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Introduction. Liver cirrhosis is one of the most important and complex problems of modern hepatology. Comorbid syntrophic affections of liver cirrhosis are also relevant, including circulatory system affection – syntropic cirrhotic cardiomyopathy and persistent arterial hypotension, which are widespread and considered to be the key in the multiorgan failure occurrence and main factors that cause death. For now, specific recommendations for the treatment of syntropic cardiovascular affections in patients with liver cirrhosis have not been developed, so the treatment complex needs to be optimized. The aim of the study. To substantiate the principles and to find out the effectiveness of the syntropic affections advanced complex differentiated treatment of the circulatory system in patients with liver cirrhosis. Materials and methods. In a randomized way and with the preliminary stratification for the presence of liver cirrhosis 603 patients (164/439 – women/men, age 18-83) who were treated within the period of 2010–2015 at the Lviv Regional Hepatology Center were involved in the research. Among them, 490 (81.3 %) patients with liver cirrhotic extrahepatic affections of the circulatory system were singled out and were stratified into three subgroups: only with syntropic cirrhotic cardiomyopathy (103 patients), only with syntropic arterial hypotension (89 patients) and other (306 patients). To compare the treatment effectiveness of patients with cirrhotic cardiomyopathy and arterial hypotension, they were divided in a randomized way into two groups: experimental, treated with the help of our modified method, and control one, treated with the standard method. The evaluation of treatment effectiveness included a “subjective” evaluation (quality of life survey – MOS 36-Item Short-Form Health Survey) and an “objective” (assessment by the patients clinical, laboratory and instrumental indicators). The factual material was processed on a personal computer with the help of EViews (Quantitative Micro Software) and Excel (Microsoft) software programs, using descriptive statistics, ANOVA analysis of variance, z-criteria for two-particles comparisons. Results. Summarizing our own clinical experience and information from the latest literature sources, we modified the conventional treatment complex for patients with liver cirrhosis with syntropic affections of the circulatory system in the following way. One should add to the treatment of patients with liver cirrhosis and syntropic secondary cirrhotic cardiomyopathy the complex β-adrenoblocker with α-blocking properties of carvedilol (in case there are other conditions, requiring the appointment of β-adrenoblockers, in the maximum tolerated dosage, and in case of their non-tolerance – 1 tablet (3.125 mg) in the morning and evening during the meal), cardio and hepatoprotection thiotriazoline: in patients with liver cirrhosis and cardiomyopathy with I degree of severity – 1 tablet (100.0 mg) three times a day, patients with liver cirrhosis and cardiomyopathy with II and III degrees of severity – intramuscular injection of 2.0 ml of 2.5 % solution (50.0 mg) three times a day for five days, then 1 tablet (100.0 mg) three times a day. The results of our “subjective” and “objective” evaluations of the complex treatment effects on patients with liver cirrhosis with syntropic cirrhotic cardiomyopathy prove that the use of our proposed modified treatment complex can improve the quality of patients’ life in 44.95 % and enhance the effectiveness of treatment. One should add to the standard therapeutic complex for patients with liver cirrhosis and syntropic arterial hypotension with I and II degrees of severity 1 tablet (5.0 mg) of ivabradine in the morning after having the meal, patients with liver cirrhosis and syntropic arterial hypotension with III degree severity – intravenous albumin liquid per 1.5 g/kg for at least 10 days. Also, alpha-lipoic acid 1 capsule (600.0 mg) in the morning after having a meal, and in case there are ascites and edema syndrome – spironolactone in a dose which is predicted by the severity of the complication, followed by a maintenance dose of 1 tablet (50.0 mg) in the morning after having a meal should be prescribed to all patients. The obtained results indicate significantly high efficiency of proposed modified treatment complex for following-up the patient with syntropic arterial hypotension, which is also proved by the life quality evaluation survey, the overall score of which increased by 40.39 %, and by the doctors-researchers’ complex evaluation of the treatment results. Conclusions. Improved medical complexes for the following-up patients with liver cirrhosis with syntropic cirrhotic cardiomyopathy and persistent arterial hypotension, taking into account the features of their pathogenesis and clinical progression, allow to improve significantly the patients’ life quality and boost the effectiveness of their treatment.

Introduction. Liver cirrhosis has a significant place among the diseases of internal organs and its comorbid syntropic lesions of the circulatory system are a common cause of disability, and often death of patients, determining the actuality, health, socio-economic importance and need for improvement of the principles of its integrated differential treatment, taking into account the state of the cardiovascular system. Aim. To analyze the studies on frequency, pathogenesis, clinics, diagnostics and treatment of polymorbid syntropic extrahepatic lesions of the cardiovascular system in patients with liver cirrhosis published until now. Materials and methods. We have worked on clinical research data for previous years and have analyzed a case of the disease of a particular patient who was under our observation. Results. Diseases of a liver as a key organ of the interorgan and intersystem relationships, lead to the circulatory system disorders. It appears, first of all, by the hemodynamics disorders with the formation of stable arterial hypotension and, consequently, microcirculatory disorders, functional failure of almost all organs and also myocardial damage resulting into cirrhotic cardiomiopathy with systolic and diastolic heart failure and changes of the heart’s parameters. The study of this problem started in Cappadocien Aretacus and Claudius Galenus, but there were only isolated reports. Detailed study of this problem began in the twentieth century. However, despite the lengthy study, today there is no there is no final answer to the questions of pathogenesis of the circulatory system lesions in patients with cirrhosis. At this moment, it is well known that cardiovascular homeostasis in patients with liver cirrhosis is associated with the presence and severity of portal hypertension and hepatocellular insufficiency, and among the molecular mechanisms the leading role is given to endothelial dysfunction with an imbalance in the system of vasoconstrictors (endothelin-1) and vasodilators (nitric oxide, carbon monoxide, hydrogen sulfide, prostacyclin, kanabioids, endogenous opioids and others), disorders in the renin-angiotensin-aldosterone system and in the autonomic nervous system. An imbalance in the mentioned system leads to the systemic vasodilation, which is the most pronounced in splanhnic vessels, causing arterial hypotension and subsequent changes in the bloodstream and in the end, leads to polyorganic failure. These vasoactive substances are able to make the cardiodepressive effect and potentially participate in the pathogenesis of cardiomyopathy in the cirrhotic patients. Clinical signs of liver cirrhosis with the involvement into the process organs of the cardiovascularsystem is poor and, most importantly, non-specific. Most often there are no complaints or regarded as a manifestation of liver disease and the results of physical, laboratory and instrumental examination are of low information. The most specific is a high heart rate, presence of «chronotropic insufficiency», the level and daily fluctuations of blood pressure. Specific treatment of the cardiovascular system lesions in case of liver cirrhosis have been not developed till now. Treatment of such patients should be individualized, aiming at the support of myocardial function and prevention of circulatory decompensation. Conclusions. According to a literature review the injury of a liver as a key organ of interorgan and intersystem relationships, leads to the disorders of the circulatory system and manifests with the hemodynamics violation resulting into the formation of stable arterial hypotension and myocardial damage known as cirrhotic cardiomiopathy with systolic and diastolic heart failure and changes of the parameters of the heart. However, disorders of blood flow in patients with liver cirrhosis require further elucidation of features of the pathogenetical mechanisms of its appearance, which will justify the new principles of the effective treatment of this category of critically ill patients.