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The jaundiced heart: evidence of blunted response to positive inotropic stimulation
D Lumlertgul1, S Boonyaprapa, D Bunnachak
1Division of Nephrology, Faculty of Medicine, Chiang Mai University, Thailand.
Insights
Jaundiced patients exhibit a blunted cardiac response to dobutamine, indicating impaired myocardial contractility. This cardiac dysfunction may increase risks of shock and kidney failure in jaundiced individuals undergoing surgery.
Area of Science:
- Cardiology
- Hepatology
Background:
- Obstructive jaundice is associated with significant hemodynamic disturbances.
- Cardiac involvement in jaundiced patients requires further investigation.
Purpose of the Study:
- To assess cardiac function in patients with obstructive or cholestatic jaundice.
- To evaluate myocardial contractile response to inotropic stimulation in jaundiced patients.
Main Methods:
- Multiple-gated blood pool cardioscintigraphy was performed on 9 jaundiced patients and 8 healthy volunteers.
- Intravenous dobutamine was administered to assess the response of left ventricular ejection fraction (LVEF).
Main Results:
- Heart rate and blood pressure changes were similar between groups after dobutamine administration.
- The increase in left ventricular ejection fraction (LVEF) in response to dobutamine was significantly blunted in jaundiced patients compared to controls (3.56% vs. 12.7%, p < 0.005).
Conclusions:
- Jaundiced patients demonstrate a blunted myocardial contractile response to beta-1 adrenergic stimulation.
- This myocardial refractoriness may predispose jaundiced patients to postoperative shock and acute renal failure.
Abstract:
Obstructive jaundice has been known to cause severe hemodynamic disturbance. The present study was therefore designed to assess the cardiac involvement in jaundiced patients. The multiple-gated blood pool cardioscintigraphic studies were done in 9 jaundiced patients who had either cholestatic or obstructive jaundice (mean total bilirubin 29.30 +/- 3.30 mg/dL), and in 8 normal volunteers (total bilirubin less than 1 mg%). None of the patients had evidences of obvious cirrhosis, intrinisic heart disease, or septicemia. Following intravenous dobutamine there was comparable change of blood pressure and heart rate in both groups. However the response of left ventricular ejection fraction (LVEF) to dobutamine (10 micrograms/kg/min x 5 min) was strikingly blunted in the jaundiced patients as compared to that seen in the normal controls (3.56 +/- 0.9 vs. 12.7 +/- 2.2%, p less than 0.005). Our present data thus show that there is blunted myocardial contractile response to the inotropic stimulation in jaundiced patients. Such myocardial refractoriness to beta-1 stimulation may contribute to the susceptibility of jaundiced patients to postoperative shock and acute renal failure.