A CASE OF SEVERE HYPOALBUMINEMIA ASSOCIATED WITH CHRONIC CONGESTIVE HEART FAILURE: THE ROLE OF THE TRICUSPID REGURGITATION

Authors

  • Ioana Dana ALEXA University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi
  • Adina Carmen ILIE University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi
  • Anca MOROSANU University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi
  • Irina CRACANA “Dr. C.I. Parhon” Hospital, Iaşi
  • Ramona ONUTU “Dr. C.I. Parhon” Hospital, Iaşi
  • Ana VOICA “Dr. C.I. Parhon” Hospital, Iaşi
  • A. LUCA University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi

Keywords:

HYPOALBUMINEMIA, CONGESTIVE HEART FAILURE, TRICUSPID REGURGITATION.

Abstract

Hypoalbuminemia is considered an independent predictor of mortality, especially in elderly patients. It is common in patients with congestive heart failure, when is due to several mechanisms: increased volume of distribution, significant stasis in the mesenteric circulation and altered protein metabolism in the liver. These alterations are even more pregnant when tricuspid regurgitation is associated or aggravated by different risk factors (recent infections, anemia, hyperthyroidism). We present the case of an elderly patient with severe hypoproteinemia and important hypoalbuminemia associated with congestive heart failure and aggravation of tricuspid regurgitation. The differential diagnosis concluded that hypoalbuminemia was influenced by tricuspid regurgitation as it enhanced liver dysfunction and enteral protein absorption due to increased stasis in mesenteric system. On the other hand, hypoalbuminemia contributed to the progression of heart failure by favoring myocardial edema, volume overload, and diuretic resistance. This is why correct management of this situation should include removal of subclinical excess of fluid and renutrition. A multidisciplinary approach is needed in order to achieve a good control of the symptoms and a significant improvement of quality of life.

Author Biographies

  • Ioana Dana ALEXA, University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi

    Faculty of Medicine
    Discipline of Internal Medicine, Nephrology and Geriatrics

  • Adina Carmen ILIE, University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi

    Faculty of Medicine
    Discipline of Internal Medicine, Nephrology and Geriatrics

  • Anca MOROSANU, University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi

    Faculty of Medicine
    Discipline of Internal Medicine, Nephrology and Geriatrics

  • Irina CRACANA, “Dr. C.I. Parhon” Hospital, Iaşi

    Department of Clinical Geriatrics

  • Ramona ONUTU, “Dr. C.I. Parhon” Hospital, Iaşi

    Department of Clinical Geriatrics

  • Ana VOICA, “Dr. C.I. Parhon” Hospital, Iaşi

    Department of Clinical Geriatrics

  • A. LUCA, University of Medicine and Pharmacy “Grigore T. Popa” - Iaşi

    Faculty of Medicine
    PhD Student

References

1. ‘Hazzard’s Geriatric Medicine and Gerontology’, Sixth Edition, 2009 The McGraw-Hill Companies, Inc. ch.38, Nutrition and Aging, page 455-460.
2. Ferguson RP, O'Connor P, Crabtree B, Batchelor A, Mitchell J, Coppola D, ‘Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents. J Am Ger Soc 1993, 41(5): 545-549.
3. Liu M, Chan C, Yan B, et al. Albumin levels predict survival in patients with heart failure and preserved ejection fraction. Eur J Heart Fail, 2011; (4): 39-44.
4. Landi F, Liperoti R, Russo A, et al. Association of anorexia with sarcopenia in a community-dwelling elderly population: results from the ilSIRENTE study. Eur J Nutr. 2013; 52(3): 1261-1268.
5. Chapman IM. The anorexia of aging. Clin Geriatr Med, 2007; 23(4): 735-756.
6. Jahn P, Renz P, Stukenkemper J, Book K, et al. Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial. Support Care Cancer. 2009; 17(12): 1543-1552.
7. Arques S: Serum albumin and heart failure: recent advances on a new paradigm. Ann Cardiol Angeiol, 2011; 60(5): 272-278.
8. Uthamalingam S, Kandala J, Daley M, et al. Serum albumin and mortality in acutely decompensated heart failure. Am Heart J. 2010; 160(6): 1149-1155.
9. Ajayi A, Adigun A, Ojofeitimi E, Yusuph H, Ajayi O. Anthropometric evaluation of cachexia in chronic congestive heart failure: the role of tricuspid regurgitation. Int J Cardiol, 1999; 71(1):79-84.
10. Sekine S, Abe T, Seki K, Goto Y, Shibata Y, Yamagishi I. Hypoproteinemia caused by tricuspid regurgitation: report of a case. Surgery Today, 1998, 28(12): 1287-1289.
11. Lau G, Tan H, Kritharides L. Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation. Am J Cardiol 2002; 15(90): 1405-1409.
12. Bleske BE, Clark MM, Wu AH, Dorsch MP. The effect of continuous infusion loop diuretics in pa-tients with acute decompensated heart failure with hypoalbuminemia. J Cardiovasc Pharmacol Ther, 2013; 18(4): 334-337.

Additional Files

Published

2018-05-14

Issue

Section

INTERNAL MEDICINE - PEDIATRICS