The Echocardiographic Findings in Kwashiorkor

Olowonyo, M. T.; Ogunkunle, O. O.; Akinbami, Felix O.; Jaiyesimi, F

doi:10.1093/tropej/41.2.74

Cited by 12 publications

(6 citation statements)

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“…For example, Öcal and colleagues reported a decrease in cardiac output and left ventricular muscle mass proportional to body size in patients with protein-energy malnutrition, but left ventricular systolic and diastolic functions were preserved even in atrophic hearts [46]. Echocardiographic studies examining cardiac function of children affected by severe malnutrition provide conflicting results and have often only investigated children with kwashiorkor [44,47,48]. Most functional studies involve small numbers of patients, with poorly documented contemporaneous data on clinical and hemodynamic status.…”

Section: Effects Of Malnutrition On the Heartmentioning

confidence: 99%

Fluid Management of Shock in Severe Malnutrition: What is the Evidence for Current Guidelines and What Lessons Have Been Learned from Clinical Studies and Trials in other Pediatric Populations?

Obonyo¹,

Maitland²

2014

Food Nutr Bull

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Management of shock in children with severe malnutrition remains controversial. To date, the evidence supporting either benefit or harm of fluid resuscitation or rehydration is weak. This issue, however, is not unique to children with severe malnutrition; pediatric guidelines worldwide have a weak level of evidence and remain unsupported by appropriate clinical studies. In this review we give an overview of the current recommendations in other pediatric populations and appraise the strength of evidence supporting these. We summarize results from the only controlled trial ever undertaken, FEAST (Fluid Expansion As Supportive Therapy), which was conducted in resource-poor hospitals involving 3,141 African children with severe febrile illnesses and shock, including large subgroups with sepsis and malaria but excluding children with severe malnutrition. This high-quality trial provided robust evidence that fluid resuscitation increased the risk of death, leading to an excess mortality of 3 in every 100 children receiving fluid boluses, compared with controls receiving no boluses. These findings may have particular relevance to management of septic shock in children with severe malnutrition. However, they cannot be extrapolated to children with gastroenteritis, since this condition was not included in the trial. Current observational studies under way in East Africa may provide insights into myocardial and hemodynamic function in severe malnutrition, including responses to fluid challenge in those complicated by gastroenteritis. Such studies are an essential step for setting the research agenda regarding fluid management of shock in severe malnutrition.

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Section: Effects Of Malnutrition On the Heartmentioning

confidence: 99%

Fluid Management of Shock in Severe Malnutrition: What is the Evidence for Current Guidelines and What Lessons Have Been Learned from Clinical Studies and Trials in other Pediatric Populations?

Obonyo¹,

Maitland²

2014

Food Nutr Bull

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“…These may variably influence the cardiac function [4] and may result in an inherent ventricular dysfunction [3]. Myocardial disorders, whether cardiac arrhythmia or heart failure, are responsible for some deaths among kwashiorkor patients [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of left ventricular systolic and diastolic functions in severely malnourished children

Bebars

Askalany

2019

Egypt Pediatric Association Gaz

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Background: Malnourished children endure many changes in body composition and lose heart and skeletal muscle mass. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction. Aim: To assess left ventricular systolic and diastolic functions in children with severe acute malnutrition using tissue Doppler imaging technique and to evaluate the effect of nutritional rehabilitation. Patients and Methods: A follow-up case-control study conducted on 60 severely malnourished children (WHZ <-3SD) and 120 age and sex-matched healthy children as a control group. Tissue Doppler imaging (TDI) was done for all included malnourished children at admission and for control to measure left ventricular systolic and diastolic functions. Nutritional rehabilitation was done according to WHO protocol and tissue doppler was repeated after rehabilitation when (WHZ >-2SD) to detect any changes in systolic or diastolic functions. Results: Systolic function was normal in malnourished children and control. Grade I diastolic dysfunction was detected in 40% and grade II in 30% of severely malnourished children in comparison to 100% normal diastolic function in control group. No correlations between diastolic dysfunction and either anthropometric measurements, electrolyte disturbances or Hb% in malnourished children before nutritional rehabilitation. Mortality from sepsis with associated ventricular dysfunction grade II documented in 3.3% of malnourished children. After nutritional rehabilitation diastolic function improved significantly as 65.6% of children attained normal diastolic function, 31% grade1 and 3.4% grade II. Positive correlations between diastolic function and WAZ, HAZ, WHZ and MUAC after rehabilitation. Conclusion: Severe acute malnutrition affects diastolic function in children which is reversible in most of these cases with rehabilitation. TDI is an easy and practical method for detection and follow-up of ventricular function in malnourished children.

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“…In addition, Phornphatkul et al (1994) reported that children with malnutrition not only have cardiac muscle wasting but also have inherent ventricular dysfunction as a result of severe malnutrition that responds to nutritional therapy. It has been reported that myocardial dysfunction either in the form of cardiac arrhythmia or heart failure are among the causes of death in kwashiorkor (Olowonyo et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

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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The Echocardiographic Findings in Kwashiorkor

Cited by 12 publications

References 0 publications

Fluid Management of Shock in Severe Malnutrition: What is the Evidence for Current Guidelines and What Lessons Have Been Learned from Clinical Studies and Trials in other Pediatric Populations?

Fluid Management of Shock in Severe Malnutrition: What is the Evidence for Current Guidelines and What Lessons Have Been Learned from Clinical Studies and Trials in other Pediatric Populations?

Assessment of left ventricular systolic and diastolic functions in severely malnourished children

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

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