Cardiac and vascular changes in cirrhosis: pathogenic mechanisms.
Cardiovascular abnormalities accompany both portal hypertension and cirrhosis. These consist of hyperdynamic circulation, defined as reduced mean arterial pressure and systemic vascular resistance, and increased cardiac output. Despite the baseline increased cardiac output, ventricular inotropic and chronotropic responses to stimuli are blunted, a condition known as cirrhotic cardiomyopathy. Both conditions may play an initiating or aggravating pathogenic role in many of the complications of liver failure or portal hypertension including ascites, variceal bleeding, hepatorenal syndrome and increased postoperative mortality after major surgery or liver transplantation. This review briefly examines the major mechanisms that may underlie these cardiovascular abnormalities, concentrating on nitric oxide, endogenous cannabinoids, central neural activation and adrenergic receptor changes. Future work should address the complex interrelationships between these systems.
Liu
HongQun
H
Liver Unit, Department of Medicine, University of Calgary. 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
Gaskari
Seyed Ali
SA
Lee
Samuel S
SS
D001775:Blood Circulation / Q000502:physiology; D063385:Cannabinoid Receptor Modulators / Q000502:physiology; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D008560:Membrane Fluidity; D009569:Nitric Oxide / Q000502:physiology; D011943:Receptors, Adrenergic, beta / Q000502:physiology; D014652:Vascular Diseases / Q000209:etiology*
D063385:Cannabinoid Receptor Modulators; D011943:Receptors, Adrenergic, beta; D009569:Nitric Oxide