Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease

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.

Figure 1

Potential pathophysiological components implicated in the development of cirrhotic cardiomyopathy. CNS, central nervous system; CO, carbon monoxide; NO, nitric oxide; QT_c, frequency adjusted QT interval; SNS, sympathetic nervous system; TNF-α, tumour necrosis factor α.