Looking Beyond Liver! Cirrhotic Cardiomyopathy: Pathophysiology, Clinical Presentation and Management Strategies (original) (raw)

Cirrhotic Cardiomyopathy; Pathophysiology and Clinical Approach

Abdomen, 2015

Cardiac dysfunction is considerably discovered in patients with liver cirrhosis. Cirrhotic cardiomyopathy (CCM) has newly been assigned to as an entity separate of the cirrhosis etiology. Increased cardiac output due to hyperdynamic circulation, left ventricular dysfunction (systolic and diastolic) and certain electro-physiological abnormal findings are pathophysiological features of the disease. The main underlying mechanisms are complex, including the impaired β-receptor and calcium signaling, altered cardiomyocyte membrane physiology, elevated sympathetic nervous tone and increased activity of vasodilatory pathways. CCM character is impaired cardiac response to stress (physical, physiological and pharmacological). Currently, no specific therapy has proved effective yet. Echocardiography and electrocardiography are the corner stones for diagnosis. In this review, we discuss in brief the pathophysiological bachground and clinical features of cirrhotic cardiomyopathy, diagnosis and the currently available treatment options.

Cirrhotic cardiomyopathy: A cardiologist’s perspective

World Journal of Gastroenterology, 2014

Cardiac dysfunction is frequently observed in patients with cirrhosis, and has long been linked to the direct toxic effect of alcohol. Cirrhotic cardiomyopathy (CCM) has recently been identified as an entity regardless of the cirrhosis etiology. Increased cardiac output due to hyperdynamic circulation is a pathophysiological hallmark of the disease. The underlying mechanisms involved in pathogenesis of CCM are complex and involve various neurohumoral and cellular pathways, including the impaired β-receptor and calcium signaling, altered cardiomyocyte membrane physiology, elevated sympathetic nervous tone and increased activity of vasodilatory pathways predominantly through the actions of nitric oxide, carbon monoxide and endocannabinoids. The main clinical features of CCM include attenuated systolic contractility in response to physiologic or pharmacologic strain, diastolic dysfunction, electrical conductance abnormalities and chronotropic incompetence. Particularly the diastolic dysfunction with impaired ventricular WJG 20 th Anniversary S Special Issues (11): Cirrho hosis TOPIC HIGHLIGHT 15492 November 14, 2014|Volume 20|Issue 42| WJG|www.wjgnet.com relaxation and ventricular filling is a prominent feature of CCM. The underlying mechanism of diastolic dysfunction in cirrhosis is likely due to the increased myocardial wall stiffness caused by myocardial hypertrophy, fibrosis and subendothelial edema, subsequently resulting in high filling pressures of the left ventricle and atrium. Currently, no specific treatment exists for CCM. The liver transplantation is the only established effective therapy for patients with end-stage liver disease and associated cardiac failure. Liver transplantation has been shown to reverse systolic and diastolic dysfunction and the prolonged QT interval after transplantation. Here, we review the pathophysiological basis and clinical features of cirrhotic cardiomyopathy, and discuss currently available limited therapeutic options.

Cirrhotic Cardiomyopathy – a significant complication of Chronic Liver Disease Patients

IOSR Journal of Dental and Medical Sciences, 2014

Cirrhosis is very serious condition and associated with a range of cardiac abnormalities. However scanty information is available about the cardiac changes in cirrhotic patients in Indian setup, like increased resting cardiac output, blunted response to stress, left ventricular diastolic dysfunction and increased wall thickness of all cardiac chambers. These concomitant cardiac abnormalities in patients with cirrhosis have been termed as 'Cirrhotic Cardiomyopathy which may be a major cause of morbidity and mortality in patients with cirrhosis and liver transplant patients. With the advent of increased liver transplantation in India, this entity may have its impact on the transplantation success.

Cardiac dysfunction in cirrhosis - does adrenal function play a role? A hypothesis

Liver International, 2012

Cirrhotic cardiomyopathy (CCM), a condition of unknown pathogenesis, is characterized by suboptimal ventricular contractile response to stress, diastolic dysfunction and QT interval prolongation. It is most often found in patients with advanced cirrhosis. It is clinically relevant during stressful conditions, such as sepsis, bleeding and surgery. CCM reverses after liver transplantation and potentially has a role in the pathogenesis of hepatorenal syndrome. In adrenal insufficiency (AI), cardiac dysfunction is a feature with low ejection fraction, decreased left ventricular chamber size and electrocardiographic abnormalities, including QT interval prolongation. With optimal diagnostic tests, AI is present in approximately 10% of patients with cirrhosis, particularly in those with advanced disease. Down-regulation and decreased number of beta-adrenergic receptors, and high catecholamine levels are common to both cardiac conditions. Thus, AI may play a role in CCM. Steroid replacement therapy reverses cardiac changes in AI, and may do so for CCM, with important therapeutic implications; this needs formal evaluation.

Physiopathological and diagnostic aspects of cirrhotic cardiomyopathy

Archivos de cardiolog�a de M�xico (English ed. Internet), 2020

Cirrhotic cardiomyopathy is characterized by the presence of structural and functional cardiac alterations in patients suffering from hepatic cirrhosis, without previously known cardiac causes that may explain it. Clinically, it is characterized by the presence of variable grades of diastolic and systolic dysfunction (SD), alterations in the electric conductance (elongation of corrected QT interval) and inadequate chronotropic response. This pathology has been related to substandard response in the management of patients with portal hypertension and poor outcome after transplant. Even when the first description of this pathology dates back from 1953, it remains a poorly studied and frequently underdiagnosed entity. Echocardiography prevails as a practical diagnostic tool for this pathology since simple measurements as the E/A index can show diastolic dysfunction. SD discloses as a diminished ejection fraction of the left ventricle and the latent forms are detected by echocardiography studies with pharmacological stress. In recent years, new techniques such as the longitudinal strain have been studied and they seem promising for the detection of early alterations.

Cardiac Changes in Cirrhotic Patients

Afro-Egyptian Journal of Infectious and Endemic Diseases, 2020

Background and study aim: Cardiac dysfunction in cirrhotic patients presented by imperfect cardiac contractility in response to stress and/or change in the diastolic relaxation of the heart with electrophysiological changes in lack of other recognized cardiac disease. The study aimed to assess the cardiac changes in cirrhotic patients. Patients and Methods: our study was conducted on 100 adult cirrhotic patients who were divided according to the Child Pugh score into 3 groups: G1: comprised 30 Child A patients. G2: comprised 30 Child B patients. G3: comprised 40 Child C patients. Full history, clinical examination, laboratory (CBC, liver and kidney function tests, viral markers and FBS), ECG and cardiac echo-doppler were done for all patients. Results: Out of 100 cirrhotic patients, QTC interval was found to be prolonged in 70 cirrhotic patients. Echocardiographic abnormalities were found in Child B and C group patients more than in Child A patients. There was significant increase in Echo parameters as (IVRT and PAP) with liver disease deterioration from Child A to Child C. There was no significant difference regarding left and right ventricular end diastolic diameter among the studied groups. Conclusion: 70% of cirrhotic patients had cardiac changes and there is positive correlation between severity of liver cirrhosis and cardiac changes.

Study of Cardiac Abnormalities in Patient with Cirrhosis of Liver

Scholars Journal of Applied Medical Sciences, 2020

Original Research Article Background: Cirrhosis is defined as diffuse disruption of the normal architecture of the liver with fibrosis and nodule formation. There are significant secondary effect of cirrhosis on cardiac, pulmonary and renal systems. Cirrhotic cardiomyopathy includes combination of reduced cardiac contractility with systolic and diastolic dysfunction and electrophysiological abnormalities. Objectives: To analyze the cardiac abnormalities in cirrhotic patients. Materials and methods: This is a retrospective study conducted at Department of General Medicine, MIMS, Mandya. ECG and 2D ECHO reports of patients admitted with cirrhosis of liver were obtained from case sheets, data entered into Excel sheet and analysed. Results: Out of the hundred patients included in study, 43 Patients had diastolic dysfunction, 19 patients had systolic dysfunction on echocardiography. 26 patients had dilated cardiomyopathy, 4 patients had mitral regurgitation, 5 patients had atrial fibrillation, 3 patients had RV dysfunction with pulmonary hypertension, ECG in 40 patients showed QTc prolongation. Conclusion: In our study Diastolic dysfunction was the most common cardiac abnormality found on echocardiography. Apart from conventional complications of cirrhosis, cardiac abnormalities are frequently present in patients with cirrhosis of liver. Which will adversely affect morbidity and mortality in these patients.