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[Ischemic hepatitis]
J Muszyński1, A Ehrmann-Jóśko, J Stanisławska-Nielepkiewicz
1Kliniki Gastroenterołogii i Chorób Przemiany Materii Akademii Medycznej w Warszawie.
Insights
Patients with severe heart failure can experience ischemic hepatitis, a condition marked by liver cell damage indicated by elevated liver enzymes. Recovery of liver function is linked to the improvement of the underlying heart condition.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Background:
- Congestive heart failure (CHF) can lead to reduced liver perfusion.
- Acute deterioration of CHF, such as pulmonary edema and hypotension, exacerbates liver hypoperfusion.
- This hypoperfusion can result in acute liver cell damage, termed ischemic hepatitis.
Observation:
- Patients with acute heart failure exacerbations exhibit signs of ischemic hepatitis.
- Key indicators include significantly elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels.
- Slight increases in bilirubin, alkaline phosphatase, and glucose may also be observed, with no evidence of viral hepatitis.
Findings:
- A case study detailed a 34-year-old male with a history of myocardial infarction and CHF, admitted in shock.
- Despite no acute myocardial infarction signs on ECG/Echo, he presented with severe liver cell damage (very high AST, ALT, LDH).
- Diagnosis was ischemic hepatitis, with liver function normalizing upon heart failure improvement.
Implications:
- Ischemic hepatitis in CHF patients is a reversible condition.
- Prognosis for ischemic hepatitis is directly dependent on the management and course of the underlying heart failure.
- This highlights the critical interplay between cardiac function and liver health.
Abstract:
The patients with chronic congestive heart failure and acute deterioration of heart failure (pulmonary oedema, significant reduction of blood pressure) have decrease liver's perfusion with signs of acute damage of liver's cells--ischemic hepatitis. Aspat, AIAT and LDH in blood rich very high level. The level of bilirubin, alkaline phosphatase and glucose increase slightly. Hepatotoxic viruses are never observed. The authors described a case of 34 years old man, who two years earlier had large myocardial infarction with aneurysm of heart and congestive heart failure. He was admitted to hospital in shock. The shock was caused probably by overdose of nitroglycerin. In ECG and Echo examinations he had no signs of acute myocardial infarction, but we observed serious damage of liver's cells with very high levels of AspAT, AIAT and LDH. Based on clinical and biochemical examinations we diagnosed ischemic hepatitis. The patient's clinical and biochemical tests were normalized after improvement of heart failure. Biopsy of liver was normal at that time. Prognosis in ischemic hepatitis depends on course of heart failure.