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Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease
1Department of Clinical Physiology, 239, Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark. soeren.moeller@hh.hosp.dk
Insights
Patients with cirrhosis exhibit a hyperdynamic circulatory system and a distinct cardiac dysfunction known as cirrhotic cardiomyopathy. This condition can lead to fluid retention and unmask heart failure, requiring careful management during procedures.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Systemic circulation in cirrhosis is characterized by a hyperdynamic state.
- Key alterations include increased cardiac output, elevated heart rate, and reduced systemic vascular resistance.
- A distinct cardiac dysfunction, termed "cirrhotic cardiomyopathy," is recognized and differs from alcoholic heart muscle disease.
Purpose of the Study:
- To describe the cardiovascular alterations in patients with cirrhosis.
- To define and differentiate cirrhotic cardiomyopathy from other cardiac conditions.
- To highlight clinical manifestations and implications for patient management.
Main Methods:
- Review of systemic circulation patterns in cirrhotic patients.
- Clinical observation of sodium and fluid retention.
- Assessment of latent heart failure unmasked by physiological stress.
Main Results:
- Cirrhosis induces a hyperdynamic systemic circulation.
- Cirrhotic cardiomyopathy is a specific cardiac dysfunction in these patients.
- Sodium/fluid retention and latent heart failure are common clinical presentations.
Conclusions:
- Cirrhotic cardiomyopathy is a significant clinical entity in liver cirrhosis.
- Careful consideration is needed for procedures stressing the heart, like shunt implantation or liver transplantation.
- No specific treatment is currently recommended, emphasizing cautious management.
Abstract:
The systemic circulation in patients with cirrhosis is hyperdynamic with an increased cardiac output and heart rate and a reduced systemic vascular resistance as the most pronounced alterations. The concomitant cardiac dysfunction has recently been termed "cirrhotic cardiomyopathy", which is an entity different from that seen in alcoholic heart muscle disease. Clinically, these patients present with sodium fluid retention and strain often unmasks the presence of latent heart failure. No specific treatment can yet be recommended but caution should be used with respect to procedures that may stress the heart such as shunt implantation and liver transplantation.