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Cardiovascular changes in children with sickle cell crisis

Published online by Cambridge University Press:  24 January 2020

Richard Onalo Open the ORCID record for Richard Onalo [Opens in a new window] ,
Peter Cooper ,
Antoinette Cilliers  and
Uche Nnebe-Agumadu
Richard Onalo*
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
Peter Cooper
Affiliation:
Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Antoinette Cilliers
Affiliation:
Paediatric Cardiology Unit, Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Uche Nnebe-Agumadu
Affiliation:
Paediatric Haematology Unit, Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
*
Author for correspondence: Richard Onalo, Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, PMB 117, Gwagwalada, Abuja, Nigeria. Tel: +234 803 701 7678; E-mail: richardonalo@yahoo.com
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Abstract

Background:

Sickle cell anaemia is characterised by frequent, sometimes serious events referred to as “crisis”. Cardiopulmonary consequences such as pulmonary hypertension and myocardial ischaemia may accompany a serious crisis.

Objective:

To determine the cardiovascular changes that occur during a severe sickle cell crisis.

Methods:

A cross-sectional comparative study of sickle cell anaemia in children (5–17 years) admitted during a severe crisis (cases) and those in steady state (controls) was conducted over a 2-year period. Effects of the crisis on the cardiopulmonary system were assessed. The diagnosis of myocardial ischaemia was made using electrocardiography and serological cardiac biomarkers, while cardiac dysfunction and the presence of pulmonary hypertension were determined using echocardiography. The presence of systemic hypertension and tachycardia was also evaluated.

Results:

A total of 176 patients were recruited, 92 in steady state (male:female ratio, 1.2:1) and 84 in severe crisis (male:female ratio, 1.3:1). The mean age was 10.4 ± 3.2 years for steady state and 10.5 ± 3.4 years for those in crisis. The mean heart rate in crisis was higher than in steady state (p < 0.0001). The blood pressures (systolic, p < 0.0001, diastolic, p < 0.0001, mean, p < 0.0001) as well as myocardial ischaemia scores (p < 0.0001) were higher in patients with crisis than in those in steady state. Similarly, conduction abnormalities, pulmonary hypertension, and ventricular dysfunction were more prevalent in the crisis than in the steady state.

Conclusion:

The present data suggest that sickle cell crisis results in a derangement of clinical, electrocardiographical, and echocardiographical parameters in children with sickle cell anaemia. Further research on these cardiovascular events may improve the overall care of these patients.

Keywords

Heart changespulmonary changessickle cell crisisNigerian children
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 2 , February 2020 , pp. 162 - 170
Copyright
© Cambridge University Press 2020

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