Pathogenesis and clinical significance of the hyperdynamic circulatory syndrome in liver cirrhosis. Review

Abstract

Portal hypertension is the major consequences of liver cirrhosis and is accompanied by pathologic increase in portal blood flow resistance. As portal hypertension develops that results in formation of vessel's collaterals and arterial vasodilatation. Hyperdynamic alternations become more significant due to hyporesponsiveness to vasoconstrictors and increased shunts formation with autonomic neuropathy. This combination of liver failure and portal hypertension leads to the hyperdynamic circulatory state partly owing to simultaneous vasodilatation of splanchnic and peripheral arterial vessels. So hyperdynamic circulatory syndrome is a late complication of portal hypertension due to liver cirrhosis. The main features of hyperdynamic circulatory syndrome are high cardiac output, increased heart rate and total blood volume coupled with decreased total systemic vascular resistance. Some of these cardiovascular changes are reversible after liver transplantation what show pathophysiological significance of portal hypertension. In this paper, we aimed to review pathophysiology and features of hyperdynamic syndrome that are well-known and directly related to portal hypertension (varices, ascites, hepatic encephalopathy and hepatorenal syndrome), while others are more rare and therefore further investigations are necessary (portopulmonary hypertension, cirrhotic cardiomyopathy).