Its very uncommon to have cirrhosis and dilated cardiomyopathy in a same patient, what is the reason?
A 2005 working group came together at the World Congress of Gastroenterology and came up with a common consensus to define this. The working definition proposes that “cirrhotic cardiomyopathy is a form of chronic cardiac dysfunction in patients with cirrhosis, characterized by blunted contractile responsiveness to stress, and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease (Møller, 2008).” Diagnostic criteria for Systolic Dysfunction and Diastolic Dysfunction were:
(1) systolic dysfunction: blunted increase in cardiac output on exercise, volume challenge or pharmacological stimuli or resting ejection fraction 80 ms)
(3) supportive criteria: electrophysiological abnormalities, abnormal chronotropic response, electromechanical uncoupling/dyssynchrony, prolonged QTc interval, enlarged left atrium, increased myocardial mass, increased brain natriuretic peptide (BNP) and pro-BNP, or increased troponin I
The mechanism of action is multifold according to multiple sources. Cirrhotic patients have high cardiac output and tachycardia. However, due to impairment of β-adrenergic receptor signaling from prolonged overstimulation,
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References
Al Hamoudi W, Lee S. Cirrhotic cardiomyopathy. Annals Of Hepatology [serial online]. July 2006;5(3):132-139. Available from: MEDLINE with Full Text, Ipswich, MA.
Møller S, Henriksen JH. Cardiovascular complications of cirrhosis. Gut. 2008;57:268–278. doi: 10.1136/gut.2006.112177.
Raevens S, De Pauw M, Colle I, et al. Prevalence and outcome of diastolic dysfunction in liver transplantation recipients. Acta Cardiologica [serial online]. June 2014;69(3):273-280. Available from: MEDLINE with Full Text, Ipswich, MA.
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