Patients with liver disease have defects in both systolic and diastolic function that only become obvious with physiologic stress such as liver transplantation or massive ascitis with failure. In addition there are additional defects in the electromechanical coupling of the heart that can have significant clinical consequences like palpitations. These collective pathologic changes are termed "cirrhotic cardiomyopathy" and occur to some degree in all patients with liver disease.
The heart reaction is quite normal, due to hypovolemia, related to ascitis.
The confusion is related to metabolic dysfunction of the brain, which can lead to hepatic coma.
It is all related to the main pathology.
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