الفهرس 
Cardiovascular manifestations of chronic renal failureOnly 14 pages are availabe for public view
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Abstract
Cardiovascular disease is the most common cause of
aetiological factors in those
patients. Meanwhilp
patients that lead to
death in chronic renal failure
cardiac lesions are many.
Different invasive and noninvasive techniques are
used in assessment of cardiac changes in chronic renal
failure patients. Echocarniography is an effective
nonivasive technique for assessment of such changes in
the heart of uraemic patients. It has an advantage on
radiography and ECG, in readily detecting the chamber
dilatation, hypertrophy of myocardium, pericardial
disease, valvular affection and estimation of left
ventricle function, even without clinical
manifestations of myocardial disease. This of value in
determination of type of therapy and following up the
prognosis of patients. Early detection of myocardial
affection is extremely important in prophyLe x i. ~CJ”’n:~:’
expected risks of cllronic renal failure patient~ as
elevation of blood pressure, hyperkalaemia and
increased blood volume which may result in development
of overt left ventricular failure,
~v~n cardiac arrest.
pulmonary oedema or
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In our study, forty patient~ with chronic renal
failure disease were selected randomly for this work.
they are classified into four groups, each consists of
10 patients: Conservative treatment group, haemodialysis
group, peritoneeal dialysis group and transplantation
group. Another ten normal volunteers serve as
control group. For each of them the following
proceedures have been done:
1- Full medical history and clinical examination.
2- Laboratory investigations including estimation of:
blood urea, serum creatinine,
potassium and serum calcium.
3- Electrocardiography.
4- Plain x-ray chest and heart.
5- Echocardiography.
The results are organised,
serum sodium, serum
tabulated and
statistically discussed. The main re~ult~ of
echocardiography are :
1- Dilatation of cardiac chembers when compared with
control group:
a) Left atrial dilatation in 47.5% of uraemic
patients.
b) Aortic root dilatation in 22.5% of uraemic
patients.
c) Dilatation of left ventricle in 40% of uraemic
patient~.
2- Left ventricular hypertrophy in 67.5% of all uraemic
patients
a) 22.5% with asymmetrical septal hypertrophy (ASH).
b) 45\ with conceentric hypertrophy of left
ventricle.
3- Impairment of left ventricular function inspite of
that 40% of them have increased stroke volume:
a) Reduced fractional shortening of left ventricle
in 27.5% of all uraemic patients.
b) Reduced ejection fraction of left ventricle in
62.5\ of all uraemic patients.
4- Pericardial effusion is present in 25\ of all patients.
5- Valvular lesions,
a) 25\ of patients have mitral regurge.
b) 2.5\ of patients have aortic regurge.
from this stUdy, we C08e to the follwing conclusions:
1- Echocardiography is a sUitable, easy noninvasive
device to assess the structural and functional changes
in the heart in chronic renal failure patients.
2- The echocardioqraphic findings vary from one group
to another according to the mode of therapy.
Dilatation of cardiac chambers is more evident in
peritoneal dialysis and transplantation groups due to
interdialytic fluid gain and corticosteroid therapy
respectively. In hemodialysis group, less dilatation is
observed when compared with other group because of
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regular cut-off of excess fluid twice or thrice weekly.
Impaired left ventricular functions occur along with
dilatation of left ventricle. So, the haemodialysis
group has insignificant decline in left ventricular
function. Volume overload predisposes to septal rather
than concentric hypertrophy of left ventricle. So, the
highest incidence of ASH is noted in peritoneal
dialysis group which have larger interdialytic weight
gain. Pericarditis and pericardial effusion are more
frequent in dialysis patients because of uraemic
pericarditis and increased fluid volume in peritoneal
group. Dialysis pericarditis and heparin are additional
factors in haemodialysis group that cause pericarditis
and pericardial effusion. Dilated cardiomyopathy is the
major explanation of high prevalence of functional
regurgitation of mitral and aortic valves in peritoneal
dialysis group that possesses the highest dimensions of
cardiac chambers and highest fluid overload.
3- The most common aetiological factors that cause
cardiac lesions in chronic renal failure patients
are: hypervolaemia, arterial hypertension, anaemia,
coronary artery disease, electrolyte disturbances,
A-V fistula and uraemic toxins.
4- Early detection of mild to moderate cardiac
impairment is important as these patients are likely
to be more sensitive and more prone to the
preViously mentioned aetiological factors.