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2012, Número 2

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Gac Med Mex 2012; 148 (2)


Epidemiología, fisiopatología y diagnóstico de la hipertensión arterial pulmonar (HAP) en el cirrótico

Uribe M, Morales-Blanhir J, Rosas-Romero R, Campos CR, Poo JL

Idioma: Español
Referencias bibliográficas: 74
Paginas: 153-161
Archivo PDF: 102.70 Kb.


RESUMEN

La cirrosis hepática es la fase avanzada de un gran número de padecimientos crónicos del hígado, en el que se desarrollan cambios estructurales de la arquitectura hepática con presencia de fibrosis y nódulos de regeneración. En países en vías de desarrollo, la etiología más frecuente es la hepatitis crónica por consumo de alcohol, seguida por las infecciones virales crónicas, como la del virus de la hepatitis C (VHC).
La insuficiencia hepática secundaria a la cirrosis induce una serie de modificaciones hemodinámicas en todos los niveles vasculares; se caracteriza por incremento del volumen vascular, disminución de las resistencias vasculares sistémicas e incremento del gasto cardíaco. La hipertensión portal es la complicación hemodinámica con mayor importancia en la cirrosis, ya que promueve una serie de cambios en la circulación portal, esplénica, pulmonar y sistémica que se relacionan con procesos fisiopatológicos y enfermedades cardiopulmonares.
La HAP es una enfermedad que, en ausencia de enfermedad cardiovascular izquierda, se encuentra relacionada con cambios estructurales de las arterias pulmonares. Es el resultado de una serie de señales celulares que se traducen en hipertrofia arterial, con incremento del tono vascular y de la presión arterial pulmonar.
La hipertensión portopulmonar (HPP) es la coexistencia de hipertensión portal e HAP. Para cumplir con los criterios diagnósticos no debe existir enfermedad cardiovascular izquierda que contribuya a la hipertensión pulmonar. En esta entidad existen componentes hemodinámicos importantes: hipertensión portal, cambios del flujo vascular, estimulación celular e hipertrofia arterial pulmonar. En esta revisión, la epidemiología, la fisiopatología y el diagnóstico son descritos para el diagnóstico temprano y el tratamiento.


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