J.Jpn. Surg. Soc.. 62(5): 467-488, 1961
STUDIES ON ELECTROCADIOGRAMS IN CHOLELITHIASIS
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Department of Surgery, Nihon Medical School (Director : Prof. Saburo MATSUKURA) Toshio KOIZUMI |
Results of the analysis revealed certain electrocardiographic features in cholelithiasis, which may be summarized as follows.
1) Abnormal electrocardiographic findings were obtained in 70 instances of 104 patients with cholelithiasis, an incidence of 67.3%. This is a high incidence of abnormal findings when compared with 23.5% in gastroduodenal ulcers or 43.5% in gastric carcinoma.
2) The chief abnormal findings in cholelithiasis are the abnormality of P (8 cases or 7.7%), that of QRS (5 cases or 4.8%), the prolongation of Qt (7 cases or 6.7%) , low voltage (10 cases or 9.6%), the low position of ST and low or inverted T (38 cases or 36.5%), and abnormality of the rhythm (2 cases or 1.9%). These findings indicated the presence of myocardial disturbances.
3) The results of liver function tests (BSP, CCF, hippuric acid synthesis, icteric index) in 104 cases of cholelithiasis indicated the presence of disturbance in 80 (76%) but no disturbance in 24 (24%) instances. Among those with hepatic dysfunction, there were 62 cases (78%) which showed abnormal findings on the electrocardiograms, but such were also noted in 8 cases (33%) among those with no definite functional disturbances of the liver. These observations point to a close correlation between hepatic dysfunction and electrocardiographic abnormalities in those patients with cholelithiasis accompanied by functional disturbances of the liver.
4) Icterus was present in 66 cases (63%) out of a total of 104 patients with cholelitithiasis, while no icterus was noted in 38 cases (37%). The number of icteric patients whose electrocardiograms presented some abnormal findings was 45 (68%), while that of nonicteric patients presenting electrocardiographic abnormatlities was 25 (65%). From these facts, it may be stated that in cholelithiasis there was no close relationship between the pathogenesis of icterus and the appearance of abnormal findings on electrocardiograms.
5) Quantative studies of serum proteins in 104 cases of cholelithiasis revealed the fact that, although hypoproteinemia was demonstrated in only 5 cases, the demonstration of decrease in serum albumin with increase in γ-globulin in 60% of cases. In those instances showing abnormal partition of serum proteins the electrocardiographic findings were also abnormal in 80%, while in 47% of those having no distorsion in serum protein fractions the electrocardiographic abnormalities were demonstrated. Moreover, all of the 5 cases showing hypoproteinemia were characterized by abnormal distribution of serum protein fractions as well as by electrocardiographic abnormalities. These findings suggest that there is a close relationship between the abnormal partition of serum proteins and the appearance of electrocardiographic abnormalities.
6) In 104 cases of cholelithiasis serum electrolyte determination revealed that no changes in the value of serum Na were noted, and, although serum K showed slightly high levels in 6% of cases, it was also within the normal range. Serum Ca was found to be increased in 70% of cases, the remainder being nearly normal. In 80% of cases serum Mg showed some increase but it was otherwise normal. Of the 6 cases showing high value for serum K, the T peak was high but in those with increased serum Ca no abnormal findings (shortening of QT) were found on the electrocardiograms.
7) Hypertension was noted in 6 of 104 cases of cholelithiasis, and cardiac hypertrophy was demonstrated by roentgenography, while both of these manifestations were found in only 2 instances. There were 5 out of these 8 cases with exhibited electrocardiographic abnormalities. On the other hand, among the 96 cases which showed neither hypertension nor cardiac hypertrophy on X-ray films, there were 65 instances (68%) which revealed abnormalities on the electrocardiograms.
8) The circulating blood and plasma volumes were found to lie within the normal limits in 84 (80%) of the total of 104 cases of cholelithiasis, only 20 (20%) showing some decrease. Of those with normal values of the circulating blood and plasma volumes, abnormal electrocardiographic findings were seen in 55 (65%) cases. However, there were 15 (75%) instances of electrocardiographic abnormalities among the cases showing decreased volumes of circulating blood and plasma. These results may be interpreted to indicate that the raduction in the circulating blood and plasma volumes contributes one of the factors in the appearance of electrocardiographic abnormalities.
9) The results of determination of hepatic blood flow in 104 cases of cholelithiasis disclosed a reduction in 20 (20%) instances the remaining 84 (80%) cases showing normal values in this respect. There were 52 (61%) cases with abnormal electrocardiographic findings among those whose hepatic flow was normal, while 18 (90%) instances with reduced values in blood flow gave abnormal electrocardiograms. Thus, it is clear that the percentage appearance of electrocardiographic abnormalities is more frequent than that with no changes in hepatic flow.
10) Electrocardiographic records made prior to the surgical intervention revealed no abnormalities in 70 of the total 104 cases of cholelithiasis. Two weeks after the application of operative treatment these patients were again examined as to the possible changes in electrocardiograms. It was found that 41 (57.8%) cases showed either disappearance or marked improvement of abnormalities, no changes in 26 (37.1%) cases, and aggravation in 3 (5.1%) cases. The reason why there are a few instances of cholelithiasis which either continue to show no beneficial influences of operation on electrocardiograms or even turn for worse was further analyzed, and the following facts have been ascertained.
a) The cases which presented hepatic dysfunction and electrocardiographic abnormalities prior to operation numbered 62, of which 41 (66%) showed improvement, 19 (35%) no change, while the abnormalities became worse in only 2 as influenced by operation.
b) Of the 18 cases with decreased hepatic blood as well as electrocardiographic abnormalities, prior to operation, 16 (88%) cases showed an improvement of the latter, and no effects were found in 19 (35%) cases, while 2 cases made a turn for worse after the operation.
c) There were 45 instances showing icterus addition to electrocardiographic abnormalities prior to operation. Of these an improvement of electrocadiograms was noted in 36 (80%), while no changes in 9 (20%) cases due to the effects of the operation.
d) Preoperative abnormalities in both serum protein fraction and electrocardiograms were seen in 48 cases, of which postoperative normalization or improvement was noted in 37 (77%), no effects in 9 and aggravation in 2 cases.
e) In 2 cases which demonstrated hyperpotassemia as well as high T peek in the electrocardiograms, both abnormalities were abolished within 2 weeks postoperatively.
f) Preoperative reduction of circulating blood volume as abnormal electrocardiographic findings were noted in 15 cases, but the latter disapperared, in 11 (73%), while no changes were found postoperatively.
g) Electrocardiographic abnormalities were detected in 5 cases with preoperatives hypertension and in 4 cases with cardiac hypertrophy on X-ray films. In neither of these two groups were there any postoperative change in electrocardiograms and in 2 instances difinite worsening was noted.
(Author's abstract)
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