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ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 125-129

Cardiac involvement in acute pancreatitis and its effect on morbidity and mortality


Department of Gastroenterology, AVBRH, Wardha, Maharashtra, India

Correspondence Address:
Dr. Atul Gawande
Meghdoot Apartment, M4-11 Wardha-Paloti Road, Sawangi, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_226_19

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Aim: Early identification of cardiac involvement in acute pancreatitis and their appropriate management can decrease significant morbidity and mortality. Very few studies have focused prospectively on cardiac involvement and its association with prognosis in acute pancreatitis. Materials and Methods: Forty-two patients admitted in Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, were enrolled in this study and were divided based on PaO2into Group 1 (PaO2> 60 mmHg) and Group 2 (PaO2< 60 mmHg). Hologram with peripheral smear, blood sugar both fasting and postprandial, hemoglobin A1C, blood urea, creatinine, serum bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, cardiac enzymes, serum amylase, and lipase were measured. Prothrombin time, activated partial thromboplastin time, and lipid profile were measured and arterial blood gas analysis was done. All patients had undergone plane chest X-ray, ultrasonography of the abdomen, contrast-enhanced computed tomography of the abdomen, electrocardiogram (ECG), and two-dimensional (2D) echocardiography (ECHO). Results: 2D echocardiographic changes were more common in Group 2 as compared to Group 1 and were statistically significant (P = 0.004). Pericardial effusion and diastolic dysfunction were more common in Group 2 and were statistically significant (P = 0.006 and 0.031, respectively) whereas the difference between the association of regional wall motion abnormality (RWMA) in the two groups was statistically insignificant (P = 0.110). Both ECG and 2D echocardiogram (ECHO) changes were reversible and were statistically significant (P = 0.05 and 0.003, respectively). The need for admission in the intensive care unit (ICU) was significantly associated with pericardial effusion (P < 0.001) and diastolic dysfunction (P = 0.013) but not associated with RWMA (P = 0.710). ECG abnormalities at admission were not related to the need for mechanical ventilation and admission to ICU (P = 0.802). Conclusion: 2D ECHO abnormalities and not the ECG abnormalities were associated with a poor prognosis. Early recognition of echocardiographic changes in acute pancreatitis can predict the severity of disease and can help in the triage of patients requiring rigorous monitoring of respiratory and hemodynamic status.


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