CARDIOVASCULAR PROBLEMS IN CRITICALLY ILL CIRRHOTIC PATIENTS

Abstract

Liver cirrhosis is a major health problem all over the world. Especially in Egypt which has the highest prevalence of viral hepatitis C globally. Many complications of cirrhosis are encountered in the intensive care unit including upper gastrointestinal bleeding, hepatic encephalopathy, tense ascites, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension and sepsis due to spontaneous bacterial peritonitis. Cirrhotic patients may also be admitted to ICU preoperatively for shunt operation, liver transplantation or other major surgeries. Cardiovascular changes in critically ill cirrhotic patients need to be well understood to be able to manage these challenges in a fragile cirrhotic patient. Cirrhotic patient shows a wide range of circulatory changes. The hyperdynamic cirrhotic circulation affects many circulation beds; hepatic, splanchnic, systemic, renal, pulmonary, cerebral and cardiac circulation. There is also a reversible cardiac change in cirrhotic patient named cirrhotic cardiomyopathy, which is diagnosed by the presence of diastolic dysfunction, systolic dysfunction to stress and electrophysiological changes (prolonged QT). These changes do reverse after liver transplantation. Cirrhotic patients shows a high risk to CAD development, in contrast to what was believed previously, this should prompt careful screening for CAD in cirrhotic population undergoing major surgeries especially liver transplantation. Percutaneous coronary intervention may be needed prior to transplantation. Arrhythmias should also be monitored in cirrhotic population to avoid complications. Cardiovascular changes in cirrhosisare major determinant of renal function and play a major role in the development of hepatorenal syndrome.