Cardiac complications

In the early part of this century it was believed that the heart was spared during starvation, a view which was widely held until the mid-1940s. It is now known that undernutrition is associated with decreases in heart rate, arterial and venous pressures, stroke volume, and cardiac output. Electrocardiographic changes included sinus bradycardia, increased Q-T interval, and diffusely decreased voltage.

Conversely, refeeding malnourished patients can precipitate congestive cardiac failure through several mechanisms:

1. expansion of ventricular volume and increase in cardiac output may outpace the increase in ventricular mass;

2. an increase in metabolic rate;

3. excessive sodium retention;

4. relative deficiencies in vitamins or minerals;

5. residual depression of myocardial contractility.

Therefore caution and patience should guide the refeeding of severely undernourished patients and their cardiac status should be evaluated. Morbidity and mortality

It has been repeatedly demonstrated that increased morbidity and mortality occur in surgical patients who are anergic to a delayed cutaneous hypersensitivity test.

Simple correction of undernutrition in surgical patients is certainly a very attractive concept, as the treatment is simple and basic. However, it has proved difficult to verify this even in the best of controlled studies because of other confounding factors. Although many such studies have been performed (over 50 to date), most can be criticized on the grounds of the trial design, the trial size, or the adequacy of the nutritional regimen used.

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