Albumin-induced changes in the electrocardiographic QRS complex

Effect of serum albumin on QRS wave amplitude in patients free of heart disease

We studied 193 patients free of heart disease to determine the relation between QRS amplitude and serum albumin. Although there were no significant differences in echocardiographic indexes between the 2 groups, albumin (35.1 +/- 4.3 vs 40.1 +/- 3.2 g/L) and colloid osmotic pressure (21 +/- 4 vs 24 +/- 3 mm Hg) were significantly lower in patients with low voltages compared with those without. Moreover, there was a good relation (r = 0.78) between change in QRS amplitude and change in albumin concentration.

Diminution of QRS complexes caused by anasarca after an acute myocardial infarction: a case report and a discussion of the plausible underlying pathophysiological mechanisms

We describe the case of an 81-year-old man with an acute anterior myocardial infarction (MI), complicated by anoxic encephalopathy, respiratory, and acute renal failure, who developed gradually marked reduction in the QRS complexes of his electrocardiogram (ECG) in the process of gaining 44 pounds, due to anasarca. Such ECG pattern has been recently associated with marked peripheral edema in the context of critical illness of varying etiologies. Our patient did not have a pericardial effusion, and his gradually increasing weight values correlated strongly with the corresponding sums of the amplitudes of the QRS complexes of the 12-lead ECGs (r =.92, P =.0029). The mechanism of this ECG phenomenon is attributed to a reduction of the overall transfer impedance of the conducting volume surrounding the heart, which leads to an attenuation of the potentials recorded on the body surface, due to a shunting effect of the edematous subcutaneous connective tissues. This reduction of the composite transfer impedance of the conducting medium is being mediated by the low resistivity of the water of the retained anasarca fluid.

Electrical resistances of interstitial and microvascular space as determinants of the extracellular electrical field and velocity of propagation in ventricular myocardium

BACKGROUND

In myocardial ventricular tissue, extracellular electrical resistance (ro) is an important determinant of propagation velocity (theta) and the magnitude of the extracellular bipolar electrogram (delta Vo). The extracellular space is composed of two compartments, the vascular space and the interstitial space. To assess the electrical equivalent of this compartmentation in the ventricular myocardium and its effect on ro, theta, and delta Vo, electrical cable analysis was performed in an arterially perfused rabbit papillary muscle.

METHODS AND RESULTS

Vascular resistivity was changed from 75 to 86 to 143 and to 221 omega/cm by variation of hematocrit in the perfusate from 0% to 10% to 40% and to 60%. As a means to vary the volume of the interstitial space and with this as its resistivity, colloid osmotic pressure (COP) in the perfusate was changed from 9 to 36 and to 94 mm Hg by altering the dextran concentration in the perfusate from 10 to 40 to 80 g/L. Decreasing COP had a marked effect on ro (56% decrease), delta Vo (decrease from 61 to 42 mV), theta (increase from 48 to 59 cm/s), and the diameter of the muscle fiber (increase of 12%). If COP was increased from 36 to 94 mm Hg, ro (by 35%) and delta Vo (from 62 to 75 mV) increased; theta and diameter showed no significant changes. In contrast, alterations of intravascular electrical resistivity in a range from 75 to 221 omega/cm did not induce any significant changes in ro, delta Vo, theta, and diameter of the preparations.

CONCLUSIONS

We conclude from our data that (1) the microvascular tree in ventricular myocardium is electrically insulated to a large degree from the interstitial space and that (2) electrical current flow in the extracellular space during excitation is confined to the narrow, anisotropic interstitial space.

Adverse reactions to human serum albumin

OBJECTIVE

To describe the adverse effects associated with human serum albumin (HSA) administration.

DATA SOURCES

A MEDLINE search and bibliography scanning were used to identify pertinent review articles, clinical studies, and case reports.

STUDY SELECTION

Emphasis was placed on reporting the results of human studies with the primary objective of investigating adverse effects attributable to HSA administration. Clinical trials that reported the occurrence of adverse effects possibly associated with HSA were also reviewed. Animal data were included where pertinent.

DATA EXTRACTION

Although isolated case reports were reviewed, data were primarily extracted from human studies involving large series of patients or studies that were randomized and prospective in nature.

DATA SYNTHESIS

Alterations in coagulation, renal, cardiovascular, and pulmonary functions were identified as potential adverse effects following the administration of HSA. Occurrences of hypersensitivity reactions, trace metal loading, and serum amino acid alterations associated with these infusions were also noted and are described here. Pulmonary and cardiovascular systems appear to be particularly prone to complications from excessive HSA administration. Adverse effects such as HSA-induced hypersensitivity reactions may be severe, but occur infrequently.

CONCLUSIONS

Controlled studies involving large numbers of patients are not currently available for an accurate assessment of the incidence of adverse effects attributable to HSA administration. Many of the reported reactions appear to be extensions of albumin's pharmacologic activities and would be expected to worsen following large doses of HSA.

The role of albumin in human physiology and pathophysiology, Part III: Albumin and disease states

The serum albumin level is one of several clinical parameters of the status of general health. There is a marked correlation between low albumin levels and the incidence of morbidity and mortality in hospitalized patients. Therefore, it is not surprising to find that hypoalbuminemia is a common finding among hospitalized patients. This results from alterations in the catabolic or anabolic rates, losses of albumin, or redistribution between the various fluid compartments of the body. Somewhat less well defined than the role of albumin as a prognostic indicator is its role in compounding pathophysiology. Hypoalbuminemia is known to be associated with delayed wound healing. The hypoalbuminemic state interferes with the normal functioning of the gastrointestinal tract. Qualitative changes in the albumin molecule which occur in renal disease may damage the nephron. Low serum albumin levels may adversely affect the coagulation system. Further investigation into the role of albumin in pathophysiology is warranted.