Fulminant Hepatic Failure Secondary to Previously Unrecognized Cardiomyopathy

Abstract

Fulminant hepatic failure is infrequently seen as a consequence of acute congestive heart failure. Recognition of this entity is important as treatment directed towards heart failure should help resolve the liver failure. A case of fulminant hepatic failure due to previously unrecognized cardiomyopathy is presented. A liver transplantation was being considered for fulminant hepatic failure until hemodynamic monitoring studies demonstrated that, in fact, the patient had severe cardiomyopathy. Treatment directed at his cardiomyopathy resolved the liver failure. Therefore, prompt recognition of such a phenomenon would enable early institution of appropriate therapeutic measures with the hope of clinical benefit to the patient.

When the heart kills the liver: acute liver failure in congestive heart failure

“…Only Kubo et al [9] reported a slight AST elevation (65 ± 82 U/L) in patients with a CI ≤ 1.5 L/min/m 2 . However, most other reports (Wiesen et al [18]; Fussell et al [4]) support the findings of our present study, where AST concentrations were shown to be elevated more than 2000-fold, despite a mean CI of 1.9 L/min/m 2 . The main difference of Kubo's report and the other studies are that Kubo described the incidence and severity of liver function abnormalities in patients with congestive heart failure, but in absence of acute decompensation.…”

“…Cardiomyopathy as the underlying cause of ALF is rare and only a few case reports are documented in the literature [5,7,8,18]. Cardiac decompensation can initially be undetected, and the usual signs of congestive heart failure may be absent [5,18]. Both, chronic and acute congestive heart failure can lead to hepatic dysfunction [10,17].…”

Case of fulminant hepatic failure due to unrecognized peripartum cardiomyopathy

“…The cardiomyopathy can initially go undetected, and the usual signs of congestive heart failure may be absent (1,2). To our knowledge, no case of fulminant hepatic failure has been reported due to cardiomyopathy developing in the peripartum period.…”

“…Cardiomyopathy as the underlying cause of fulminant hepatic failure is rare, with only a few case reports documented in the literature (1)(2)(3)(4). The cardiomyopathy can initially go undetected, and the usual signs of congestive heart failure may be absent (1,2).…”

“…In all but the most severe cases, treatment directed at improving cardiac function will result in improvement of the hepatic dysfunction, whether it is simply abnormal liver chemistry tests or fulminant hepatic failure (1)(2)(3)(4). Treatment of peripartum cardiomyopathy is similar to treatment for other causes of nonischemic dilated cardiomyopathy and includes afterload and preload reduction, inotropy, and beta-receptor blockade (6).…”