Clinical implications of the hyperdynamic syndrome in cirrhosis

Abstract

The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis. The principal hemodynamic manifestations of the hyperdynamic syndrome are high cardiac output, and increased heart rate and total blood volume, accompanied by reduced total systemic vascular resistance. Pathophysiology involves a complex of humoral and neural mechanisms that can determine hemodynamic changes, and lead to hyperdynamic circulation. In this review we focus our attention on the manifestations of the hyperdynamic syndrome. Some of these are well described and directly related to portal hypertension (varices, ascites, hepatic encephalopathy, and hepatorenal syndrome), while others, such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy, are less known as clinical manifestations related to cirrhosis and, therefore, merit further investigation.

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

“…These mechanisms determine hemodynamic changes and lead to a peculiar systemic circulation pattern [3] . The clinical implications of these peculiar systemic hemodynamics in patients with LC have been described as a hyperdynamic state (so-called "hyperdynamic syndrome") [3] . Specific manifestations that have been described include high cardiac output (CO), a large blood volume (BV), low total peripheral resistance (TPR), hyponatremic electrolyte abnormalities, and a lower potassium level due to secondary aldosteronism [5] .…”

“…The systemic hemodynamic state in patients with LC has been characterized as hyperdynamic [3,6,7] . Cirrhotic hemodynamics are characterized as hyperdynamic by a high CO, large BV, low TPR, mildly tachycardic heart rate (HR), and low or normal mean arterial pressure (MAP) [1][2][3][4]6,[8][9][10] .…”

“…Some pathognomonic findings (e.g., varices, splanchnic congestion, intractable ascites, hepatic encephalopathy, and hepatorenal syndrome) are directly related to PH [3,4] , and the pathophysiology of PH involves a complex of humoral and neural mechanisms [3] . These mechanisms determine hemodynamic changes and lead to a peculiar systemic circulation pattern [3] . The clinical implications of these peculiar systemic hemodynamics in patients with LC have been described as a hyperdynamic state (so-called "hyperdynamic syndrome") [3] .…”

“…Long-term PH results in various vascular alterations, such as venous dilatation, endothelial damage, collateral pathway formation, and shunt development [1][2][3] . Some pathognomonic findings (e.g., varices, splanchnic congestion, intractable ascites, hepatic encephalopathy, and hepatorenal syndrome) are directly related to PH [3,4] , and the pathophysiology of PH involves a complex of humoral and neural mechanisms [3] . These mechanisms determine hemodynamic changes and lead to a peculiar systemic circulation pattern [3] .…”

Cerebral hemodynamics in patients with cirrhosis

“…These are often associated with a hyperdynamic circulatory state, which affects cerebral blood flow (CBF). CBF generally decreases in patients with cirrhosis (1)(2)(3)(4)(5).…”