Hepato-cardiac disorders

Table 2 Comparison between acute and chronic hepatic complications of cardiac failure

	Chronic congestive hepatopathy	Acute ischemic hepatitis
Aetiology	Chronic heart failure	Acute heart failure
Pathophysiology	Perisinusoidal edema	Tissue hypoxia
	Increased lymph flow	Zone 3 necrosis
	Zone 3: alternating necrosis and hemorrhage
	Sinusoidal thrombosis
Manifestations	Right hypochondrial pain	Asymptomatic or nonspecific
	Edema, ascites, jaundice	(nausea, vomiting, jaundice, right hypochondrial pain)
Laboratory data
Bilirubin	Mild increase	Marked elevation
ALT and AST	Normal mild elevation	Marked elevation
LDH	Normal or mild elevation	Marked elevation
Prothrombin time	Prolonged	Normal or prolonged
ALP	Normal or mild elevation	Increased
Albumin	Hypoalbuminemia	Normal
Traetment	ACE inhibitors	Oxygen therapy
	b-blockers	Avoid precipitating factors
	Diuretic	Inotropic agents with caution
	Amiodarone	Vasopressor with caution
	Statins with caution	Diuretics in hypervolemia
Prognosis	Slowly progressive course	Benign and usually self limited

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDH: Lactic dehydrogenase; ALP: Alkaline phosphatase; ACE: Angiotensin-converting enzyme.