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Fulminant hepatic failure due to transient circulatory failure in patients with chronic heart disease
Insights
Heart failure can cause massive liver cell death and acute liver failure. This occurs after circulatory collapse, even when heart function stabilizes, leading to hepatic encephalopathy and jaundice.
Area of Science:
- Cardiology
- Hepatology
- Critical Care Medicine
Background:
- Heart failure is an uncommon cause of massive liver cell necrosis.
- Clinical consequences are often masked by cardiac insufficiency.
Observation:
- Six patients with chronic heart failure experienced acute circulatory failure.
- This led to massive liver cell necrosis and fulminant hepatic failure.
Findings:
- Fulminant hepatic failure manifestations (encephalopathy, jaundice, coagulopathy) appeared 1-3 days post-circulatory event.
- These occurred despite the patients' hemodynamic status returning to baseline.
Implications:
- Highlights a critical link between cardiac and hepatic health.
- Suggests careful monitoring for liver dysfunction in heart failure patients post-circulatory events.
- Underscores the potential for delayed hepatic failure following cardiac decompensation.
Abstract:
Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequences of which are intermingled with those of cardiac insufficiency in most cases. We report the cases of six patients suffering from chronic heart failure in whom an episode of acute circulatory failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure, ie, hepatic encephalopathy, jaundice, and marked increase in prothrombin time, developed after an interval of one to three days, after the episode of acute circulatory failure, while the patiens' hemodynamic condition had returned to the previous basal status.