Electric and Hemodynamic Effects of Beta-Blockers in Patients With Liver Cirrhosis

Acute and chronic heart failure can lead to acute or chronic liver injury through various mechanisms. Treatment in these cases should primarily target heart disease. Patients with advanced liver disease may experience various manifestations at the cardiac level, mainly cardiomyopathies (dilatation cardiomyopathy of alcoholic aetiology, hypertrophic cardiomyopathy). These conditions involve hemodynamic changes, systolic function impairment, diastolic dysfunction, reduced cardiac output (low left ventricular ejection fraction -LVEF) and electrophysiological abnormalities (rhythm disturbances, QT prolongation, driving disturbances). Patients with liver cirrhosis usually have rhythm disturbances (tachycardia, bradycardia). The inability to maintain a high heart rate may later contribute to a reduced cardiac output, insufficient to meet the needs of systemic circulation. Beta-blockers (NSBB) are a class of drugs that are extremely important because of their use in various conditions. Their discovery dates back more than 100 years ago when researchers have launched the idea that the pharmacological action of catecholamines consists in the selective binding of certain receptors for which they have a high selectivity. Beta-blockers with intrinsic sympathomimetic action reduce heart rate at rest, lower than propranolol or metoprolol, but interfere with maintaining adequate heart rate under stress or physical effort.