Hemodynamic derangement and cardiac dysfunction in cirrhosis.

Liver cirrhosis is characterized by a long course that lasts between 15 and 20 years. The natural history of this disease depends mainly on the occurrence and progression of single complications which are today more fully understood and therefore more treatable. More specifically, those complications involving hemodynamic mechanisms have been extensively studied in recent years. Indeed, the mechanisms involved in the occurrence of sodium positive balance and ascites, with or without renal dysfunction, have been clarified. It is now possible to distinguish between two different stages in the presence of hemodynamic modifications. In the first stage, an increasing accumulation of water and sodium may occur, leading to an increase in total plasma flow. Subsequently, there is a period of vascular instability and finally, the progressive appearance of typical signs of hyperdynamic circulation. During the second stage, cardiac function may be modified and consequently profoundly altered. The early administration of diuretics (antialdosteronics) seems to be capable of modifying cardiac dysfunction, leading to a return towards a physiological status through a rapid increase in diuresis and natriuresis and a decrease in plasma volume.