Document Detail


Frequency of arrhythmias and other cardiac abnormalities in fulminant hepatic failure.
MedLine Citation:
PMID:  1008959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In a series of 106 patients with fulminant hepatic failure and grade 4 encephalopathy, cardiac arrhythmias and other abnormalities occurred in 92 per cent. The most common was sinus tachycardia (75%) and this was the only abnormality in 22 per cent of the patients. Sudden cardiac arrest occurred in 25 per cent, various ectopic beats in 20 per cent, and heart block or bradycardia in 18 per cent. Other electrocardiographic abnormalities, mostly of the T wave and ST segment, were found in 31 per cent. Cardiac and respiratory arrests were usually unrelated to each other and both frequently occurred without warning. Only 7 out of 71 patients with arrhythmias other than sinus tachycardia survived, compared with 15 out of 31 patients without them (P less than 0-005). During the latter part of the series when an arrhythmia computer was used to monitor 38 patients, it was shown that significantly lower arterial oxygen levels occurred in those with arrhythmias, other than sinus tachycardia, than in those without. They were also found to be more acidotic and hyperkalaemic, and a higher number required dialysis and ventilation. Macroscopical cardiac abnormalities including scattered petechial haemorrhages, small pericardial effusions, and fatty, pale, and flabby ventricles, were found at necropsy in 64 per cent of the patients examined. Combinations of these macroscopical abnormalities occurred, particularly in the paracetamol overdose group. Another necropsy finding of possible significance in the pathogenesis of arrhythmias was cerebral oedema, present in 48 per cent of the patients examined, and often associated with coning of the brain stem. However, 7 of the 16 patients who suffered asystolic cardiac arrests had no macroscopical abnormality of either heart or brain. In the management of patients with fulminant hepatic failure continuous cardiac monitoring is essential. Correction of the biochemical and coagulation defects may decrease the frequency of arrhythmias but studies of the mechanism and control of cerebral oedema and its relation to cardiovascular function are urgently needed.
Authors:
M J Weston; I C Talbot; P J Horoworth; A K Mant; R Capildeo; R Williams
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British heart journal     Volume:  38     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1976 Nov 
Date Detail:
Created Date:  1977-03-15     Completed Date:  1977-03-15     Revised Date:  2008-11-20    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1179-88     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / poisoning
Adolescent
Adult
Aged
Arrhythmias, Cardiac / epidemiology*
Brain / pathology
Child
Electrocardiography
Heart Arrest / epidemiology
Hepatic Encephalopathy / blood,  complications*,  pathology
Humans
Male
Middle Aged
Myocardium / pathology
Oxygen / blood
Prognosis
Respiratory Insufficiency / epidemiology
Tachycardia / epidemiology
Chemical
Reg. No./Substance:
103-90-2/Acetaminophen; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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