Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes. After partial response to current therapies, the patient presented a clinical and laboratorial response with improvement of renal function after infusion of dobutamine. Clinical studies are needed for the therapy approach to HRS taking into account myocardial dysfunction as a major contributing factor for renal dysfunction.
Cirrhotic Cardiomyopathy is a recently recognized condition consisting of myocardial dysfunction manifested in cirrhotic patients in the absence of previous cardiac disease. The underlying pathogenetic mechanisms includes a "miocardiotoxic" environment that leads to a blunted heart response to stress, whether physical or pharmacological. This condition is now better understood and can be diagnosed supported clinical, by laboratory electrocardiography and echocardiography criteria. Clinically, systolic incompetence is most evident when cirrhotic patients are placed under stress, whether physical or pharmacological. Despite of being well understood, there is a lack of knowledge to a proper practical application. Recent case reports have suggested that CCM must be treated early because it may be an triggering factor for cirrhosis complications. Studies are needed to identify potential treatments that alter the natural history of heart disease in cirrhotic patients, especially in the phases in which the patients are asymptomatic.
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