Lviv clinical bulletin 2020, 4(32): 8-15

https://doi.org/10.25040/lkv2020.04.008

Syntropic Lesions of the Cardiovascular System in Patients with Liver Cirrhosis: their Determination; Selected Pathogenetic Mechanisms; Characteristics and Specifics; Clinical Markers, Their Prognostic Value; Justification and Effectiveness of Modified Treatment (Second Notice)

M. Farmaha, M. Abrahamovych, O. Abrahamovych, O. Fayura, V. Chemes 

Danylo Halytsky Lviv National Medical University

Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis (LC), although often fatal, are poorly studied.

The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with LC, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment.

Materials and methods. We processed medical records of 603 patients with LC and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy (CCMP), and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of LC. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with LC and syntropic cardiovascular lesions as well as to assess its effectiveness.

Results. The presence of the combination of such complaints as nausea, jaundice of the skin and sclera in patients with LC and the absence of the “jellyfish head” symptom lets us think with 97.09 % sensitivity, 98.02 % specificity and      97.70 % accuracy about syntropic secondary CCMP. In the presence of the combination of such complaints as pain and heaviness in the right side of the abdomen, ascites, hepato-, splenomegaly and telangiectasia lets us think with 85.39 % sensitivity, 98.61 % specificity and 94.75 % accuracy about syntropic persistent hypotension. Improvement of the comprehensive treatment of patients with LC, syntropic secondary CCMP and persistent hypotension, taking into account the peculiarities of their pathogenesis and clinical course, can improve the quality of life of patients by 44.95 % and 40.39 %, respectively, and significantly increase the effectiveness of treatment.

Conclusions. Clinical symptom complexes that indicate the presence of syntropic lesions of the circulatory system – a combination of complaints of nausea, jaundice and sclera in the absence of symptoms of “jellyfish head” indicates CCMP, and a combination of complaints of pain and heaviness in the right hypochondrium, ascites, hepato- and splenomegaly and telangiectasia indicate persistent hypotension. Improvement of the comprehensive treatment of patients with LC and CCMP by adding a β-blocker with α-blocking properties of carvedilol (1 tablet (3.125 mg) twice a day), cardio- and hepatoprotector thiotriazoline (in patients with LC and CCMP of the 1st degree of severity (100.0 mg) three times a day, patients with LC and CCMP II and III degrees of severity – intramuscularly 2.0 ml of 2.5 % solution (50.0 mg) three times a day for five days, then 1 tablet (100.0 mg) three times a day), and improvement of the comprehensive treatment of patients with LC and persistent hypotension of I and II degrees of severity by adding ivabradine (1 tablet (5.0 mg) in the morning after meals), patients for hypotension of III degree of severity – intravenous albumin solution (at the rate of 1.5 g/kg for at least 10 days), as well as α-lipoic acid (1 capsule (600.0 mg) in the morning after meals), in the presence of ascites and edema syndrome – spironolactone (in the dosage, which is provided by the severity of the complication, of us a blunt transition to a maintenance dose of 1 tablet (50.0 mg) in the morning after a meal) enhanced the quality of life by 44.95 % and 40.39 %, respectively, and significantly increased the effectiveness of treatment.

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