A Study of Myocardial Damage in Patients with Hepatic Diseases, Especially the Hepatic Cirrhosis, Primarily on the Relation between Serum Proteins and Electrocardiographic Changes

Abstract

Concerning the intimate relation between the heart and liver, the hepatic damage which occur due to congestive heart failure is well known. However, systematic studies concerning the influence of hepatic disease on heart, especially the myocardium, has been scarce.The liver is an important center of body metabolism. On the other hand, as studies on cardiac metabolism progressed, it was found that damage to the myocardium could be brought about by various metabolic abnormalities of the body.An example of this is the non-inflamatory myocardial damage caused by disturbances in metabolism, seen for instance in hepatic disease, which F. Wuhrmann called "Myokardose". In liver disease he felt that the cause was primarily dysproteinemia. However, in his study, the relation between serum proteins and electrocardiographic findings was not investigated thoroughly.In the present study, changes in the serum protein and electrocardiographic findings of patients with hepatic disease, most prone to cause disturbances in serum protein metabolism, were carefully analysed and the relation between the two was made clear. Materials and Methods : A total of 117 cases were studies, including 31 cases of acute hepatitis, 22 cases of chronic hepatitis, 59 cases of hepatic cirrhosis and 5 cases of hepatic coma due to fulminating hepatitis, which were hospitalized in our department of internal medicine. Patients with histories of cardiovascular diseases were excluded.Various serum colloidal reactions, serum protein fractionation by a salting out method and 12 lead electrocardiograms were done on all cases. Results and Conclusion : ❲1❳ Serum Protein Fractions and Serum Colloidal Reactions in Hepatic Disease In general, the total protein (TP) tends to decrease, but the decrease is often covered by an increase of γ-globulin (γ-GL). Decrease of albumin (AL) and increase of globulin (GL), especially γ-GL, were seen in most cases, and this tendency was stronger as the disease was more severe. The tendency was especially prominent in hepatic cirrhosis and hepatic coma. α- and β-globulins were usually within the normal range. (Fig. 1∼12)The serum colloidal reactions in most cases of acute and chronic hepatitis were (+)∼(〓), and in hepatic cirrhosis and hepatic coma(〓)∼(△).As for the relation between serum colloidal reaction and serum protein fractions, the decrease of AL and increase of GL or especially γ-GL, which means the decrease of A/G and A/γ, correlated well with the positivity of all colloidal reactions. The decrease of TP correlated with Gross and Takata reactions.Thus, the principal factors of serum protein changes in hepatic disease are the decrease of AL, increase of γ-GL and decreases of A/G and A/γ. When the various degrees of this dysproteinemia is indicated by the scale (+)∼(△), most cases of acute and chronic hepatitis showed (〓) changes, while cases of hepatic cirrhosis and hepatic coma generally showed (〓)∼(△) changes. (Tab. 4)The prognosis of hepatic disease correlated best with decreases of A/G and A/γ, the severer the case the lower were the values. But when the degree of abnormality was studied in terms of protein-curves (Fig. 23), the A/γ was more sensitive than A/G. Especially, the A/γ was better in determining the prognosis of hepatic cirrhosis.❲2❳ Electrocardiographic Findings in Hepatic Diseases Frequently encountered changes were ; low voltage R (16.2%), low T (46.1%), depressed ST (31.6%) and prolonged QT (40.1%). To these, atrial fibrillation, prolonged PQ and bundle branch block can be added, and these may be considered collectively as the 7 principal findings. (Tab. [the rest omitted]