Cardiomyopathy unrecognized as a cause of hepatic failure.

Abstract:

:Two patients with similar symptoms referred for diagnosis and treatment of hepatic failure subsequently proved to have cardiomyopathy as the cause of their hepatic decompensation. Except for fatigue and edema, symptoms of congestive heart failure were absent and no history of dyspnea, orthopnea, or paroxysmal nocturnal dyspnea could be elicited. Hepatomegaly was present in both patients, but neck venous distension and hypotension were not apparent, and both patients were able to lie flat. The diagnosis of cardiomyopathy was made by echocardiogram showing global hypokinesis and low ejection fractions; right atrial pressures were markedly increased. Liver biopsies demonstrated centrilobular necrosis and congestion. Treatment for heart failure led to a prompt response in both patients with rapid return of all hepatic parameters toward normal. Paradoxically, our patients had striking evidence of hepatic failure and a notable absence of symptoms and signs of congestive heart failure. An awareness of this unique presentation may avoid prolonged evaluations in such critically ill patients.

journal_name

J Clin Gastroenterol

authors

Hoffman BJ,Pate MB,Marsh WH,Lee WM

doi

10.1097/00004836-199006000-00015

subject

Has Abstract

pub_date

1990-06-01 00:00:00

pages

306-9

issue

3

eissn

0192-0790

issn

1539-2031

journal_volume

12

pub_type

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