Département de cardiologie, Hôpital Lariboisière, Paris, Division of Cardiovascular Disease, University of Alabama, Birmingham, USA, Service d’hépatologie, Hôpital Beaujon, Clichy
Liver cirrhosis results in significant changes in the loading conditions of the heart. The most important abnormality is marked arterial vasodilation leading to increased stroke volume and cardiac output. Volemia may be increased or decreased. Ventricular diameters are increased. Alterations in the sympathetic nervous system have also been described but their role seems minor. The dilemma for a cardiologist facing a patient with liver cirrhosis, alcoholic or not, is to detect a latent subtle myocardial dysfunction which, if overlooked, may result in heart failure in the event of betablocker therapy initiation ; TIPS creation or peritoneo-jugular shunt instauration, liver transplantation. Cardiac involvement in liver cirrhosis, in the absence of heart failure, does not require specific therapy. Vasodilator therapy is not logical, neither is betablockade, however largely used in case of portal hypertension.