Cardiac Cirrhosis and Congestive Hepatopathy Treatment & Management

  • Author: Xiushui (Mike) Ren; Chief Editor: Henry H Ooi, MBBCh   more...
 
Updated: Mar 2, 2012
 

Medical Care

No prospective studies have been performed to evaluate the medical treatment of cardiac cirrhosis. Because no data suggest that the presence of cardiac cirrhosis worsens mortality or morbidity rates, direct treatment at the underlying source of elevated right-sided heart pressure and hepatic venous congestion.

  • Initiate treatment in an inpatient setting, both to rule out ischemic heart disease and to administer IV diuretics.
  • In most cases, diuresis is the cornerstone of initial medical therapy for symptomatic relief.
  • Once the patient is euvolemic, beta-blockers and ace inhibitors should be added if the underlying cause is left ventricular dysfunction.
  • Spironolactone should be considered, especially if there is New York Heart Association class III or IV heart failure.
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Surgical Care

Definitive treatment of cardiac cirrhosis sometimes requires surgical intervention, particularly when the underlying structural or anatomic lesion remains symptomatic despite maximal medical therapy.

Examples of surgical intervention include the following:

  • Coronary artery bypass surgery or percutaneous transluminal coronary angioplasty for ischemic cardiomyopathy
  • Tricuspid valve repair or replacement for tricuspid regurgitation or tricuspid stenosis
  • Pericardiectomy (cardiac decortication) for constrictive pericarditis
  • Peritoneovenous shunt not indicated to treat cardiac ascites
  • Transjugular intrahepatic portosystemic shunt (TIPSS): This is generally contraindicated because of the risk of acute right-sided decompensation from increased venous return. One recent case report illustrated the use of TIPSS procedure in a patient with cardiac cirrhosis after heart transplant that resulted in a successful outcome.[6]
  • Cardiac transplantation can be considered for end-stage cardiomyopathy. The presence of cardiac cirrhosis with significant liver fibrosis is considered a contraindication to transplantation. Although standard transplant criteria applies, several caveats should be considered. First, right-heart failure can be accompanied by significant pulmonary hypertension, which may necessitate combined heart-lung transplant. Second, synthetic liver function may be affected, leading to bleeding complications associated with transplantation. However, a study examining the reversibility of cardiac cirrhosis in patients undergoing heart transplant showed that synthetic function significantly improved within 3 months after transplant.[7]
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Consultations

  • Cardiology
  • Gastroenterology
  • Diet and/or nutrition
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Diet

Sodium restriction is a fundamental component of long-term management. The sodium intake goal is less than 2 g/d.

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Activity

A sensible exercise program is appropriate for most patients with cardiac cirrhosis after medical control of their underlying heart failure.

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Contributor Information and Disclosures
Author

Xiushui (Mike) Ren  MD, Cardiovascular Physician, Department of Cardiology, Kaiser Medical Center; Associate Director of Research, Cardiovascular Diseases Fellowship, California Pacific Medical Center

Xiushui (Mike) Ren is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, and American Society of Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Justin D Pearlman, MD, ME, PhD, FACC, MA  Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Director of Cardiology Quality Program KMC, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School

Justin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald J Oudiz, MD, FACP, FACC, FCCP  Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting; Medtronic Consulting fee Consulting; Novartis Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Henry H Ooi, MBBCh  Director, Advanced Heart Failure and Cardiac Transplant Program, Nashville Veterans Affairs Medical Center; Assistant Professor of Medicine, Vanderbilt University School of Medicine

Disclosure: Nothing to disclose.

References

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Cardiac cirrhosis. Congestive hepatopathy with large renal vein.
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