Cardiac Findings in Patients 6-60 Months of Age Filipinos with Acute Malnutrition: A Preliminary Study

There is a consensus that cardiac size is reduced in proportion to body mass in malnourished children, but with conflicting findings in cardiac functions. This descriptive-cross sectional study was conducted at a tertiary hospital to evaluate the cardiac findings among patients 6-60 months old with acute malnutrition using chest x-ray, electrocardiogram (ECG), and 2-D echocardiogram (2D-echo). Included in the study were 22 patients. Fourteen (14) of whom had moderate acute malnutrition (MAM) while 8 had severe acute malnutrition (SAM). Both the MAM and SAM groups have cardiothoracic (CT) ratios within normal range but lower than the mean for MAM patients 6-36 months old. ECG studies generally showed low R wave amplitude in both groups and shortened PR interval in the SAM group. Sinus tachycardia appeared to be more common in the SAM group at 50% (4/8) compared to the MAM group at 21% (3/14). 2D-echo measurements of chamber and wall dimensions on both groups were within normal limits; comparison of both groups showed the SAM group had lower left atrial dimensions and left ventricular end-systolic dimensions (LVESD) compared to the MAM group (p values of 0.006 and 0.037 respectively). Pulmonary artery pressure was higher in SAM compared to MAM with a p value of 0.026. In both groups, systolic and diastolic functions were within normal range. MAM patients 6-36 months of age have CT ratios lower than the mean. Low R wave amplitudes are seen in both groups. Those with SAM have more tachycardia and shorter PR interval. There is a trend for the SAM group to have a smaller left atrial and left ventricular end-systolic dimensions and higher pulmonary artery pressure. Systolic and diastolic functions are preserved in both groups. These cardiac findings are suggestive of the effects of malnutrition on the heart.