Patients with cirrhosis and portal hypertension exhibit characteristic haemodynamic changes. A vasodilatatory state and a hyperdynamic circulation affect various functions, resulting in multi-organ failure. Thus, the circulation of the lungs, kidneys, brain, gastrointestinal tract and periphery is disturbed. The recently defined cirrhotic cardiomyopathy affects systolic and diastolic functions of the heart and implies electromechanical abnormalities. In addition, baroreceptor response and regulation of circulatory homoeostasis are impaired, and reduced cardiac reserve may also play a role in the development of hepatorenal syndrome. Pulmonary dysfunction involves diffusing abnormalities, with development of hepatopulmonary syndrome and portopulmonary hypertension in some patients with cirrhosis. Recent research has focused on the assertion that haemodynamic and neurohumoral dysregulation are of major importance for the development of many of the organ-related complications in cirrhosis. This aspect is important to take into account in the management of these patients.