The hemodynamic status of preascitic cirrhosis: an evaluation under steady-state conditions and after postural change
| Autor: | Pietro Andreone, Lorenzo Fornalè, Carlo De Collibus, F. Zaca, Amedeo Ligabue, Carmela Cursaro, Giovanni Gasbarrini, Claudio de Marco, Mario Baraldini, Franco Trevisani, Mauro Bernardi |
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| Rok vydání: | 1992 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Mean arterial pressure Cardiac output Posture Hemodynamics Plasma renin activity Norepinephrine Internal medicine Renin medicine Humans Hepatology business.industry medicine.disease Endocrinology medicine.anatomical_structure Cardiology Vascular resistance Arterial blood business Hypervolemia Venous return curve Atrial Natriuretic Factor |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 0270-9139 |
| Popis: | To assess the hemodynamic status of patients with compensated cirrhosis, mean arterial pressure, cardiac index and peripheral vascular resistance and markers of central (plasma concentrations of atrial natriuretic factor) and arterial volemia (plasma norepinephrine concentration, plasma renin activity) were studied in 10 patients and 10 healthy control subjects under steady-state conditions (after 2 hr of standing) and after assumption of the supine position (30, 60, and 120 min). After standing, neither hemodynamics nor markers of effective volemia differed significantly between controls and patients. By evaluating the areas under the curve during the 2 hr of supine posture, the increase in cardiac output and plasma natriuretic factor and the decrease in peripheral vascular resistance were greater in patients (2.59 +/- 0.43 [S.E.M.] L/min/hr; 32.8 +/- 7.2 pg/ml/hr -1,103 +/- 248.4 dyn.sec/cm5/hr, respectively) than in controls (0.53 +/- 0.24 L/min/hr, p = 0.005; 17.4 +/- 4.7 pg/ml/hr, p = 0.005; -265.5 +/- 206.2 dyn.sec/cm5/hr, p = 0.02). The declines in heart rate, plasma norepinephrine concentration and plasma renin activity did not differ significantly. Mean arterial pressure did not significantly change. Our results suggest that during periods of upright posture, cirrhotic patients in the preascitic stage, who are known to have expanded blood volume, compensate for dilatation of the splanchnic vascular bed through total hypervolemia. The latter becomes excessive during recumbency, leading to supernormal increases in venous return, central volemia and cardiac index. The decline in peripheral vascular resistance appears to be a compensatory mechanism to maintain steady arterial blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Databáze: | OpenAIRE |
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