"Acute liver failure": the heart may be the matter

• Published in: Acta clinica belgica (English ed. Online) 2011-05, Vol.66 (3), p.236-239
• Main Authors: de Leeuw, K, Meertens, J H J M, van der Horst, I C C, van der Berg, A P, Ligtenberg, J J M, Tulleken, J E, Zijlstra, J G
• Format: Article
• Language: English
• Subjects: Abdomen; Acute Disease; Antibiotics; Diagnosis, Differential; Disease; Enzymes; Family medical history; Female; Gallbladder; Heart failure; Heart Failure - complications; Heart Failure - diagnostic imaging; Hepatitis; Hepatitis - diagnosis; Hepatitis - etiology; Hospitals; Humans; Hypoxia - complications; L-Lactate Dehydrogenase - blood; Liver; Liver - enzymology; Liver failure; Liver Failure - diagnosis; Liver Failure - etiology; Medical treatment; Middle Aged; Radiography; Transaminases - blood; Transplantation; Ultrasonography; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnostic imaging; Viral infections
• ISSN: 1784-3286; 2295-3337
• DOI: 10.2143/ACB.66.3.2062557

Hypoxic hepatitis secondary to heart failure is a known and treatable cause of liver failure. The diagnosis may be difficult, especially when symptoms of heart failure are absent. We present two patients who were transferred to our hospital with the diagnosis of acute liver failure to be screened for a liver transplantation. Both patients had increased serum levels ofaminotransferases, lactic acidosis, coagulation disorders, and non-specific clinical symptoms. Echocardiography revealed right ventricular dysfunction. Treatment with inotropes resulted in a fast normalization of liver enzymes, acidosis and coagulation, confirming the diagnosis hypoxic hepatitis. In conclusion, when the cause of acute liver dysfunction is unclear, hypoxic hepatitis due to heart failure should be considered and echocardiography should be performed, even when symptoms are non-specific for heart failure.