12/07/2025
When The Heart Kills The Liver
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Only recently it has been hypothesized that an episode of acute decompensation affects, not only the cardiovascular system itself but may also deteriorate the function of other organs, causing serious clinical consequences.
Traditionally this phenomenon has been investigated on cardio-renal axis and the term “Cardio-renal syndrome” has been proposed to link cardiac dysfunction with the subsequent deterioration in renal function.
The interaction between impaired hemodynamic characterizing the early stage of AHF with other key organs have been rather poorly described.
Liver function abnormalities have been well characterized mainly in patients with Chronic heart failure (non ischemic and ischemic etiology). The available data shows that organ hypoperfusion as a consequence of low cardiac output and liver congestion may lead to liver dysfunction. Additionally several reports have linked abnormal liver function tests with poor outcome in chronic setting.
Surprisingly, there are only few reports comprehensively assessing liver function concomittently in setting of acute ischemic heart failure syndrome. Abnormal LFT with high Hb % (marker of low fluid status hemoconcentration) which subsequently may lead to hypoperfussion and liver cell dysfunction/damage.
Implications of LFT in acute Heart Failure:
• Liver cell dysfunction
• Liver cell damage
Cardio-renal syndrome may also influence bilateral cardio-hepatic interaction. HF and abnormal LFT with normal renal function.
This can be explained by the fact that liver, unlike the kidneys has dual (portal vein and hepatic artery) blood supply, which should make this organ more resistant to decrease cardiac output and low perfusion state.
Elevated RAP ( Right atrial Pressure ) and decreased cardiac index results in elevation of both transaminase and total billirubin. Where as reduced cardiac index alone leads to increase in AST, ALT and direct but not total billirubin.
Thus, both hypoperfussion and congestion play an important role in the development of the liver dysfunction in acutely decompensated heart failure syndrome. Bilirubin may be the marker of venous pressure and liver congestion.
Dr. Asadullah Khan Soomro ,Consultant Cardiologist and Heart Failure Specialist ,When Heart Kills The Liver , Altamash General Hospital, Karachi is available...
