Centre of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Eur Heart J. 2013 Sep;34(36):2804-11. doi: 10.1093/eurheartj/eht246. Epub 2013 Jul 12.
There is a mutual interaction between the function of the heart and the liver and a broad spectrum of acute and chronic entities that affect both the heart and the liver. These can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. In chronic and acute cardiac hepatopathy, owing to cardiac failure, a combination of reduced arterial perfusion and passive congestion leads to cardiac cirrhosis and cardiogenic hypoxic hepatitis. These conditions may impair the liver function and treatment should be directed towards the primary heart disease and seek to secure perfusion of vital organs. In patients with advanced cirrhosis, physical and/or pharmacological stress may reveal a reduced cardiac performance with systolic and diastolic dysfunction and electrophysical abnormalities termed cirrhotic cardiomyopathy. Electrophysiological abnormalities include prolonged QT interval, chronotropic incompetance, and electromechanical uncoupling. No specific therapy can be recommended, but it should be supportive and directed against the heart failure. Numerous conditions affect both the heart and the liver such as infections, inflammatory and systemic diseases, and chronic alcoholism. The risk and prevalence of coronary artery disease are increasing in cirrhotic patients and since the perioperative mortality is high, a careful cardiac evaluation of such patients is required prior to orthotopic liver transplantation.
心脏和肝脏的功能之间存在相互作用，并且有广泛的急性和慢性实体影响心脏和肝脏。这些可以分为影响肝脏的心脏病、影响心脏的肝病以及同时影响心脏和肝脏的情况。在慢性和急性心脏肝病中，由于心力衰竭，动脉灌注减少和被动充血的组合导致心脏肝硬化和心源性缺氧性肝炎。这些情况可能会损害肝功能，治疗应针对主要的心脏病，并设法确保重要器官的灌注。在晚期肝硬化患者中，身体和/或药理学应激可能会导致收缩和舒张功能障碍以及称为肝硬化心肌病的电生理异常的心脏性能降低。电生理异常包括 QT 间期延长、变时性无能和机电分离。目前还没有推荐特定的治疗方法，但应支持和针对心力衰竭进行治疗。许多情况会同时影响心脏和肝脏，如感染、炎症和全身性疾病以及慢性酒精中毒。肝硬化患者的冠心病风险和患病率正在增加，由于围手术期死亡率较高，因此在进行原位肝移植之前，需要对这些患者进行仔细的心脏评估。
