Case of Ischemic Hepatitis in the Setting of HFpEF Exacerbated by Persistent Atrial Fibrillation

Area of Science:

• Cardiology
• Hepatology
• Internal Medicine

Background:

• Congestive hepatopathy from chronic heart failure typically presents as cholestatic liver injury.
• Severe hepatocellular injury is often associated with cardiogenic shock and reduced ejection fraction.

Observation:

• This case report details a patient with preserved ejection fraction experiencing rapid atrial fibrillation and hypotension.
• The patient presented with severe ischemic hepatitis, indicated by elevated liver enzymes (AST and ALT > 1000).

Findings:

• Hepatic ischemia in the context of atrial fibrillation and preserved ejection fraction is an under-recognized cause of acute liver injury.
• This presentation challenges the traditional understanding of heart failure-related liver dysfunction.

Implications:

• Clinicians should consider ischemic hepatitis in patients with atrial fibrillation and hypotension, even with preserved ejection fraction.
• This finding expands the differential diagnosis for acute liver injury in cardiac patients.