Cardiac Cirrhosis and Congestive Hepatopathy Follow-up
- Author: Xiushui (Mike) Ren; Chief Editor: Henry H Ooi, MBBCh more...
Further Inpatient Care
- With few exceptions, patients presenting with cardiac cirrhosis and acute heart failure symptoms require hospital admission. This is particularly true in the initial presentation of heart failure.
- Admission also is indicated when chronic symptoms become refractory to outpatient therapy and large doses of oral diuretics do not provide adequate diuresis.
- Consider initial admission to a telemetry unit for continuous ECG monitoring.
Further Outpatient Care
- Instruct patients to maintain a diary of their daily weights. Specific instructions may be issued to increase the patient's oral diuretic dose, as well as to return for immediate medical evaluation when certain weight increases are exceeded (eg, 2 lb/d or 5 lb/wk).
- Schedule periodic follow-up.
- Monitor symptoms, preferably using well-defined activities (eg, walking 100 ft on ground level, climbing 1-2 flights of stairs).
- Follow serum levels of potassium, BUN, and creatinine.
- Follow serum levels of AST, ALT, alkaline phosphatase, and total bilirubin. All should normalize with attainment of heart failure compensation.
- Failure of levels to resolve despite heart failure resolution should prompt evaluation of noncardiac sources of liver disease.
Transfer
- Consider initial transfer to a telemetry ward for continuous ECG monitoring with new presentations of cardiac cirrhosis.
- Transfer to a tertiary care facility may be warranted for surgical treatment of the following:
- Atherosclerotic coronary artery disease - Either with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery
- Severe valvular disease
- Constrictive pericarditis
Deterrence/Prevention
The patient may prevent hospitalization for heart failure by enrolling in a heart failure clinic or agreeing to frequent brief physician visits for any of the following:
- Reinforcing recognition of early heart failure symptoms
- Close following of daily weight log
- Encouraging adherence to a low-sodium diet
- Reviewing medical compliance
- Drug interactions
Complications
Possible complications include acute renal failure secondary to overdiuresis.
Prognosis
- The independent effect of cardiac cirrhosis on morbidity or mortality rate is unknown.
- Prognosis is based on the patient's underlying heart failure condition.
Patient Education
Additional patient information may be found at Heart Failure Online and Heart Information Network.
For patient education resources, see the Heart Center, as well as Congestive Heart Failure.
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