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Cirrhosis causes circulatory issues like hyperkinetic circulation and potential cardiomyopathy. While cirrhosis may protect against overt heart failure, it impacts cardiac function and increases endocarditis risk.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Cirrhosis presents with significant circulatory abnormalities, including hyperkinetic circulation.
- Patients may have subclinical cardiomyopathy, particularly with alcoholic cirrhosis.
Purpose of the Study:
- To explore the multifaceted cardiac complications and associations in patients with cirrhosis.
- To investigate the impact of cirrhosis on cardiac function, atherosclerosis, and infection risk.
Main Methods:
- Review of existing literature on circulatory changes in cirrhosis.
- Analysis of cardiac function, including ventricular function under stress.
- Examination of associations with coronary atherosclerosis, endocarditis, and ascites.
Main Results:
- Typical hyperkinetic circulation with low arterial pressure and peripheral resistance.
- Subclinical cardiomyopathy is common, especially in alcoholic cirrhosis, with delayed overt heart failure.
- Cirrhosis is linked to reduced coronary atherosclerosis and increased bacterial endocarditis risk.
Conclusions:
- Cirrhosis induces complex circulatory and cardiac changes, including cardiomyopathy.
- Ascites impacts cardiac output, while cirrhosis may paradoxically reduce heart failure progression.
- Understanding these cardiac effects is crucial for managing cirrhotic patients.
Abstract:
Cirrhosis is associated with several circulatory abnormalities. A hyperkinetic circulation characterized by increased cardiac output and decreased arterial pressure and peripheral resistance is typical. Despite this hyperkinetic circulation, some patients with alcoholic cirrhosis have subclinical cardiomyopathy with evidence of abnormal ventricular function unmasked by physiologic or pharmacologic stress. Florid congestive alcoholic cardiomyopathy develops in a small percentage, but the concurrent presence of cirrhosis seems to retard the occurrence of overt heart failure. Even nonalcoholic cirrhosis may be associated with latent cardiomyopathy, although overt heart failure is not observed. Tense ascites is associated with some cardiac compromise, and removing or mobilizing ascitic fluid by paracentesis or peritoneovenous shunting results in short-term increases in cardiac output. Cirrhosis also appears to be associated with a decreased risk of major coronary atherosclerosis and an increased risk of bacterial endocarditis. Small hemodynamically insignificant pericardial effusions may be seen in ascitic patients. The release of atrial natriuretic peptide appears to be unimpaired in cirrhosis, although the kidney may be hyporesponsive to its natriuretic effects.