The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis
Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension results in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral...
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| Veröffentlicht in: | Liver international 2018-04, Vol.38 (4), p.570-580 |
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| creator | Møller, Søren Bendtsen, Flemming |
| description | Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension results in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction and renal dysfunction as part of a cardiorenal syndrome. Several of the cardiovascular changes are reversible after liver transplantation and point to the pathophysiological significance of portal hypertension. In this paper, we aimed to review current knowledge on the pathophysiology of arterial vasodilatation and the hyperdynamic circulation in cirrhosis. |
| doi_str_mv | 10.1111/liv.13589 |
| format | Article |
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The combination of liver failure and portal hypertension results in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction and renal dysfunction as part of a cardiorenal syndrome. Several of the cardiovascular changes are reversible after liver transplantation and point to the pathophysiological significance of portal hypertension. In this paper, we aimed to review current knowledge on the pathophysiology of arterial vasodilatation and the hyperdynamic circulation in cirrhosis.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.13589</identifier><identifier>PMID: 28921803</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adrenal Insufficiency ; Arterial Pressure ; Blood flow ; Blood volume ; cardiac dysfunction ; Cardiac Output ; Cardiomyopathy ; Cardiovascular system ; Cirrhosis ; Collateral Circulation ; Complications ; Humans ; Hypertension ; Hypertension, Portal - drug therapy ; Hypertension, Portal - etiology ; Hypertension, Portal - physiopathology ; Hypovolemia ; Liver ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - physiopathology ; Liver diseases ; liver failure ; Liver Failure - etiology ; Liver Failure - physiopathology ; Liver transplantation ; Multiple Organ Failure ; multi‐organ syndrome ; portal hypertension ; Renal function ; Splanchnic Circulation - drug effects ; Translocation ; Transplantation ; Vascular Resistance ; Vasoconstrictor Agents - therapeutic use ; Vasodilation ; Vasodilation - drug effects ; Vasodilators</subject><ispartof>Liver international, 2018-04, Vol.38 (4), p.570-580</ispartof><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2018 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4949-84cf07aea91bf72581ab1aa741f895c2987f4f112a6ee137b6054703b79991b43</citedby><cites>FETCH-LOGICAL-c4949-84cf07aea91bf72581ab1aa741f895c2987f4f112a6ee137b6054703b79991b43</cites><orcidid>0000-0001-9684-7764</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fliv.13589$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fliv.13589$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28921803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Møller, Søren</creatorcontrib><creatorcontrib>Bendtsen, Flemming</creatorcontrib><title>The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension results in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction and renal dysfunction as part of a cardiorenal syndrome. Several of the cardiovascular changes are reversible after liver transplantation and point to the pathophysiological significance of portal hypertension. In this paper, we aimed to review current knowledge on the pathophysiology of arterial vasodilatation and the hyperdynamic circulation in cirrhosis.</description><subject>Adrenal Insufficiency</subject><subject>Arterial Pressure</subject><subject>Blood flow</subject><subject>Blood volume</subject><subject>cardiac dysfunction</subject><subject>Cardiac Output</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular system</subject><subject>Cirrhosis</subject><subject>Collateral Circulation</subject><subject>Complications</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Portal - drug therapy</subject><subject>Hypertension, Portal - etiology</subject><subject>Hypertension, Portal - physiopathology</subject><subject>Hypovolemia</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - physiopathology</subject><subject>Liver diseases</subject><subject>liver failure</subject><subject>Liver Failure - etiology</subject><subject>Liver Failure - physiopathology</subject><subject>Liver transplantation</subject><subject>Multiple Organ Failure</subject><subject>multi‐organ syndrome</subject><subject>portal hypertension</subject><subject>Renal function</subject><subject>Splanchnic Circulation - drug effects</subject><subject>Translocation</subject><subject>Transplantation</subject><subject>Vascular Resistance</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><subject>Vasodilation</subject><subject>Vasodilation - drug effects</subject><subject>Vasodilators</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LxDAQhoMofh_8A1LwoofVTJM2yVEWv2DBi4q3MO2mNpJtatIq_fd2rXoQnMvMMM-8zLyEHAE9hzEunH0_B5ZJtUF2gQs5YymDzd86ZTtkL8ZXSkGpDLbJTipVCpKyXfL8UJukxa72bT1E651_GRJfJRg6Eyy65B2jX1qHHXbWNwk2y6QeWhOWQ4MrWyalDWXvpqFt1m2ofbTxgGxV6KI5_M775PH66mF-O1vc39zNLxezkiuuZpKXFRVoUEFRiTSTgAUgCg6VVFmZKikqXgGkmBsDTBQ5zbigrBBKjSuc7ZPTSbcN_q03sdMrG0vjHDbG91GD4uPbNFNsRE_-oK--D814nU4piDyXKl9TZxNVBh9jMJVug11hGDRQvbZbj3brL7tH9vhbsS9WZvlL_vg7AhcT8GGdGf5X0ou7p0nyEy3oibk</recordid><startdate>201804</startdate><enddate>201804</enddate><creator>Møller, Søren</creator><creator>Bendtsen, Flemming</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9684-7764</orcidid></search><sort><creationdate>201804</creationdate><title>The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis</title><author>Møller, Søren ; Bendtsen, Flemming</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4949-84cf07aea91bf72581ab1aa741f895c2987f4f112a6ee137b6054703b79991b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adrenal Insufficiency</topic><topic>Arterial Pressure</topic><topic>Blood flow</topic><topic>Blood volume</topic><topic>cardiac dysfunction</topic><topic>Cardiac Output</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular system</topic><topic>Cirrhosis</topic><topic>Collateral Circulation</topic><topic>Complications</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Portal - drug therapy</topic><topic>Hypertension, Portal - etiology</topic><topic>Hypertension, Portal - physiopathology</topic><topic>Hypovolemia</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - physiopathology</topic><topic>Liver diseases</topic><topic>liver failure</topic><topic>Liver Failure - etiology</topic><topic>Liver Failure - physiopathology</topic><topic>Liver transplantation</topic><topic>Multiple Organ Failure</topic><topic>multi‐organ syndrome</topic><topic>portal hypertension</topic><topic>Renal function</topic><topic>Splanchnic Circulation - drug effects</topic><topic>Translocation</topic><topic>Transplantation</topic><topic>Vascular Resistance</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><topic>Vasodilation</topic><topic>Vasodilation - drug effects</topic><topic>Vasodilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Møller, Søren</creatorcontrib><creatorcontrib>Bendtsen, Flemming</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Møller, Søren</au><au>Bendtsen, Flemming</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2018-04</date><risdate>2018</risdate><volume>38</volume><issue>4</issue><spage>570</spage><epage>580</epage><pages>570-580</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension results in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction and renal dysfunction as part of a cardiorenal syndrome. Several of the cardiovascular changes are reversible after liver transplantation and point to the pathophysiological significance of portal hypertension. 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| source | MEDLINE; Wiley Online Library |
| subjects | Adrenal Insufficiency Arterial Pressure Blood flow Blood volume cardiac dysfunction Cardiac Output Cardiomyopathy Cardiovascular system Cirrhosis Collateral Circulation Complications Humans Hypertension Hypertension, Portal - drug therapy Hypertension, Portal - etiology Hypertension, Portal - physiopathology Hypovolemia Liver Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - physiopathology Liver diseases liver failure Liver Failure - etiology Liver Failure - physiopathology Liver transplantation Multiple Organ Failure multi‐organ syndrome portal hypertension Renal function Splanchnic Circulation - drug effects Translocation Transplantation Vascular Resistance Vasoconstrictor Agents - therapeutic use Vasodilation Vasodilation - drug effects Vasodilators |
| title | The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis |
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