“Cardiac Hepatopathy”: A Review of Liver Dysfunction in Heart Failure

Abstract

The unique dual circulation of the liver confers relative protection against ischemic injury; however, low oxygen tension in the microcirculation (sinusoidal blood of the hepatic acinus) may render hepatocytes in zone 3 relatively vulnerable to ischemic injury and necrosis. Severe congestive heart failure is associated with two distinct forms of liver dysfunction under the umbrella term “cardiac hepatopathy”. The two entities include: jaundice related to passive congestion (congestive hepatopathy from backward cardiac failure) and acute hepatocellular necrosis caused by impaired hepatic perfusion (hypoxic hepatitis from forward cardiac failure). This article provides a comprehensive, up-to-date review on the topic and focuses on the epidemiology, pathology, pathogenesis, clinical manifestations, diagnostic testing and treatment strategies pertaining to liver disease in circulatory failure.