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Cardiac cirrhosis: A ‘broken’ heart can give hard time to the liver
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Cardiac cirrhosis: A ‘broken’ heart can give hard time to the liver

Right heart failure can cause pressure overload on the liver, hardening it and affecting its functions

Heart issues can also impact liver health. Similar to other organs, the liver also requires adequate circulation to be able to function properly. It can develop irreversible conditions if the circulation gets affected due to problems in the heart. Cardiac cirrhosis is one such serious liver disease that can manifest as a result of heart-related issues.

What is cardiac cirrhosis?

Dr Abhijit Vilas Kulkarni, senior interventional cardiologist at Apollo Hospitals, Bangalore, says as the name implies, cirrhosis is the problem associated with the liver. “Cardiac cirrhosis refers to liver complications arising from heart issues. This condition can result in the gradual hardening of the liver, making it non-functional over time.

The liver is connected to the heart through hepatic veins that are linked to the inferior vena cava, the largest vein in the body, which in turn connects to the heart. Dr K S Somasekhar Rao, senior consultant gastroenterologist, hepatologist and advanced therapeutic endoscopist at Yashoda Hospitals, Hyderabad, explains, “The heart receives all venous blood. When there is an increase in the pressure on the right side of the heart, it results in a pressure overload on the liver. If this chronic pressure on the liver persists for a long time, such as six months to a year, it causes cirrhosis. When the liver problem is secondary to the heart problem, it is called cardiac cirrhosis.”

He further explains that the liver is a soft organ that hardens due to pressure overload. When the severity is relatively low, the condition is termed congestive hepatopathy. “Congestive hepatopathy is a reversible condition where the pressure can be reduced with diuretics. It progresses to cardiac cirrhosis if not treated properly on time,” says Dr Rao.

What are the causes of cardiac cirrhosis?

Cardiac cirrhosis is caused due to right heart failure. Dr Kulkarni says, “Any valve or associated muscle problems of the right heart like tricuspid regurgitation and pericardium issues, respectively, can cause right heart failure. Generally, left heart failure is the primary cause of right heart failure. If the left heart is diseased, often due to blockages or heart attacks and left pumping dysfunction, it can impact the right side of the heart.” He adds even lung conditions like COPD (Chronic Obstructive Pulmonary Disease) linked to an increase in smoking habits, can increase the pressure on the right side of the heart, causing its failure.

“There are some infections like tuberculosis which can affect the outer covering of the heart. This condition is called constrictive pericarditis. This can also affect the right side of the heart and cause cardiac cirrhosis,” Dr Kulkarni says.

Symptoms of the cardiac cirrhosis include:

  • Swelling in the abdomen and feet
  • Engorgement of the neck veins
  • Weakness
  • Tiredness and fatigue
  • Loss of appetite
  • Abdominal pain

Dr Rao adds, that over a period of time, one can also develop symptoms of liver diseases like jaundice.

Holistic approach to diagnosis

Cardiac cirrhosis can be difficult to diagnose as the symptoms can be similar to other liver conditions. Experts say it is diagnosed when there is an associated heart condition and all the other causes for cirrhosis of the liver are ruled out. “When there is swelling in the feet, we try to rule out other causes associated with it. Any deficiency in the blood, kidney or liver issues are the other usual suspects. An ECHO is done to diagnose the right heart failure. Once that is diagnosed, cardiac cirrhosis is generally inferred. However, it’s crucial to recognize that not all cases of right heart failure progress to cardiac cirrhosis. The overall status of liver health must be assessed to establish a connection between the two conditions,” says Dr Kulkarni.

Dr Rao adds liver health is diagnosed with ultrasound and FibroScan which helps differentiate between congestive hepatopathy and cardiac cirrhosis. “If the liver is too stiff, it is diagnosed as cardiac cirrhosis,” he says.

Hence, experts say the diagnosis needs to have a holistic approach with proper workup of the person for easier and quicker diagnosis. Cardiac cirrhosis can affect the quality of life of a person adversely as one loses appetite and has no energy to do daily tasks. Dr Kulkarni says, “Their immunity also comes down, making them more susceptible to infections. Then, one thing leads to another and causes more health problems.”

How do you treat cardiac cirrhosis?

Cardiac cirrhosis is treated by treating the cause of the right heart failure. Dr Kulkarni says, “In case of right heart failure, the valve in the right side of the heart can leak, which can affect the liver functioning. There are medical interventions like TAVR (Transcatheter aortic valve replacement) to help reduce the leak and improve the functioning of the valve.”

Effective treatment of cardiac cirrhosis can help improve liver health, especially if the condition is reversible. Although the five-year mortality rate for any heart failure is generally high, Dr Kulkarni says in about 70 to 80 percent of the cases, favorable modifications can be achieved through available medical interventions today. This positive outcome is upon accurate and early diagnosis.

Takeaways

  • Cardiac cirrhosis is the condition where the liver gets hardened, affecting its function due to pressure overload.
  • It is caused mostly by right heart failure.
  • Treating causes of right heart failure can help improve liver condition, if it is reversible.
  • Symptoms include abdominal pain and swelling, loss of appetite, fatigue and engorged neck veins.
  • Early diagnosis and proper treatment are the keys to improving quality of life and life expectancy.

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