Cardiac abnormalities in cachectic patients before and during nutritional repletion

Abstract

The effect of PCU and HA on heart dimensions and function was examined with non-invasive methods in 10 patients with severe undernutrition of diverse etiology. Control subjects were 10 normal men and women matched to their cachectic counterparts by height and sex. The study was conducted in two phases. In phase A, baseline studies of heart dimensions and function were completed. Phase B consisted of cardiovascular and metabolic monitoring during 4 to 6 weeks of enteral or parenteral HA. Phase A was characterized by a reduced radiographic total heart volume, echo EdV, LV mass, and CO. These reductions, however, were only one half to one eighth as great as the losses in BW. The patients therefore entered HA with an elevated LV mass index and cardiac index. Ejection phase indices of LV function (EF and Vcf) were normal or enhanced. Phase B studies in five subjects showed that decreased cardiac size and output were correctible by HA, but at differing rates. Ventricular volume and CO corrected more rapidly than LV mass under the conditions of rapid repletion where the daily sodium intake was 2 to 4 grams, and values for cardiac index reached 250 per cent of normal. Resting metabolic rate also increased during phase B. The combination of an elevated output, excessive sodium retention, and increased metabolic rate while LV mass was still reduced appeared to be responsible for cardiac decompensation in two of five repleted patients. To prevent cardiac decompensation during the HA of undernourished subjects, we propose the use of low salt regimens, a slower rate of HA and serial monitoring of cardiac dimensions and function by clinical examination and echo.