Seeking Insights on Autonomic Dysfunction Related to Chronic Liver Disease
I am reaching out to find fellow medical professionals or patients who might have encountered similar symptoms or cases. I suspect I'm dealing with autonomic dysfunction connected to a chronic liver condition, specifically splanchnic vasodilation and pooling, even though I do not exhibit signs of advanced fibrosis or cirrhosis. I've been diagnosed with MASLD for several years, but it has remained stable over time. Two liver biopsies and measurements of hepatic venous pressure gradient (HVPG) revealed values of 8 mmHg and 3 mmHg (notably, the latter was recorded while I was on Jardiance), indicating low or borderline portal pressures. Recently, however, I have begun to exhibit characteristics of a high-output cardiac state without any visible heart failure: - Increased cardiac output at rest and during exertion - Reduced systemic vascular resistance (SVR) - Severe fatigue, low blood pressure, and dyspnea when changing positions - Muscle weakness that intensifies following meals or when standing or sitting upright Clinically, my experience mirrors that of a patient with significant cardiac and liver failure, yet there are no structural findings to corroborate this. The hepatologists I’m currently consulting cannot decipher this situation, and I am finding it challenging to be taken seriously, despite clear hemodynamic issues. Has anyone encountered this type of presentation—where autonomic or vascular disturbances arise in connection with liver disease yet lack the typical indications of decompensation? Any advice, insights, or inquiries would be deeply appreciated. Thank you for considering my request.
Answers (1)
6/29/2025, 7:40:40 PM
OpenHealth AI
It sounds like you're dealing with a complex and challenging situation related to your chronic liver disease and the accompanying symptoms that suggest autonomic dysfunction. Your experience is valid and your symptoms deserve attention, especially given their impact on your daily life.
Summary of Concerns:
- You have chronic liver disease (MASLD) with stable biopsies and low portal pressures.
- You've noted symptoms like increased cardiac output, fatigue, low blood pressure, and positional dyspnea, resembling issues in both cardiac and hepatic function.
- Current medical consultations haven’t led to deciphering your symptoms satisfactorily.
Explanation:
Autonomic dysfunction occurs when the autonomic nervous system (ANS) doesn't work properly, which can lead to symptoms like those you've described. Patients with liver disease can sometimes experience this dysfunction even without signs of advanced liver disease, as the liver plays a role in regulating various bodily systems, including blood flow and vascular resistance.
In your case, conditions like splanchnic vasodilation could lead to systemic vasodilation, thereby causing low systemic vascular resistance and the symptoms you’re experiencing after meals or from position changes (postural hypotension).
Next Steps:
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Monitor and Record Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers (e.g., meals, activity levels). This can help identify patterns and provide valuable insights for healthcare providers.
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Hydration and Salt Intake: Since low blood pressure is a concern, maintaining hydration and possibly adjusting dietary salt (under guidance from your healthcare provider) may help manage symptoms.
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Gradual Position Changes: When changing positions (like standing up), do so slowly to allow your body time to adjust, reducing the risk of dizziness or faintness.
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Symptom Management: Discuss with your healthcare provider about potential medications or interventions that could help with blood pressure regulation or manage autonomic symptoms. Things like compression garments or medications for vascular resistance might be worth exploring.
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Explore Multidisciplinary Care: Consider seeking out specialists in autonomic disorders or working with a center that specializes in complex cases involving both liver and autonomic dysfunction. This might provide a more comprehensive approach to your care.
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Community Support: Engage in support groups (either online or locally) where you can share your experiences with other patients. Hearing from others who have faced similar challenges can provide not only practical insights but also emotional support.
It’s essential that you continue to advocate for your health and seek the answers you deserve. You should not feel alone in this, and there are others who have navigated similar challenges. Please feel free to reach out if you need further advice or support.
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