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Cardiovascular response in anemia
1Department of Pediatrics, Christian Medical College, Ludhiana, Punjab, India.
Insights
Nutritional anemia in children compromises cardiovascular response to exercise, impacting their physical potential. Early prevention is crucial for school-aged children to ensure optimal development and activity levels.
Area of Science:
- Pediatric Cardiology
- Sports Medicine
- Nutritional Science
Background:
- Nutritional anemia is a prevalent condition in children, potentially affecting physiological functions.
- Exercise performance is a key indicator of overall health and functional capacity in pediatric populations.
Purpose of the Study:
- To investigate the functional consequences of nutritional anemia by evaluating exercise performance in anemic children.
- To assess the impact of anemia severity on cardiovascular responses during physical exertion.
Main Methods:
- A comparative study involving 30 anemic children (mild and moderate severity) and 30 healthy controls, aged 7-14 years.
- Exercise testing using a modified Bruce protocol on a stress treadmill with continuous electrocardiographic monitoring.
- Evaluation of parameters including heart rate, systolic blood pressure, double product, ECG changes, metabolic equivalents (METS), and exercise duration.
Main Results:
- Anemic children exhibited a significantly lower end-point heart rate in the fatigue group and achieved fewer metabolic equivalents (METS).
- Anemic children showed a greater percentage gain in systolic blood pressure at peak exercise and during recovery.
- Electrocardiographic changes, primarily ST depression, were significantly more frequent in anemic children, particularly those with moderate anemia.
Conclusions:
- Children with nutritional anemia demonstrate compromised cardiovascular responses to physical exercise.
- This compromise may limit their ability to reach full potential in physical activities and school-based exercises.
- Prioritizing anemia prevention in school-aged children is essential for their optimal physical development and performance.
Objective:
To study the functional consequences of nutritional anemia by evaluating the exercise performance in these children.
Methods:
The study was conducted on 30 each of anemic and normal children of both sexes aged between 7 and 14 years. Relevant history was taken, and detailed examination was done. These children were classified according to severity of anemia based on hemoglobin estimation as mild (10-11.9 g/dl), moderate (7-9.9 g/dl) and normal (>12 g/dl). Children with severe anemia (Hb < 7g/dl), heart disease, non-nutritional anemia, acute febrile or respiratory illness were excluded. The subjects were tested on Mortara X Scribe colour stress treadmill using the modified Bruce protocol. Continuous computerised electrocardiographic analysis was done. The parameters studied included heart rate, systolic blood pressure, double product (DP = HRxSBP), ECG changes, metabolic equivalents (METS) and exercise duration. The end point of the test was a HR of 170/min (non-fatigue group) or inability to perform further (fatigue group). Statistical analysis was done by appropriate tests.
Results:
Fifteen children each with mild and moderate anemia and 30 age-matched controls were enrolled in the study. There was no significant difference in the resting HR, exercise duration or DP between the cases and controls. Thirty-one children reached the target HR (non-fatigue group). The end-point HR was significantly lesser among the anemic children in the fatigue group (P 0.04). The percent gain of SBP, at peak exercise (P 0.0007) and recovery SBP as percent of resting SBP (p 0.006) were significantly more in the anemic children, more so in the mildly anemic ones. Lesser METS was achieved by anemics as compared to controls (P 0.04). ECG changes occurred significantly more often in anemic children, 53.8% of those with changes being moderately anemic, the main abnormality being ST depression. None developed arrhythmia during exercise testing.
Conclusion:
The cardiovascular response to physical exercise is compromised in children with nutritional anemia and hence these children may never attain their full potential in various school activities. Prevention of anemia should be a priority in school going children.
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