Poster - #2022SPHU-52 - Keywords: Cardiac Cirrhosis Right Heart Failure Liver

Cardiac Cirrhosis: Acute on Chronic Right Heart Failure and Associated Consequence on Liver

Shikha Jha MD, Pratik Patel MD
Saint Peter's University Hospital, New Jersey, USA

ABSTRACT:
Background: Cardiac cirrhosis is a spectrum of hepatic disorders secondary to cardiac dysfunction. Any pathology of right heart failure can increase hepatic venous congestion and hepatic sinusoid pressure. Over the course of time, fibrotic changes occur leading to liver cirrhosis. Case presentation: A 79-year-old male who presented to the emergency department with shortness of breath. His history is significant of chronic smoking, pulmonary hypertension, tricuspid regurgitation, and multiple past admissions for right heart failure. He was hypoxic and had elevated jugular venous pressure. A high-pitched holo-systolic murmur was heard in the right upper sternal border and apex, decreased bilateral breath sound in the bilateral lower zone of the chest. Ascitic changes were noted in the abdomen. Result: An electrocardiogram showed normal sinus rhythm. Cardiac troponin was 0.048 ng/mL and NT pro-Brain Natriuretic Peptide level was 14300 pg/mL. Chest X-ray showed bilateral pleural effusion and pulmonary vascular congestion. CT abdomen showed a nodular contour of the liver. Abdominal Doppler ultrasound showed pulsatile flow in the portal, hepatic, and inferior vena cava veins. An echocardiogram showed dilated right atrium, enlarged right ventricle, elevated right ventricular systolic pressure, mild to moderate tricuspid and mitral regurgitation, and normal ejection fraction. Decision making: The patient was clearly in volume overload and cirrhotic changes were secondary to right heart failure. Oxygen support and diuresis were the cornerstones of patient management. Conclusion: Recurrent right heart failure can occur due to chronic smoking, pulmonary hypertension, and tricuspid regurgitation. This leads to congestive hepatopathy with eventual liver cirrhosis changes. Treatment is based on managing the underlying cardiac condition.