Hyperdynamic States and the

The ability of the cirrhotic patient to withstand the acute stress of variceal hemorrhage or necessary portal decompressive surgery is shown to be related to the adequacy of the cardiovascular and cardiorespiratory interrelationships. Based on a multivariable statistical analysis of 17 variables in 28 patients and 81 controls, three different hyperdynamic cardiovascular states are described in cirrhotic patients: (1) a control hyperdynamic state characterized by an increased cardiac output, without evidence of abnormal peripheral vascular or pulmonary dysfunction; (2) a balanced hyperdynamic response to stress in which a further increase in cardiac output is usually compensated for by an adequate increase in myocardial contractility and oxygen consumption; and (3) an unbalanced hyperdynamic stress state in which there is evidence of severe peripheral vascular abnormality, impaired oxygen extraction, and a tendency to the development of high-output cardiac failure. Guidelines for the clinical recognition of these states and a rational basis for specific cardiorespiratory therapy are discussed.