Ischemic hepatitis in a patient with congestive cardiomyopathy: an innovative approach to therapy using intravenous...

Patients who sustain a transient period of hypotension or low cardiac output can develop massive elevations of the serum transaminases without serum markers of acute hepatitis, a recent myocardial infarction or exposure to toxins and chemicals. This condition is often termed "ischemic hepatitis" (IH), with its pathological correlate being centrilobular necrosis. Recognition of IH can help in the appropriate management of these patients, and avoid unnecessary diagnostic testing. The authors describe a patient with congestive cardiomyopathy in whom IH developed as part of a complicated hospital course. The condition appeared to reverse with the administration of dobutamine, suggesting inotropic therapy as an appropriate treatment modality.