THE ELECTROCARDIOGRAPHIC CHANGES IN CHILDREN WITH ANAEMIA SEEN IN IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA

Abstract

Anaemia is a major cause of morbidity and mortality in Nigerian children. It
affects all the systems of the body including the heart. Electrocardiography was used in
this study to investigate the prevalence and pattern of ECG abnormalities in Nigerian
children with anaemia. The knowledge of this information in these children when
available to the physician will modify the immediate and long term treatment given to
these children to reduce morbidity and mortality.
A prospective cross sectional study of 94 children (cases) aged 6 months to 16
years with anaemia (packed cell volume (PCV) <33%) and 94 age and sex- matched
controls without anaemia (PCV >33%) recruited from the Paediatric Out Patients Clinic,
Children Emergency Room and the Paediatric Medical Ward of Irrua Specialist Teaching
Hospital (ISTH), Irrua, was done from September to December 2009. Each case and
control was assessed clinically following which the cardiovascular function was
evaluated using eletrocardiography.
The cases were classified as sickle cell anaemia (SCA) cases, non-SCA cases
without anaemic heart failure (AHF) and cases with AHF. Data was analysed using the
appropriate statistical test. P-values less than 0.05 were taken as indicative of statistical
significance.
The prevalence of ECG abnormalities was significantly higher in the cases
(76.6%) than in the controls (40.4%) (X2 = 25.3, p = 0.00). The prevalence of ECG
abnormalities was also significantly higher in the cases without SCA and AHF (66.7%)
than in the controls ( X² = 8.8, p = 0.003) . A significantly higher number of non-SCA,
non-AHF cases than the controls had sinus tachycardia ( X2= 6.1, p = 0.014).
The prevalence of ECG abnormalities in SCA cases (82.9%) although higher,
was not significantly different from that in the non-SCA, non-AHF cases (66.7%) ( X² =
2.7, p =0.09). The SCA cases had a higher prevalence of ventricular hypertrophy,
especially biventricular hypertrophy (17.1% versus 0%, p = 0.01) . The prevalence of
long QTc in the SCA cases was statistically higher than in the controls ( p = 0.012) and
the mean QTc interval was also longer in the SCA cases.
Sinus tachycardia was the major abnormality in the cases with anaemic heart
failure and occurred in 100% of the cases. The study also showed that the prevalence of
ECG abnormalities increased with increased severity of anaemia.
There was a significant positive correlation, in the severely anaemic cases, between
the PCV and the P amplitude ( p = 0.03), PR interval ( p = 0.024), QRS duration ( p =
0.049), QT interval ( p = 0.042) and RV6 ( p = 0.028) and a significant negative
correlation with the heart rate ( p = 0.009).
It was concluded from the findings in this study that anaemia is associated with
an increased prevalence of ECG abnormalities, mainly sinus tachycardia and ventricular
hypertrophy, that, the main additional effects of SCA in anaemia were biventricular
hypertrophy and long QTc interval while increased prevalence of sinus tachycardia was
the main additional ECG abnormality in AHF . It was also concluded that the prevalence
of ECG abnormalities increased with the severity of anaemia .
The findings in this study imply that children with anaemia are prone to ECG
changes that are potentially life threatening and may therefore contribute to morbidity
and mortality. Routine ECG for these patients may be necessary for early detection of
abnormalities and appropriate intervention but as the limitations of this study cannot
support a definitive conclusion, further studies using more rigourous methods will be
required.

THE ELECTROCARDIOGRAPHIC CHANGES IN CHILDREN WITH ANAEMIA SEEN IN IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA