The systemic circulation in a patient with cirrhosis is often hyperdynamic with an increase in heart rate and cardiac output and a decrease in systemic vascular resistance. The patient may also show increased fluid retention, arteriovenous shunting and increased sympathetic tone.
Findings seen in a patient with cirrhotic cardiomyopathy:
(1) structural changes in the cardiac chambers (hypertrophy, dilatation) not explained by other causes
(2) histologic evidence of myocardial injury not explained by other causes
(3) prolonged QT interval or other electrophysiological abnormalities not due to medication or other identifiable cause
(4) elevated serum troponin and/or brain natriuretic peptide
(5) normal or increased left ventricular systolic contractility at rest but systolic and/or diastolic dysfunction under stress
Differential diagnosis:
(1) cardiomyopathy due to an agent affecting both heart and liver (alcohol, hemochromatosis)
If the patient develops ascites and edema, then monitoring of the jugular venous pressure can be helpful in determining the cause. In heart failure the jugular venous pressure will be increased. In portal hypertension the jugular venous pressure will be normal or decreased.
