The heart and the liver

Area of Science:

• Cardiology
• Hepatology
• Internal Medicine

Background:

• Cardiac failure and liver dysfunction are interconnected, with heart failure leading to conditions like cardiac cirrhosis and cardiogenic ischemic hepatitis.
• Advanced cirrhosis can manifest as cirrhotic cardiomyopathy, characterized by reduced cardiac performance, systolic/diastolic dysfunction, and electrophysiological abnormalities.

Purpose of the Study:

• To explore the intricate relationship between cardiac failure and liver dysfunction.
• To describe cirrhotic cardiomyopathy and its underlying pathophysiological mechanisms.
• To review the cardiac implications of interventions like transjugular intrahepatic portosystemic shunt insertion and liver transplantation in portal hypertensive patients.

Main Methods:

• Literature review of studies investigating the cardiac and hepatic interplay.
• Analysis of pathophysiological mechanisms in cirrhotic cardiomyopathy, including beta-adrenergic receptor signaling and electromechanical coupling.
• Examination of cardiac stress testing and imaging modalities for cirrhotic patients undergoing liver transplantation.

Main Results:

• Cardiac failure can cause liver damage, while liver cirrhosis can lead to cirrhotic cardiomyopathy with impaired cardiac function.
• Common findings in cirrhotic cardiomyopathy include systolic and diastolic dysfunction, electrophysiological abnormalities, and a prolonged QT interval.
• Procedures like transjugular intrahepatic portosystemic shunt insertion and liver transplantation pose risks to the cirrhotic heart, necessitating careful cardiac evaluation.

Conclusions:

• Treatment for cardiac dysfunction in liver disease should target the primary cardiac condition and ensure vital organ perfusion.
• While no specific therapy for cirrhotic cardiomyopathy exists, supportive care addressing heart failure is crucial.
• Thorough cardiac assessment, including stress testing and imaging, is vital for cirrhotic patients undergoing liver transplantation due to high perioperative risks.