LIVER ABNORMALITIES IN PATIENTS WITH HEART FAILURE

Abstract

Cardiac hepatopathy is the term that describes liver damage due to cardiac diseases. The cardiac hepatopathy is divided into congestive hepatopathy, due to passive venohepatic congestion, and acute cardiogenic liver injury, due primarily to acute cardio-circulatory failure. Congestive hepatopathy can be determined by chronic heart failure, constrictive pericarditis, tricuspid regurgitation and right-sided heart failure. On the other hand, acute myocardial infarction, acute decompensated heart failure or myocarditis may cause acute cardiogenic liver injury. Monitoring of liver function tests, such as -glutamyltransferase, alkaline phosphatase and liver-derived metabolites, such as bilirubin, is an effective way to assess liver function. Also, the measurement of serum aminotransferases concentration is increasingly being studied, in order to identify the correlation between their values and the extent of the cardiac damage. Clinical examination, laboratory tests, and imaging tests are necessary for the diagnosis of cardiac cirrhosis in patients with heart failure. Patients with cardiac cirrhosis may be asymptomatic, but present abnormal liver biochemistry. Patients with congestive hepatopathy have elevated cholestasis markers, such as bilirubin, alkaline phosphatase, and -glutamyltransferase, while elevated levels of aminotransferases and lactate dehydrogenase are found in acute cardiogenic liver injury. There is no specific treatment for congestive hepatopathy, the treatment is that of the underlying cardiac disease. Restoration of the cardiac output and hemodynamics is the most important in the management of the acute cardiogenic liver injury.

Keywords

• aminotransferases
• cholestasis
• congestive hepatopathy
• acute cardiogenic liver injury