Cirrhotic cardiomyopathy

Soonkoo Baik, Tamer R. Fouad, Samuel S. Lee

Research output: Contribution to journalReview article

71 Citations (Scopus)

Abstract

Cirrhotic cardiomyopathy is the term used to describe a constellation of features indicative of abnormal heart structure and function in patients with cirrhosis. These include systolic and diastolic dysfunction, electrophysiological changes, and macroscopic and microscopic structural changes. The prevalence of cirrhotic cardiomyopathy remains unknown at present, mostly because the disease is generally latent and shows itself when the patient is subjected to stress such as exercise, drugs, hemorrhage and surgery. The main clinical features of cirrhotic cardiomyopathy include baseline increased cardiac output, attenuated systolic contraction or diastolic relaxation in response to physiologic, pharmacologic and surgical stress, and electrical conductance abnormalities (prolonged QT interval). In the majority of cases, diastolic dysfunction precedes systolic dysfunction, which tends to manifest only under conditions of stress. Generally, cirrhotic cardiomyopathy with overt severe heart failure is rare. Major stresses on the cardiovascular system such as liver transplantation, infections and insertion of transjugular intrahepatic portosystemic stent-shunts (TIPS) can unmask the presence of cirrhotic cardiomyopathy and thereby convert latent to overt heart failure. Cirrhotic cardiomyopathy may also contribute to the pathogenesis of hepatorenal syndrome. Pathogenic mechanisms of cirrhotic cardiomyopathy are multiple and include abnormal membrane biophysical characteristics, impaired β-adrenergic receptor signal transduction and increased activity of negative-inotropic pathways mediated by cGMP. Diagnosis and differential diagnosis require a careful assessment of patient history probing for excessive alcohol, physical examination for signs of hypertension such as retinal vascular changes, and appropriate diagnostic tests such as exercise stress electrocardiography, nuclear heart scans and coronary angiography. Current management recommendations include empirical, nonspecific and mainly supportive measures. The exact prognosis remains unclear. The extent of cirrhotic cardiomyopathy generally correlates to the degree of liver insufficiency. Reversibility is possible (either pharmacological or after liver transplantation), but further studies are needed.

Original languageEnglish
Article number15
JournalOrphanet Journal of Rare Diseases
Volume2
Issue number1
DOIs
Publication statusPublished - 2007 May 9

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Cardiomyopathies
Liver Transplantation
Heart Failure
Exercise
Hepatorenal Syndrome
Transjugular Intrahepatic Portasystemic Shunt
Hepatic Insufficiency
Retinal Vessels
Cardiovascular System
Coronary Angiography
Routine Diagnostic Tests
Cardiac Output
Adrenergic Receptors
Physical Examination
Stents
Signal Transduction
Electrocardiography
Differential Diagnosis
Fibrosis
Alcohols

All Science Journal Classification (ASJC) codes

  • Genetics(clinical)
  • Pharmacology (medical)

Cite this

Baik, Soonkoo ; Fouad, Tamer R. ; Lee, Samuel S. / Cirrhotic cardiomyopathy. In: Orphanet Journal of Rare Diseases. 2007 ; Vol. 2, No. 1.
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Cirrhotic cardiomyopathy. / Baik, Soonkoo; Fouad, Tamer R.; Lee, Samuel S.

In: Orphanet Journal of Rare Diseases, Vol. 2, No. 1, 15, 09.05.2007.

Research output: Contribution to journalReview article

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