EVALUATION OF HEPATIC HEMODYNAMICS. IN HEART FAILURE

Abstract

Heart failure 1s a complex syndrome with 2 prominent pathophysiological features: - (1) inadequate or reduced cardiac output • and (2) increased filling of venous compartments (peripheral, splanchnic and pulmonary congestion). These 2 components are usually referred to as forward and backward cardiac failure. Liver enlargement is considered a sequence of this condition. Portal vein flow depends on several factors, cardiac output, splanchnic flow and intrahepatic microcirculation. Heart failure syndrome results in impaired (reduced) cardiac output and venous congestion. It can alter the liver size, morphology and circulation. Similarily, liver cirrhosis also causes complex hemodynamic changes within the liver.

As heart failure and liver cirrhosis cause alteration and reduction of portal blood flow, this results in reciprocal increase of hepatic arterial flow. Moreover, the high hepatic vein compliance exhibits the normal triphasic waveform of hepatic veins in Doppler ultrasound. Cirrhosis increases the parenchymal stiffness impairs this compliance and reduces the phasic oscillation.

This study included 90 indeviduals presenting to tropical medicine and cardiology departments or attending their out patient clinics. They weare classified 6 groups, 3 of which were suffering from heart failure. There were 34 male and 41 female. Their ages ranged from 18- 65. All patients and controls were subjected to thorough history taking ,complete clinical examination, routine laboratory investigations, abdominal ultrasonography, X-ray chest, ECG, echocardiography.