Heart Rate Variability in Cirrhosis Liver.

Aravindh, S (2009) Heart Rate Variability in Cirrhosis Liver. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Hyperdynamic circulatory state is a common and long-recognized feature of patients with decompensated chronic liver disease. It is characterized by elevated cardiac rate and output and reduced peripheral vascular resistance, with pooling of blood in the splanchnic and peripheral circulation and effective central hypovolemia. The autonomic nervous system plays a central role in modulating cardiac performance and the vasomotor activity in the hyperdynamic circulatory state. The presence of an autonomic dysfunction (AD) in cirrhosis has been clearly shown through different experimental approaches, including the evaluation of the cardiovascular and sudomotor responses to physiological and pharmacological stimulation), and by showing a hyperproduction of weak adrenergic neurotransmitters. It has also been reported that the severity of AD is proportional to the severity of cirrhosis, and its presence is an indicator of poor prognosis in patients with both early and advanced liver disease. In an earlier study from our department, the presence of AD correlated with the occurrence of variceal bleed . Heart rate variability implies variations in the interval between consecutive heart beats as well as between consecutive instantaneous heart rate, ie, it describes the variations of both instantaneous heart rate and RR intervals. It is a simple test to assess the function of the autonomic nervous system and its modulation on the heart rate. Measurement of AD in chronic liver disease, using Heart rate variability (HRV), has been shown to correlate with the underlying severity of the liver disease. But, there are no studies from India, on the impact of Heart rate variability in predicting the severity, prognosis and bleed pattern in patients with cirrhosis liver. AIM OF THE STUDY : To assess Heart rate variability (HRV) as a test for Autonomic nervous system (ANS) function in patients with liver cirrhosis, comparing it with healthy controls. To correlate HRV results with the severity of the underlying liver disease To compare HRV outcome between – Bleeders and non-bleeders – Survivors and non-survivors. CONCLUSION : HRV analysis is a simple, noninvasive test to assess the cardiovascular autonomic function in patients with chronic liver disease. Patients with liver cirrhosis have significantly reduced heart rate variability (decreased parasympathetic activity) and an increased sympathetic tone in supine posture. Cirrhotics have an abnormal homeostatic response to standing with no increase in sympathetic tone in the upright posture. With worsening Child Pugh class (A vs B/C), there is an increase in autonomic dysfunction, with an increased activity of the sympathetic component. There were no significant differences in HRV parameters between bleeders versus non-bleeders and survivors versus non-survivors.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Heart Rate Variability ; Cirrhosis Liver.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:17
Last Modified: 13 Jul 2017 04:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/1580

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