children

Abstract

Important electrocardiographic and echocardiographic abnormalities have been found in malnourished children associated with their nutritional status. Special precaution must be taken about the possibility of occurrence of arrhythmias and sudden death related with malnutrition.

Electrocardiographic findings in chronic hemodialysis patients

“…19 Olivares et al 20 encontraram valores mais altos de intervalo QTc em crianças desnutridas em relação a controles saudáveis (p = 0,000). Não há estudos publicados que tenham evidenciado associação entre desnutrição e morte súbita relacionada com prolongamento do intervalo QT, mas a associação entre baixo IMC e prolongamento do intervalo QTc demonstrada em nosso estudo induz a uma especulação de que o intervalo QT prolongado possa ser um link entre desnutrição e morte súbita na população em hemodiálise.…”

Myocardial dysfunction in malnourished children

“…[12] PEM affects approximately one-third of children worldwide and is frequently seen in less-developed countries due to inadequate food intake, socioeconomic factors or, at times, due to natural disasters. [34] Thus, PEM is the concern of many researches. [5] Malnourished children suffer several alterations in body composition, with loss of heart and skeletal muscle mass, complicated by electrolyte abnormalities and mineral or vitamin deficiencies that could produce cardiac abnormalities, including hypotension, cardiac arrhythmias, cardiomyopathy, cardiac failure and even sudden death.…”

“…[5] Malnourished children suffer several alterations in body composition, with loss of heart and skeletal muscle mass, complicated by electrolyte abnormalities and mineral or vitamin deficiencies that could produce cardiac abnormalities, including hypotension, cardiac arrhythmias, cardiomyopathy, cardiac failure and even sudden death. [36] Cardiac troponins are regulatory proteins of the thin actin filaments of the cardiac muscle. [7] Myocardial cell injury results in the release of cardiac troponin, which differs from troponin isoforms of the skeletal muscle, and thus is a highly sensitive and specific biomarker of myocardial damage.…”

Tailoring management of severe and complicated malnutrition: more research is required first.

“…[19][20][21] Evidence for myocardial atrophy derived from radiographic studies showing reduced cardiothoracic ratios on x-rays, 22,23 echocardiography studies 24,25 and autopsies 26 -but have been countered by others suggesting that myocardial size was appropriate for overall body mass. 17,27,28 Kerpel-Fronuis disagreed with the argument for expanded extracellular space (ECF) who suggested this was spurious and only relative to intracellular compartment contraction evident in severe wasting. 29 Recent interventional studies have challenged the notion these children have myocardial dysfunction intolerant to the fluid loading.…”