Heart failure (HF) is characterized by the inability of systemic perfusion to meet
the body's metabolic demands and is usually caused by cardiac pump dysfunction and
may occasionally present with symptoms of a noncardiac disorder such as hepatic dysfunction.
The primary pathophysiology involved in hepatic dysfunction from HF is either passive
congestion from increased filling pressures or low cardiac output and the consequences
of impaired perfusion. Passive hepatic congestion due to increased central venous
pressure may cause elevations of liver enzymes and both direct and indirect serum
bilirubin. Impaired perfusion from decreased cardiac output may be associated with
acute hepatocellular necrosis with marked elevations in serum aminotransferases. Cardiogenic
ischemic hepatitis (“shock liver”) may ensue following an episode of profound hypotension
in patients with acute HF. We discuss pathophysiology and identification of liver
abnormalities that are commonly seen in patients with HF.
Heart failure - liver dysfunction - cardiovascular disease - pulsatile liver - hepatic
congestion - shock liver - cardiac output
