الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
Liver cirrhosis is associated with cardiovascular and circulatory
abnormalities. Scanty information was available as to whether
these include left ventricular diastolic dysfunction and wall
thickness increase.
The aim of our study was to clarify the nature of cardiac
involvement in liver cirrhosis. The study included three groups:
Group I: include 20 cirrhotic patients with tense ascites.
Group II: include 20 cirrhotic patients with previous episodes
of ascites.
Group Ill: include I0 healthy control subjects of average age
and sex for comparison.
All cases were admitted in the department of general medicine
at Benha teaching hospital and were subjected to bed rest, low
sodium diet and wash out from any diuretics.
All patients were subjected to the following:
l-Full history taking;
Stressing on age, cardiovascular disease (including rheumatic
fever, congestive heart failure, hypertension), renal disease,
diabetes mellitus, hepatitis, hepatic encephalopathy,
Bilharziasis, jaundice, severe anemia, recent haematemesis and
melena, and systemic lung disease.
2-Clinical examination including:
Pulse, blood’ pressure, jaundice, edema lower limb, cardiac
examination, chest examination and abdominal examination.
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3-Laboratory investigation:
Assessment of liver function including SGOT, SGPT, alkaline
phosphatase, total bilirubin, serum albumin. Total protein, Renal
function tests, fasting blood glucose, hepatitis marker, IRA,
arterial blood gases, hemoglobin.
4-Abdominal ultrasound:
Assess the hepatic findings, portal vein diameters, biliary tract,
splenomegally, the presence of ascites, exclude tumors,
examination of the kidney and pancreas.
5- X ray chest and heart:
Both ~teroposterior and lateral view for evaluation of heart size
and other cardiopulmonary findings.
6- Electrocardiography:
All 12 leads ECG were done during rest at rate of 50 ms and
examined according to standard criteria stressing on signsof
chambre enlargement, ischemia, conduction abnormalities, Q-T
interval corrected-- for heart rate. ( calculated from Bazzet’s
formula
Q-Tc Ims = measured Q-Tc I JR R
Q_T c interval more than 440 111S was considered prolonged.
7-Doppler echocardiography:
Echocardiography was done for all patients and control by 3.5
Mh-z _ phased array transducer probe using M mode and B
mode. Measurement from at least three cardiac cycles were
averaged.
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’-
cchocal’diographic parameters were
The following
measured:
1- Left atrial diameter.
2-Right ventricular diameters,
3-Parameters of left ventricular systolic function including:
-Left ventricular dimensions fcm (left ventricular diameter
diastole and left ventricular diameter systole).
-Left ventricular volumes in ern’ calculated according to
Teichholz formula:
End diastolic volume = 7 (EDD) 3
2.4+ EDD
End systolic volume = 2.4: ESD (ESD)3
- Fraction shortage % = EDD - ESD
EDD x 100
- Ejection fraction =
EDV - ESV
EDV x 100
4- Left ventricular wall thickness was obtained from the sum of
posterior wall thickness and interventrticular septal thickness.
5-Parameters of left ventricular diastolic function including
- Peak filling velocity during early ventricle diastole (E)
- Filling velocity during atrial systole(A)
- EfA ratio
- Deceleration time of the E velocity .
from our study the following results have been found.
As regard the clinical data the following were found:
• Significant increase in heart rate in both groups of cirrhotic
patients that were marked in-patients with tense ascites.
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• Significant decrease of blood pressure in patients with
tense ascites and non Significant decrease of blood pressure
in patients with previous episodes of ascites.
Arterial blood oases chanoes in different rou s:
• Significant decrease was observed in Pa02 in both groups
of cirrhotic patients.
• Significant decrease was found in PaC02 in both groups of
cirrhotic patients.
X ray findings in cirrhotic patients with and without ascttes;
• A significant prevalence of pleural effusion w.as found in
cirrhotic patients with tense ascites.
Electrocardiographic changes in cirrhotic patients with and
without ascites:
• Significant prolongation of the Q-Tc interval was found in
both groups of cirrhotic patients that correlate positively
with Child Pugh Score .
• No significant correlation was found between Q-Tc interval
prolongation and both the etiology ofliver cirrhosis and
portal vein diameter
Echocardiographic finding in cirrhotic patients with and
without ascites:
• Significant increase of the left atrial diameters in cirrhotic
patients with and without ascites that more marked in
patients with tense ascites.
• Although still with the normal limits, left ventricular
diastolic and systolic diameters were significantly higher’
than control.
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• Althouzh still within thenormallimits, left ventricular end
diastolic and end systolic volumes were significantly higher
than control.
• Ejection fraction was normal in both groups of cirrhotic
patients but was significantly lower in cirrhotic patients
with tense ascites than control.
• Fraction shortening % was normal in all groups.
• Left ventricular wall thickness was significantly increased
in both groups of cirrhotic patients than control.
• No significant difference in E wave velocity in different
groups.
• Marked increase of the A wave velocity in both groups of
cirrhotic patients than control.
• Marked reduction of the E/A ratio in both groups of
cirrhotic patients than control.
• Marked increase of the deceleration time of the E velocity
in both groups of cirrhotic patients than control.
• A significant positive correlation exists between the
parameters of diastolic function and Child Pugh Score in
cirrhotic patients with tense ascites.
• No significant correlation was found between the etiology
of liver cirrhosis and echocardiographic changes in both
groups of cirrhotic patients.
• No significant correlation was found between the portal
vein diameter and echocardiographic parameters of left
ventricular diastolic and systolic function and wall
thickness.
• Prevalence of other cardiac abnormalities such as
pericardia! effusion and anterior mitral valve prolapse.