European Journal of Cardiovascular Medicine

Introduction: Hyponatremia is serum sodium less than 135 meq/lit. Hyponatremia is the most common electrolyte disorder in hospitalised patients. In advanced cirrhosis a disturbance of body water homeostasis is a common feature. Hence there is higher rate of renal retention of water in relation to sodium due to a reduction in solute-free water clearance. Pathologic features consist of the development of fibrosis to the point that there is architectural distortion with the formation of regenerative nodules. This results in a decrease in hepatocellular mass, and thus function, and an alteration of blood flow. The induction of fibrosis occurs with activation of hepatic stellate cells, resulting in the formation of increased amounts of collagen and other components of the extracellular matrix.Material And Methods: This is cross-sectional study conducted in the Department of General Medicine at Mahalakshmi Multispeciality Hospital, Ambattur, Chennai from June 2021 to May 2023. Patients were selected based on clinical examination, biochemical tests and ultrasound abdomen. Informed consent was obtained from all patients enrolled for the study. The data of the patients like relevant clinical history, examination findings, laboratory investigations were recorded in a proforma sheet. All the patients enrolled in the study were examined at the time of admission in the hospital and their serum sodium levels were checked and the patients were followed during their stay in the hospital. The severity of cirrhosis was assessed according to Child-Pugh score. MELD score and MELD-Na score were also calculated at the time of admission. Results: The mean age of the patients was 48.15±13.79 and consisted of 85 (94.4%) men and 05 (5.6%) women. Causative factors for liver cirrhosis included alcoholism in 90% of patients, hepatitis B in 5.6% of patients and hepatitis C in 4.4% of the patients. Alcohol was the most common etiology in present study, seen in 94.4% patients.In the present study, alcohol is found to be cause of cirrhosis in 24 patients out of 25 (96%) in the group with serum sodium levels ≤ 130 meq/L, in 23 patients out of 28 (82%) in patients with serum sodium levels between 131-135 meq/L, in 33 out of 37 patients (89.2%) in the group with serum sodium levels ≥136 meq/L. In the present study, there is no significant statistical differencebetween the three groups with respect to alcohol as the cause of cirrhosis (p value 0.25). Conclusions: Dilutional hyponatremia is frequent in cirrhotic patients and low serum sodium levels are associated with severe complications of liver cirrhosis like hepatic encephalopathy, hepatorenal syndrome. Hyponatremia is also associated with high morbidity and mortality in cirrhotic patients. Hence hyponatremia is a valuable marker that can be used to assess the prognosis in patients with cirrhosis of liver. Incorporation of sodium levels in MELD score is much more useful than MELD score alone to assess the prognosis and to refer the patient for liver transplantation.

Sigmoid volvulus is a rare but potentially life-threatening condition caused by abnormal changes in the sigmoid colon surrounding the mesentery. The purpose of this article is to determine the trunk length of the unchecked S-bracket. Methods: This study was a case-control study conducted in two tertiary teaching hospitals in central India. Patients included patients 18 years of age or older with surgically proven sigmoid volvulus; controls included people aged 18 years or older who had undergone other surgeries that did not involve the colon, sigmoid, or rectum. Results: Intraoperative sigmoid measurements, including midsigmoid root width and midsigmoid length. Observations and results: A total of 30 cases and 30 controls were included. The sigmoid colon was longer and wider in the subjects than in the control group. However, mean sigmoid root width was similar between groups. These findings support that sigmoid torsion results from broad-based rotation of a long and wide midsigmoid colon. This is the first adequately controlled study to examine the anatomy of sigmoid torsion and provides strong evidence to confirm previous theories about the anatomical basis of sigmoid torsion.

Background – Cirrhosis of the liver is a frequently encountered disease. The commonly available tests used in assessing the severity of cirrhosis have certain drawbacks. The estimation of serum cholinesterase is useful to assess the severity and prognosis of the disease. Aim – The aim of the study is to compare the level of serum cholinesterase in patients with cirrhosis with other tests of liver function like serum albumin, serum bilirubin, PT INR, MELD and Child Pugh score. Materials and Methods – This was a hospital based observational study conducted for six months between March to August 2016 at Apeksha Critical care and multispecialty hospital private limited Nanded. Patients who were diagnosed with cirrhosis both clinically and by ultrasound were included in the study. The assay for serum cholinesterase was done in all patients. The correlation between the values of serum cholinesterase and serum albumin, bilirubin, INR, Child Pugh and MELD score were analysed. Results – A total of 100 patients were studied. The majority were males ( 80%) in the age group of 41to 50 years.(40%). The most common aetiological factor in this study was alcohol (68%). Of the clinical signs studied 83% had ascites, 72% had icterus, 63% had splenomegaly and 31% had hepatic encephalopathy. On analysis of the laboratory parameters, 71% had a bilirubin level more than 3 and 73% had an INR less than 1.7. The majority of the patients were in Child Pugh class B ( 41%) and 64% had MELD score greater than 15. On analyzing the correlation between serum cholinesterase and other tests of liver function, it was found that there was significant correlation with albumin, bilirubin, INR levels, Child Pugh and MELD score. Conclusion – A significant correlation was found between serum cholinesterase levels and the severity of Cirrhosis.

Background: Liver cirrhosis significantly affects health outcomes, with rising cases linked to nonalcoholic steatohepatitis (NASH) in addition to chronic alcohol abuse. "Cirrhotic cardiomyopathy" is defined by systolic and diastolic dysfunction along with electrophysiological abnormalities, absent other cardiac disease. Patients are at risk of heart failure under stress, diagnosed through electrocardiography, 2D echocardiography, and biomarkers such as BNP. Key diagnostic indicators include a resting ejection fraction < 55%, diminished cardiac output under stress, and an E/A ratio < 1.0, while additional supportive features like electrophysiological changes and elevated biomarkers may be helpful but are not required. Methods: This cross-sectional study at Dr. PSIMS & RF Hospital included 50 cirrhosis patients, assessed using Child-Pugh and MELD scores. Evaluations included QTc interval assessment, 2D echocardiography, and cirrhotic cardiomyopathy criteria from the 2005 World Congress of Gastroenterology, Montreal. Inclusion criteria were hospitalized patients with cirrhosis, while those under 18 years of age, with COPD, or with co-existing heart disease were excluded. Statistical analysis used SPSS version 21, with significance set at p < 0.05. Results: Patients with QTc intervals ≤ 440 ms generally exhibited better liver function, with 65.5% in Child-Pugh Class A and 37.9% with MELD scores ≤ 9. Conversely, those with QTc intervals > 440 ms often had more severe liver impairment, with 71.4% in Child-Pugh Class C and 42.9% with MELD scores ≥ 30, showing significant differences (p < 0.05). Ejection fractions > 55% were associated with better liver function, while ejection fractions ≤ 55% indicated more severe impairment, with significant differences (p < 0.05). Cardiac parameters, including right atrial size, left atrial size, and ejection fraction, differed significantly across Child-Pugh classes, with Class C patients having larger right and left atrial sizes and lower ejection fractions compared to Classes A and B (p < 0.05). Conclusion: In conclusion, the study reveals that in liver cirrhosis patients, prolonged QTc intervals are strongly correlated with Child-Pugh and MELD scores, while an ejection fraction ≤ 55% indicates more severe impairment, highlighting the critical need for continuous cardiac monitoring.

Introduction: Portopulmonary hypertension (PoPH) is a severe complication of chronic liver disease (CLD) caused by pulmonary vascular remodeling due to portal hypertension. Early detection is essential, particularly in liver transplant candidates. This study assesses the prevalence, clinical characteristics, and risk factors for PoPH in CLD patients. Material and Methods: A prospective observational study at Dr. N Y Tasgaonkar Institute of Medical Science (January 2023–January 2025) enrolled 100 CLD patients. Clinical, biochemical, imaging, and hemodynamic assessments were performed, including transthoracic echocardiography (TTE), right heart catheterization (RHC), pulmonary function tests (PFT), and six-minute walk test (6MWT). PoPH was diagnosed per ESC/ERS guidelines. Statistical analysis included chi-square tests, t-tests/Mann-Whitney U tests, and multivariate logistic regression. Results: PoPH prevalence was 29% (54% mild, 8% moderate, no severe cases). Mean age was 53.42 ± 9.13 years, with 75% male. Alcoholic liver disease (46%) and NAFLD (28%) were the most common etiologies. Higher BMI (p = 0.002), male sex (p = 0.041), smoking (p = 0.032), and comorbidities (p = 0.023) were significantly associated with PoPH. Pulmonary function impairment (FEV1 < 70%, p = 0.028) and reduced exercise tolerance (6MWT < 350m, p = 0.008) were significant. Liver disease severity (Child-Pugh, p = 0.015; MELD, p = 0.041) was strongly linked to PoPH. Conclusion: PoPH is prevalent in 29% of CLD patients, with BMI, male sex, smoking, comorbidities, and liver disease severity as major risk factors. Pulmonary function impairment and reduced exercise capacity underscore the need for early screening and cardiopulmonary assessment. Routine echocardiography and pulmonary function testing should be prioritized for early detection and management.

Background: Cirrhosis is a chronic liver condition characterized by hepatic fibrosis, anatomical distortion, and compromised liver function. Autonomic dysfunction (AD) is a significant concern due to its impact on cardiovascular stability, hemodynamic modulation, and patient prognosis. AD is characterized by irregularities in heart rate variability, impaired blood pressure management, and abnormal reflex reactions, which can increase the risk of cardiac events. Cirrhotic cardiomyopathy, characterized by compromised ventricular contractility and electromechanical dysfunction, is linked to autonomic abnormalities. ECG and ECHO are vital tools for assessing heart function in cirrhosis patients, revealing anatomical and functional heart alterations. Objective: This study aims to evaluate autonomic dysfunction in individuals with liver cirrhosis, its impact on ECG abnormalities, heart rate variability, blood pressure regulation, and cardiovascular reflexes, and its influence on various Child-Pugh and MELD score groups. It also seeks to identify potential predictors of autonomic dysfunction in cirrhosis, which could aid in early risk assessment and therapeutic management. Methods: A retrospective analysis was performed on clinical data from 100 patients admitted with cirrhosis over an 18-month period, from May 2023 to December 2024, at Shri B M Patil Medical College and Research Center, Vijayapura, where the data was collected. The information gathered included the patient's demographics, clinical conditions at admission, ECG results (QTc interval), echocardiographic results, and signs of autonomic dysfunction. Results: The study examined the age distribution and physiology of patients with heart conditions, focusing on 20-60-year-olds. Pulse rates were categorized into three ranges: 81-100 bpm, 60-80 bpm, and 101-130 bpm. The Valsalva maneuver showed a similar distribution, with 52% falling in the 81-100 bpm range and 36% in the 60-80 bpm range. Blood pressure was measured using a blood pressure cuff, with higher pressure indicating a higher risk of heart failure. The study also examined blood pressure readings under three conditions: Supine BP (lying down), Standing BP, and Hand Grip BP. The Child-Pugh classification assessed the severity of chronic liver disease, with the mean age group mostly middle-aged. The study found a strong link between autonomic dysfunction, cardiovascular abnormalities, and liver disease progression. Conclusion: The study reveals a significant gender disparity in the population, with 95% being males. Cardiovascular assessments show normal physiological responses, but some individuals show signs of autonomic dysfunction. ECG analysis reveals abnormalities in sinus rhythms, highlighting the need for continuous monitoring. Liver function assessments reveal a high prevalence of severe liver disease, necessitating urgent medical interventions. Early detection and management of these health issues are crucial for improving health outcomes. Future research should focus on lifestyle modifications, targeted treatments, and long-term monitoring.