Cardiovascular Alterations in Acute and Chronic Liver Failure

The liver and heart are closely related in health and in disease; the liver receives 25 to 30% of total cardiac output via the hepatic artery, and the portal vein. Liver disease can result from right-sided heart failure, with manifestations ranging from mild reversible liver injury to hepatic fibrosis, and, in its most severe form, cardiac cirrhosis. On the other end of the spectrum, advanced liver disease can manifest itself as a hyperdynamic state with decreased vascular resistance, but with concomitant cardiac dysfunction that is termed cirrhotic cardiomyopathy. The degree of cardiac derangement correlates with the degree of liver dysfunction, and may lead to other disease processes such as hepatorenal syndrome and hepatic encephalopathy. Prompt recognition and treatment of the underlying cause of acute decompensation is the only definitive therapy for this devastating disease process.