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

Department of Clinical Physiology, 239, Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark

Correspondence to:
Correspondence to:
Dr S Møller, Department of Clinical Physiology, 239, Hvidovre Hospital, DK-2650 Hvidovre, Denmark;
soeren.moeller{at}hh.hosp.dk

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.

Keywords: cirrhotic cardiomyopathy; hyperdynamic circulatory dysfunction; liver failure; heart failure

Abbreviations: CO, cardiac output; PAP, pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; RAP, right atrial pressure; TIPS, transvenous intrahepatic portosystemic shunt

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