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Cardiovascular changes in children with sickle cell crisis
Richard Onalo1, Peter Cooper2, Antoinette Cilliers3
1Paediatric Cardiology Unit, Department of Paediatrics, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria.
Insights
Severe sickle cell crisis significantly impacts children's cardiovascular health, causing increased heart rate, blood pressure, and higher risks of myocardial ischemia and pulmonary hypertension. These findings highlight the critical need for further research into these cardiovascular events for improved patient care.
Area of Science:
- Pediatric Cardiology
- Hematology
- Cardiopulmonary Medicine
Background:
- Sickle cell anaemia (SCA) is a genetic blood disorder.
- SCA crises are associated with serious cardiopulmonary complications.
- Pulmonary hypertension and myocardial ischemia are known SCA crisis complications.
Purpose of the Study:
- To investigate the cardiovascular changes during severe sickle cell crisis in children.
- To compare cardiopulmonary parameters in children with SCA during crisis versus steady state.
Main Methods:
- Cross-sectional comparative study of children (5-17 years) with SCA.
- Cases: children admitted during severe crisis; Controls: children in steady state.
- Assessment included ECG, cardiac biomarkers, echocardiography, and blood pressure measurements.
Main Results:
- Patients in crisis showed significantly higher heart rate and blood pressure than controls.
- Myocardial ischemia, conduction abnormalities, pulmonary hypertension, and ventricular dysfunction were more prevalent in the crisis group.
- Statistical significance (p < 0.0001) was observed for most parameters.
Conclusions:
- Sickle cell crisis leads to significant clinical, ECG, and echocardiographic changes in children.
- Cardiovascular derangements are common during severe SCA crises.
- Further research on these events can enhance the management of SCA patients.
Background:
Sickle cell anaemia is characterised by frequent, sometimes serious events referred to as "crisis". Cardiopulmonary consequences such as pulmonary hypertension and myocardial ischaemia may accompany a serious crisis.
Objective:
To determine the cardiovascular changes that occur during a severe sickle cell crisis.
Methods:
A cross-sectional comparative study of sickle cell anaemia in children (5-17 years) admitted during a severe crisis (cases) and those in steady state (controls) was conducted over a 2-year period. Effects of the crisis on the cardiopulmonary system were assessed. The diagnosis of myocardial ischaemia was made using electrocardiography and serological cardiac biomarkers, while cardiac dysfunction and the presence of pulmonary hypertension were determined using echocardiography. The presence of systemic hypertension and tachycardia was also evaluated.
Results:
A total of 176 patients were recruited, 92 in steady state (male:female ratio, 1.2:1) and 84 in severe crisis (male:female ratio, 1.3:1). The mean age was 10.4 ± 3.2 years for steady state and 10.5 ± 3.4 years for those in crisis. The mean heart rate in crisis was higher than in steady state (p < 0.0001). The blood pressures (systolic, p < 0.0001, diastolic, p < 0.0001, mean, p < 0.0001) as well as myocardial ischaemia scores (p < 0.0001) were higher in patients with crisis than in those in steady state. Similarly, conduction abnormalities, pulmonary hypertension, and ventricular dysfunction were more prevalent in the crisis than in the steady state.
Conclusion:
The present data suggest that sickle cell crisis results in a derangement of clinical, electrocardiographical, and echocardiographical parameters in children with sickle cell anaemia. Further research on these cardiovascular events may improve the overall care of these patients.
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