Cardiomiopatía cirrótica – ¿Realidad clínica o simple curiosidad académica? Revisión.

Parte 3: tratamiento

Autores/as

  • Hugo R. Ramos, M.D., Ph.D. Facultad de Ciencias Médicas, Universidad Nacional de Córdoba. División Cardiología, Instituto Modelo de Cardiologia
  • Mario H. Altieri, M.D. Service de Médecine, Centre Hospitalier Marguerite de Lorraine, Mortagne au Perche, France

DOI:

https://doi.org/10.31053/1853.0605.v81.n3.44420

Palabras clave:

cirrosis hepática, cardiomiopatía, tratamiento, trasplante hepático

Resumen

El tratamiento de la enfermedad hepática terminal con Cardiomiopatía Cirrótica (CMC) es el trasplante hepático (TH), sin embargo el tratamiento médico con la combinación de diuréticos y beta bloqueantes no selectivos antes y después tienen un rol importante. A diferencia de la insuficiencia cardíaca de otras etiologías, los inhibidores de la enzima convertidora (IECA), los bloqueadores del receptor de angiotensina 2 (ARA-2) o los inhibidores del receptor de angiotensina y de neprilisina (ARNI) no se recomiendan debido a la fisiopatología particular de la CMC. El shunt porto-sistémico intrahepático transyugular (Transjugular intrahepatic porto-systemic shunt: TIPS) tiene sus indicaciones con posibles beneficios y riesgos pero más estudios son necesarios en la CMC. El TH es la opción más eficaz y puede revertir el QTc del ECG y la disfunción diastólica y sistólica; en las últimas décadas, a pesar del aumento de la complejidad en los pacientes (mayor score MELD), con la mejoría de la técnica quirúrgica, cuidados intensivos, drogas inmunosupresoras y diagnóstico por imágenes la sobrevida ha mejorado significativamente.

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Biografía del autor/a

  • Hugo R. Ramos, M.D., Ph.D., Facultad de Ciencias Médicas, Universidad Nacional de Córdoba. División Cardiología, Instituto Modelo de Cardiologia

    Egresado de la Universidad Nacional de Córdoba. Especialista en Clínica Médica, Especialista en Cardiología (CMPC y UNC), Especialista en Medicina de Emergencias (CMPC). Doctor en Medicina y Cirugía FCM, UNC. Ex Jefe del Depto de Clínica Médica del Hospital Municipal de Urgencias de Córdoba, Cardiólogo en Instituto Modelo de Cardiología de Córdoba. Prof. Asociado en la Cátedra de Clínica Médica I, UHMI 2 del Hospital San Roque, FCM, UNC. Campo de investigación: biomarcadores cardíacos, insuficiencia cardíaca, cardiopatía isquémica. ORCID ID: https://orcid.org/0000-0001-6772-903X

  • Mario H. Altieri, M.D., Service de Médecine, Centre Hospitalier Marguerite de Lorraine, Mortagne au Perche, France

    Egresado de la Universidad Nacional de Córdoba. Especialista en Medicina Interna y Terapia Intensiva (CMPC), Especialista en Terapia Intensiva (Francia). Ex Prof. de Medicina Intensiva de la Universidad Católica de Córdoba. Ex Director del programa Medicob de trasplante de Hígado, Caen, Francia. Miembro fundador del Cirrhotic Cardiomyopathy Consortium. Ex Miembro del Comité Ejecutivo de la International Liver Transplant Society (ILTS) para problemas cardiovasculares y cirrosis. ORCID ID: https://orcid.org/0000-0003-4164-1771.

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Publicado

2024-09-27

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1.
Ramos H, Altieri M. Cardiomiopatía cirrótica – ¿Realidad clínica o simple curiosidad académica? Revisión. : Parte 3: tratamiento. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2024 Sep. 27 [cited 2024 Dec. 5];81(3):608-26. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/44420

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