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Heart diseases affecting the liver and liver diseases affecting the heart
J E Naschitz1, G Slobodin, R J Lewis
1Department of Internal Medicine A, the Bnai Zion Medical Center, Haifa, Israel.
Insights
This study outlines the association between cardiac and liver disorders, categorizing them into three main types. This classification aids physicians in simplifying diagnosis and workup for patients with combined heart and liver conditions.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- The interplay between cardiac and liver disorders is not well-defined in medical literature.
- Understanding these associations is crucial for comprehensive patient care.
Purpose of the Study:
- To systematically review and categorize the associations between cardiac and liver diseases.
- To propose a diagnostic framework for managing patients with combined cardiac and hepatic conditions.
Main Methods:
- A comprehensive survey of the MEDLINE database was conducted.
- Research status on cardiac and liver disorder associations was assessed.
Main Results:
- Combined cardiac and hepatic disorders manifest in three ways: heart affecting liver, liver affecting heart, or joint etiology.
- Specific examples include cardiogenic ischemic hepatitis, hepatopulmonary syndrome, and cirrhotic cardiomyopathy.
- A diagnostic approach is proposed based on disease onset, multisystem involvement, and specific features.
Conclusions:
- Categorizing patients into the three identified groups simplifies differential diagnoses.
- This structured approach facilitates a more straightforward diagnostic workup for combined cardiac and hepatic disorders.
Background:
The association of cardiac and liver disorders has not been extensively outlined in the literature.
Methods:
A survey of the MEDLINE database was performed to assess the current status of research regarding the association between cardiac and liver disorders.
Results:
Combined cardiac and hepatic disorders occur in 3 different settings: heart diseases affecting the liver, liver diseases affecting the heart, and cardiac and hepatic disorders with joint etiology. The spectrum of heart diseases affecting the liver includes mild alterations of liver function tests in heart failure, cardiogenic ischemic hepatitis, congestive liver fibrosis, and cardiac cirrhosis. The liver diseases affecting the heart include complications of cirrhosis such as hepatopulmonary syndrome, portopulmonary hypertension, pericardial effusion, and cirrhotic cardiomyopathy as well as noncirrhotic cardiac disorders such as high-output failure caused by intrahepatic arteriovenous fistulae. Cardiac and hepatic disorders with joint etiology include infectious, metabolic, immune, vasculitic, and toxic disorders. We propose a practical approach to a diagnostic workup of combined cardiac and hepatic disorders based on recognizing the sequence of appearance of the cardiac and liver disease, presence of features of a multisystem disease, and presence of pathognomonic features. The evaluation of combined cardiac and hepatic disorders takes into consideration the expected benefit of treatment and the risks related to invasive procedures. Accordingly, investigations can be limited to ancillary tests for patients with congested liver and mild alterations of liver function tests, in cardiogenic ischemic hepatitis, patients with cardiac cirrhosis who are proposed for conservative treatment, and multisystem disease involving the heart and the liver. Conversely, comprehensive investigations are recommended when invasive therapeutic interventions are considered for the treatment of hepatopulmonary syndrome, portopulmonary hypertension, or arteriovenous fistulae.
Conclusion:
Classification of a patient to any of the 3 categories-heart diseases affecting the liver, liver diseases affecting the heart, and cardiac and hepatic disorders with joint etiology-permits the physician to narrow the span of the possible diagnoses and allows for a more simple workup.