Cardio-Hepatic Syndrome in Iron Overload: A Scenario Beyond Alcohol and Metabolic Dysfunction

Liver disease and heart failure have interconnected pathophysiology and frequently coexist within the common framework of systemic metabolic disorder, as a result of alcohol overuse, or as a consequence of one organ's failure precipitating the other, in the form of congestive hepatopathy or, conversely, cirrhotic cardiomyopathy. Iron overload represents a less common but potentially devastating cardio-hepatic phenotype that may be missed when liver dysfunction, diabetes, arrhythmia, and heart failure are attributed prematurely to more prevalent causes. In this narrative mini-review, illustrated by an autopsy-confirmed case of fatal multiorgan iron overload, we aim (i) to raise clinical suspicion of iron overload among cardiologists, (ii) to address the wide spectrum of differential diagnoses to consider when liver disorder and heart failure coexist, and (iii) to emphasize the need for correct interpretation of iron indices and targeted management to improve patient outcomes.