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[A case of elevated transaminases caused by congestive heart failure simulating chronic hepatitis]
A de-Hoyos1, M L Loredo, O Henne
1Departamento de Gastroenterología, Instituto Nacional de Cardiología, Ignacio Chávez, México, D.F.
Insights
This case highlights how congestive heart failure (CHF) can cause persistent liver injury, mimicking other liver diseases. Elevated ALT and AST levels in patients with CHF warrant investigation for cardiac dysfunction.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- A young male patient presented with hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, congestive heart failure (CHF), and pulmonary hypertension.
- He later developed jaundice and hepatomegaly, initially diagnosed as acute viral hepatitis A.
Observation:
- Laboratory findings revealed persistently elevated ALT and AST levels, approximately seven times the normal mean, over a six-year period.
- Liver biopsies performed in 1991 and 1993 indicated liver injury solely secondary to CHF.
Findings:
- Congestive heart failure (CHF) can manifest as significant and prolonged elevations in liver enzymes (ALT and AST).
- This cardiac-related liver injury can be mistaken for primary hepatobiliary diseases.
Implications:
- Clinicians should consider liver injury secondary to CHF in patients with unexplained persistent elevations of ALT and AST.
- Early recognition and management of CHF are crucial to prevent or mitigate cardiac-related liver complications.
Abstract:
We report the case of a young man first seen by is in 1989 at the age of 20 years. The diagnoses of hypertrophic cardiomyopathy, Wolf-parkinson-White syndrome, congestive heart failure and pulmonary hypertension were made. One month later the patient had jaundice and hepatomegaly and a diagnosis of acute viral hepatitis A was established by laboratory findings. The ALT and AST levels were persistently elevated, seven times the normal mean, during six years. Two liver biopsies in 1991 and 1993 showed liver injury secondary to congestive heart failure (CHF) as the only abnormality. This case illustrates the importance of liver injury secondary to CHF as a cause of a marked and persistent increase of ALT and AST that resembles that of other liver diseases.