The Jaundiced Heart: Evidence of Blunted Response to Positive Inotropic Stimulation

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Abstract
Obstructive jaundice has been known to cause severe hemodynamic disturbance. The present study was therefore designed to assess the cardiac involvement in jaundiced patients. The multiple-gated blood pool cardioscintigraphic studies were done in 9 jaundiced patients who had either cholestatic or obstructive jaundice (mean total bilirubin 29.30 ± 3.30 mg/dL), and in 8 normal volunteers (total bilirubin < 1 mg%). None of the patients had evidences of obvious cirrhosis, intrinisic heart disease, or septicemia. Following intravenous dobutamine there was comparable change of blood pressure and heart rate in both groups. However the response of left ventricular ejection fraction (LVEF) to dobutamine (10 μg/kg/min × 5 min) was strikingly blunted in the jaundiced patients as compared to that seen in the normal controls (3.56 ± 0.9 vs. 12.7 ± 2.2%, p < 0.005). Our present data thus show that there is blunted myocardial contractile response to the inotropic stimulation in jaundiced patients. Such myocardial refractoriness to beta-1 stimulation may contribute to the susceptibility of jaundiced patients to postoperative shock and acute renal failure.