CAMBIOS CARDIOVASCULARES EN LA CIRROSIS. EL IMPACTO DE LAS COMPLICACIONES Y LOS TRATAMIENTOS





CAMBIOS CARDIOVASCULARES EN LA CIRROSIS. EL IMPACTO DE LAS COMPLICACIONES Y LOS TRATAMIENTOS

(especial para SIIC © Derechos reservados)
El reconocimiento de cambios leves en la estructura cardíaca que pueden ser detectados incluso en las etapas iniciales de la cirrosis preascítica ha contribuido a una mejor comprensión de los trastornos cardiovasculares que se observan a medida que progresa la enfermedad.
pozzi9.jpg Autor:
Massimo Pozzi
Columnista Experto de SIIC

Institución:
Università degli Studi Milano-Bicocca


Artículos publicados por Massimo Pozzi
Coautores
Daniela Prata Pizzala* Laura Ratti* Maria Milanese* Alberto Doretti* Guido Grassi* Giuseppe Mancia* 
Università degli Studi Milano-Bicocca, Monza, Italia*
Recepción del artículo
4 de Abril, 2008
Aprobación
8 de Mayo, 2008
Primera edición
19 de Marzo, 2009
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
En tiempos recientes, la miocardiopatía cirrótica ha pasado a ser considerada una nueva entidad clínica. El reconocimiento de cambios leves en la estructura cardíaca que pueden ser detectados incluso en las etapas iniciales de la cirrosis preascítica ha contribuido a una mejor comprensión de los trastornos cardiovasculares que se observan a medida que progresa la enfermedad. Se han categorizado cambios cardíacos estructurales y se diagnóstica, con frecuencia, la disfunción diastólica. La cirrosis descompensada se caracteriza por una disminución de la presión sanguínea y de la resistencia vascular periférica, y un aumento del gasto cardíaco y de la frecuencia cardíaca, los cuales se producen en un escenario de circulación hiperdinámica favorecida por la expansión del volumen total sanguíneo, la sobrecarga circulatoria y la hiperactividad de los sistemas endógenos vasoactivos. La vasodilatación periférica evita la insuficiencia cardíaca. Recientemente se ha reconocido la existencia de una menor respuesta cardíaca en situaciones de estrés como son los cambios en las condiciones de la carga cardíaca en presencia de un mayor deterioro de la función hepática, tales como la ascitis refractaria, el síndrome hepatorrenal, la peritonitis bacteriana espontánea y la hemorragia de várices esofágicas. Ante la disponibilidad de intervenciones terapéuticas (paracentesis, comunicación portosistémica intrahepática transyugular, comunicación venosa peritoneal, trasplante hepático) utilizadas actualmente para manejar las complicaciones potencialmente mortalesen las formas más avanzadas de cirrosis, el conocimiento del impacto que tienen en la función cardiovascular es de suma importancia. Se encuentran en progreso las intervenciones terapéuticas dirigidas a prevenir y manejar el deterioro cardiovascular.

Palabras clave
miocardiopatía cirrótica, ascitis, circulación hiperdinámica


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Abstract
Cirrhotic cardiomyopathy has recently gained the dignity of a new clinical entity. The knowledge of subtle cardiostructural changes that can be detected even in the early stages of preascitic cirrhosis have contributed to a better understanding of the cardiovascular derangement observed as disease severity progresses. Diastolic dysfunction is frequently detected in this setting and heart structural changes are being characterized. Decompensated cirrhosis is characterized by decreased arterial blood pressure and peripheral vascular resistances, increased cardiac output and heart rate in the setting of hyperdynamic circulation favoured by total blood volume expansion, circulatory overload and overactivity of the endogenous vasoactive systems. Peripheral vasodilation prevents over heart failure. Reduced heart responses to stressful conditions such as changes in cardiac loading conditions in presence of further deterioration of liver function, such as refractory ascites, hepatorenal syndrome, spontaneous bacterial peritonitis and bleeding esophageal varices, have been recently identified. Facing the availability of therapeutic interventions (paracentesis, transjugular intrahepatic porto-systemic shunt -TIPS, peritoneovenous shunt, liver transplantation) currently employed to manage the life-threatening complications of the most advanced phases of cirrhosis, the knowledge of their impact on cardiovascular function is of paramount relevance. Therapeutic interventions targeted to prevent and manage cardiovascular deterioration are in progress.

Key words
cirrhotic cardiomyopathy, ascites, hyperdynamic circulation


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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
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Especialidades
Principal: Cardiología
Relacionadas: Cuidados Intensivos, Gastroenterología, Medicina Interna, Trasplantes



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