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as a diagnostic less frequently
tinued mately at
with true cardiac and undernutrition.
and expired Hospital.
secondary patient hospitalization
countered than cardiac ever, when it is seen,
consider a variety of
the physician must causative disorders.
initial be obtained.
Generally speaking, microcardia with or without associated cardiac
Microcardia with cardiac atrophy
in association with or undernutrition, out cardiac atrophy
dary to a rapid
chronic wasting disease while microcardia withis usually seen secondecrease in blood volume
rhage. In underlying disease restores the heart
dehydration both instances,
or massive correction
by appropriate size to normal.
CASE II. (B.H.). This 4 year old girl was admitted to the Children’s Memorial Hospital, Oklahoma City, on July 20, 1966 with severe dehydration. She had been discharged just 13 days previously following evaluation of possible parental abuse and anemia. The hemoglobin at that time was 8 gm. per soo ml., and the hematocrit 25 per cent. The etiology of the anemia was thought to be on the basis of iron deficiency.
one case cardiac illustrating atrophy
cardiac atrophy and microcardia without reported.
REPORT CASE I.
pulse 180 per minute, respirations 40 per minute and weight 28 pounds. The patient was unconscious and severely dehydrated. Signs of shock were present in that the blood
pressure was 70/50 mm.
Hg, and the pulse
(P.Z.). This i i year old boy was admitted to the Children’s Memorial Hospital, Oklahoma City, on March 28, 1960, 10 months after a tonsillectomy. On this admission he presented with a mass behind the right ear, a biopsy of which revealed fibrosarcoma. It was thought that the tumor originated in the par-
and thready. Laboratory vealed a sodium of 169
studies at the time mEq./l., potassium 136 mEq./l., CO,
cent. on her
ml., and hematocrit of these values with admission, especially the
regional lymph nodes. Treatment a radical neck dissection and
chemotherapy (cytoxan-cyclophosphamide). Immediately after the neck dissection and for a period of months thereafter, the patient’s condition was good. However, deterioration became apparent after this period and the patient lost considerable weight, some 17 pounds over a month period. He also showed the generalized wasting and debilitation of the final
stage of neoplastic disease.
grams at this time showed the cardiac silhouette to be abnormally small (Fig. i, A and B) and it was believed that this represented micro*
marked degree of hemoconcentration. A chest roentgenogram at this time revealed a marked decrease in the size of the heart, as compared to the roentgenogram obtained during the previous admission (Fig. 2, A and B). It was believed that this represented microcardia due to the severe dehydration. Fluid replacement, consisting of plasma and intravenous fluid, was immediately initiated. With rehydration, the heart returned to its original size within 4 hours (Fig. 3). Pulmonary edema, probably resulting from the vigorous fluid replacement, was present at this time but cleared completely on the following day. With rehydration the hemoglobin returned
of Oklahoma Medical Center, Children’s Memorial Hospital,
The patient’s general condition continued improve rapidly and within 72 hours she completely recovered. This represents in response to severe . 1968 FIG. as seen on chest to roent- genography../ioo per cent-values the previous ml. (B) due to cardiac atrophy as a result Fifteen months later. is usually considered be of wF 111G. original admission The heart and was. 2. microcardia is present.ii6 Leonard E. (A) The heart is minimally enlarged reflecting the underlying anemia. She was discharged DISCUSSION A small heart..6 gm. effort is more shallow than that in A. Case II. This of terminal neoplastic disease. to 8. (B) There is a marked decrease microcardia in cardiac size even though the inspiratory dehydration. Case. quite admission and the comparable when hematocrit to the to 27 proximately at that time. (A) The was heart is of normal proportions. had re- configuration. state of hydration was normal. 1. Swischuk MAY. to its turned those on patient’s to had ap- 6 weeks after normotensive.
atrophy namely and microcardia microcardia A case and the Leonard l)epartment University cardiac atrophy are discussed. Note size and the typical the return “butterfly” to original pattern heart of pul- i. without cardiac atrophy by our second decrease is dary demonstrated marked and sure and There depression are. Medical Publishers. most commonlv due to severe diarrhea or massive hemorrhage. 103. F. diseases which rapid lead time this signs It produced type of of a small microcardia heart. condition actual with being decrease the most Addison’s in cardiac commonly weight cited and Adsmall that frequently dehydration is probable lowered blood dison’s heart. to avoid edema is exemplified corrects the be employed pulmonary II. X-Ray Diagnosis. severe case. Dehydration is secondary to markedly reduced fluid intake or extensive fluid loss. Chicago.D. to an (atrophy). J.”2’4’5 but as fluid the infant manifest in therapy but caution overhydration this it baland more age readily should and in Case is is It might with prolonged decrease in blood pressure and volume. the heart is required to do less work and disuse atrophy ensues. in fact. i Microcardia significance and. 387. CAFFEV. . however..”4” even It can ance young readily group. 1”ourth Inc. showed instances. precarious it becomes more fluid profoundly Appropriate condition. and in where a in blood volPatients with exhibit cases. 3.VOL. such It starvation is usually or seen chronic as the wasting result of disand cases. This atrophy is evidently reversible as the heart returns to normal with a consequence and size cardiac of with appropriate atrophy undernutrition by our also therapy.4 cardiac asthmatic these counted “elongation” and an is noted attacks the apparent decrease in secondary to severe and bronchiolitis. Case II. Swischuk. of Radiology of Oklahoma. No. case. Book p. not as widely with mentioned cardiac This type appreciated atrophy. the diaphragm. Two with without broad cardiac groups. Street 73104 Children’s Memorial Hospital Soo Northeast Thirteenth Oklahoma City. in most standard in of microcardia as is microcardia though textbooks. This has been substantiated by Hellerstein and Santiago_Stevenson’ in their comprehensive study of cardiac that with atrophy. are frequently size this Small seen in is probably a corcardiac silhouettes normal asthenic in- ease as malignant neoplasms dividuals. Pediatric Year 1961. illustrating each type is reported etiologic factors are considered. disease that the hypotension volume encountered are be in the responsible further for postulated shock may be present. In changes of chronic infection. Oklahoma REFERENCES Fic. for to the of can the heart be ac- by “squeezing” the of increased mediastinum intrathoracic and seconpres- most commonly associated and chronic infection. edition. monary edema due to overhydration. and at all ages. be seen is more child. M. as demonstrated SUMMARY The rather rare problem of microcardia is reviewed. in the vast first severe I 17 little majority rect clinical of assumption. was neoplasm Microcardia it where they.”4 Microcardia occurs and as cachexia.
244-245. W. B. Philadelphia.ii8 2. SHANKS. 5950. HELLERSTEIN. 26. Company. Saunders 3. H. C. of Pediatrics. Circulation. 5. Atrophy of heart. Editors. p. Philadelphia. 27.. MAY. E. 4. W. Editor. Eighth edition.. correlative study eighty-five proved cases. P. 5964. K. 1290-1293. 1962. Saunders Company. D. Leonard Golden’s Diagnostic Roentgenology. pp. and Wilkins Company. A Third edition. 5968 Williams 5964. and KERLEY. S. pp. E. Baltimore. Swischuk NELSON. and SANTIAGO-STEVENSON. Textbook B. Textbook of X-Ray Diagnosis. . 93-I of I.