Profound Electrocardiogram Changes in a Patient With Liver Cirrhosis

Further Questions Regarding Electrocardiogram Prior to Liver Transplant—Reply

“…In our case, both the electrocardiogram (ECG) and Doppler echocardiogram were normal at the initial transplant evaluation. Several months later, at the time of liver transplantation, a routine preoperative ECG was still within normal limits.…”

“…If these tests suggest de novo PoPH, right heart catheterization should be performed. Such an aggressive approach may help prevent tragic outcomes such as was seen in our case …”

“…In Reply We thank Bakinde et al for their interest in our work and allowing us to elaborate on the time course of the development of portopulmonary hypertension (PoPH). Typically, PoPH occurs 4 to 7 years after patients are diagnosed with portal hypertension .…”

Further Questions Regarding Electrocardiogram Prior to Liver Transplant

“…To the Editor We read with great interest the Challenges in Clinical Electrocardiography by Littman et al published in a recent issue of JAMA Internal Medicine . The authors present the electrocardiogram (ECG) as a simple and inexpensive, yet powerful, tool for the early detection of portopulmonary hypertension (PPHTN).…”

“…As Littman et al have noted, we agree that the use of ECG is a simple, inexpensive, and powerful tool in the early detection of PPHTN. However, although a pretransplant ECG was noted to be normal, it is difficult to assess when this ECG was performed and whether any ECGs that may have been performed afterwards (prior to the posttransplant ECG of 3 months) revealed any new signs of right heart strain.…”