Circulatory changes in chronic liver disease

doi:10.1016/0002-9343(58)90322-X

The American Journal of Medicine

Volume 24, Issue 3, March 1958, Pages 358-367

https://doi.org/10.1016/0002-9343(58)90322-X Get rights and content

Abstract

The circulatory findings in twenty-four patients with portal cirrhosis were compared with results in six patients with biliary cirrhosis, six patients with extrahepatic portal vein obstruction and fourteen normal subjects.

Half the patients with portal cirrhosis had a cardiac index above the upper limit of normal. Clinically, these patients had evidence of increased peripheral blood flow and ejection systolic murmurs. Roentgenographic or electrocardiographic changes were uncommon. Patients with biliary cirrhosis and portal vein obstruction had normal cardiac indices.

An increased total blood volume, mainly plasma volume, was found in patients with portal cirrhosis who had an increased cardiac index, a large portal-systemic collateral circulation, arterial oxygen desaturation and low serum albumin levels. The increased portal venous network did not account for the increased blood volume in portal cirrhosis as patients with extrahepatic portal vein obstruction had virtually normal blood volumes. The low serum albumin levels may in part represent the dilution of a normal amount of circulating albumin by an increased plasma volume.

Four patients had low arterial oxygen saturation. Cardiac catheterization data in one patient and studies in two others suggest that the arterial desaturation may be due to the shunting of blood through pulmonary arteriovenous anastomoses. One of these cases is presented in detail.

In most patients with portal cirrhosis the increased cardiac output was tolerated without evidence of decomposition. Congestive heart failure was present in one patient reported in detail. As liver function and the clinical status of patients with portal cirrhosis improved, the cardiac output returned toward normal.

The mechanism of production of the hyperdynamic circulatory state in portal cirrhosis is unknown. There is profound vasodilatation and the mechanism of this is discussed.

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^☆: The expenses of this work were defrayed, in part, by the Medical Research Council (Great Britain),

^†: Present address: Department of Medicine, University of California School of Medicine, Los Angeles, California.

¹: From the Department of Medicine, Postgraduate Medical School, London, England.

View full text

Clinical studyCirculatory changes in chronic liver disease☆

Abstract

Am. J. Med.

Am. J. Med.

Lancet

Am. J. Med.

Diseases of the Heart and Circulation

The cardiac output at rest in Laennec's cirrhosis

J. Clin. Investigation

Influences of ergotamine tartrate upon peripheral blood-flow in subjects with liver disease

Über Fingernagelveränderungen bei Lebercirrhose als Folge veränderter peripherer Durchblutung

Klin. Wchnschr.

Respiratory properties of the arterial blood in normal man and in patients with disease of the liver: position of the oxygen dissociation curve

J. Clin. Investigation

The plasma volume in Laennec's cirrhosis of the liver

Ann. Int. Med.

Hypervolemic anemia in cirrhosis

J. Clin. Investigation

The clinical investigation of the portal circulation with particular reference to portal venography

Quart. J. Med.

Studies on the circulation. I. Injection method: physical and mathematical considerations

Am. J. Physiol.

The quantitative estimation of valvular incompetence by dye dilution curves

Clin. Sc.

A practical method for the determination of blood volume with the dye T-1824

J. Lab. & Clin. Med.

Clinical study
Circulatory changes in chronic liver disease☆