A Study of Cardiac Dysfunction in Cirrhotic Patients.

INTRODUCTION : Liver cirrhosis is associated with a wide range of cardiovascular abnormalities. This was first described by Kowalski and Abelmann who noted a higher resting cardiac output and decreased systemic vascular resistance in patients with cirrhosis. However, despite the hyperdynamic circulation, impaired ventricular contractility in response to stimuli was described in cirrhotic patients. These abnormalities were initially thought to be a manifestation of latent alcoholic cardiomyopathy. But in the mid- 1980s, studies in nonalcoholic patients and in experimental animal models showed a similar pattern of blunted cardiac contractile responsiveness. Thus these cardiovascular changes are now termed ‘cirrhotic cardiomyopathy’. The prevalence of cirrhotic cardiomyopathy remains unknown at present. Features include structural, histological, electrophysiological, systolic and diastolic dysfunction. Multiple factors are considered as responsible, including impaired beta-adrenergic receptor signal transduction, abnormal membrane biophysical characteristics, and increased activity of cardiodepressant systems mediated by cGMP. Overt heart failure is not generally a feature of cirrhotic cardiomyopathy, because the associated marked vasodilatation accompanying the hyperdynamic circulation significantly reduces ventricular afterload. However, major stresses on the cardiovascular system such as liver transplantation, infections and insertion of transjugular intrahepatic portosystemic 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 and circulatory failure in liver cirrhosis. Diastolic dysfunction is present in the vast majority of patients with cirrhotic cardiomyopathy, and that simple echocardiographic indices such as the E/A ratio may detect diastolic dysfunction even at rest. This may therefore represent the best available screening test to diagnose cardiac dysfunction. AIM OF THE STUDY : 1. To study the cardiac dysfunction in cases diagnosed with cirrhosis of liver of nonalcoholic etiology. 2. To study the conduction disturbances in cases diagnosed with cirrhosis of liver of nonalcoholic etiology. 3. To assess the relationship between the severity of cirrhosis and the presence of cirrhotic cardiomyopathy. 4. To assess the relationship between ascites and the presence of cirrhotic cardiomyopathy. CONCLUSION : Cirrhotic patients with non alcoholic etiology do have evidence of cirrhotic cardiomyopathy. They have features in the form of diastolic dysfunction and prolonged QTc interval. Diastolic dysfunction is manifested as E/A ratio less than 1. • The presence of cirrhotic cardiomyopathy was independent of the etiology. • Some degree of diastolic dysfunction is seen in almost all cirrhotics. • Diastolic dysfunction seen in cirrhosis is associated with older age. • Ascites is a significant feature of all cases with diastolic dysfunction. • The severity of cirrhosis does not correlate with the presence of diastolic dysfunction • Prolongation of QTc interval is influenced by the sex of the cirrhotic individuals • Ventricular end diastolic volume, end systolic volume and ejection fraction are not significantly affected in cirrhotic individuals