Ischaemic hepatitis precipitated by recurrent episodes of atrial fibrillation

We report a case of ischaemic hepatitis associated with recurrent fast atrial fibrillation (AF) episodes in a 59-year-old male who presented with shortness of breath, nausea and vomiting. The patient had a history of ischaemic cardiomyopathy. An emergency electrocardiogram showed fast AF with a ventricular rate of 190 min(-1). The aspartate aminotransferase (AST) level was 2222Ul(-1), alanine aminotransferase (ALT) was 1255Ul(-1), lactate dehydrogenase (LDH) was 1842Ul(-1) and serum creatinine was 150 μmoll(-1). An ultrasound of the abdomen showed an enlarged liver with hypoechoic lesions. The patient received digoxin. In the next few days, while liver enzymes and serum creatinine started to return to normal levels, the patient had two attacks of fast AF, each associated with elevated liver enzymes and a concomitant rise in serum creatinine. The patient was transferred to the intensive care unit to improve control of his AF, after which his liver enzymes and renal function gradually returned to normal.