Hyperdynamic circulation

Vallance, P. and Moncada, S. (1991). Hyperdynamic circulation in cirrhosis, a role for nitric oxide Lancet 337, 776-778. 

Whittle, B.J.R. and Moncada, S. (1992). Nitric oxide, the elusive mediator of the hyperdynamic circulation of cirrhosis Hepatology 16, 1087-1092. 

Cardiovascular The hyperdynamic circulation caused by hydralazine may accentuate specific cardiovascular inadequacies. It may reduce the pressor responses to epinephrine. Postural hypotension may result from hydralazine. Use with caution in patients with cerebral vascular accidents. 

Portal hypertension in cirrhotic patients leads to arterial vasodilation in the splanchnic circulation, owing to an increased production of nitric oxide and other vasodilatory substances. This results in a low peripheral vascular resistance and a hyperdynamic circulation, with the development of arterial hypotension. In order to compensate for this... 

Despite the development of portosystemic collaterals, which ought to lead to a fall in portal hypertension, the hyperdynamic circulation accompanied by splanchnic vasodilation (= increased cardiac output, decreased systemic vascular resistance, hypervolaemia, systemic arteriolar vasodilation) maintains portal hypertension in both the splanchnic and systemic vascular systems. (10, 47, 87) The hyperdynamic circulation is either the cause... 

Groszman, R.J. Hyperdynamic circulation of hver disease 40 years later pathophysiology and chnical consequences. Hepatology 1994 20 1359-1363... 

Circulatory disorders In general, acute liver failure is initially accompanied by hyperdynamic circulation. During the further course, approx. 80% of patients develop hypotension, which above all results in a considerable reduction in hepatic, cerebral and renal perfusion. At the same time, peripheral vasodilation is usually witnessed. Bradycardia, generally resulting from cerebral oedema, worsens the cardiovascular conditions and is considered to be a poor prognostic sign. Ultimately, the patient does not respond to volume expansion and catecholamines. 

Portal decompensation The various forms manifest as (i.) hypersplenism, (2.) increasing collateral varicosis with a simultaneous rise in the splanchnic flow due to hyperdynamic circulation and vasodilatation in the area of the splanchnic vessels, (3.) hepatic encephalopathy, and (4.) oedema and ascites. (see chapters 14,15 and 16)... 

Hyperdynamic circulation has a close correlation to portal hypertension, which results in (i.) reduction in vascular resistance and (2.) vasodilation of the splanchnic arteries and arterioles with increased blood volume in this vascular system. This leads to underfilling of the... 

Cirrhotic cardiomyopathy This term is defined as a left ventricular functional disorder due to stress (e. g. hyperdynamic circulation) or as pharmacological stimulation. But also the possibility of (toxically induced ) subclin-ical myocardial damage is discussed, especially because elevated troponin 1 serum values are detectable in every third patient. (81, 142, 187) (Troponin is connected with propomyosin in the actin filaments at regular intervals and, as a relaxing protein , has an important function in muscle metabolism, also in the heart). 

Arkenan, H.-T., Stichtenoth, D.O., FrohRch, J.C., Manns, M.P., Bdker, K.-H.W. Elevated nitric oxide levels in patients with chronic liver disease and cirrhosis correlate with disease stage and parameters of hyperdynamic circulation. Z. Gastroenterol. 2002 40 907—912... 

Hyperdynamic circulation in patients with cirrhosis direct measurement of nitric oxide levels in hepatic and portal veins. X Hepatol 1997 26 75-80... 

Campillo. B., Bories, P.N., Benvenuti, C., Dupeyron, C. Serum and urinary nitrate levels in liver cirrhosis endotoxemia, renal function and hyperdynamic circulation. J. Hepatol 1996 25 707-714... 

Similar observations have been made following the infusion of bolus doses of 50, 100, or 200mg/kg of Hb-PHP in septic sheep. All three doses of Hb reversed the hyperdynamic circulation that had developed during sepsis by increasing MAP and SVR while decreasing CL Although pulmonary arterial pressure increased after Hb infusion, it neither adversely... 

Bone, H.G. Schenarts, P.J. Booke, M. McGuire, R. Harper, D. Traber, L.D. Traber, D.L. Oxalated pyridoxalated hemoglobin polyoxyethylene conjugate normalizes the hyperdynamic circulation in septic sheep. Crit. Care Med. 1997, 25 (6), 1010-1018. 

Portosystemic collaterals can divert up to 80% of the portal vein blood away from the liver. This initially results in haemodynamic disorders with subsequent (multifactorial) hyperdynamic splanchnic circulation. More and more varices develop around the bypasses in various venous areas, primarily in the form of oesophageal varices. Damage to the mucous membrane in the stomach and in the colon takes the form of hypertensive... 

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