Circulatory changes in chronic liver disease

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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.