Cardiac Cirrhosis and Congestive Hepatopathy Follow-up

Updated: Dec 22, 2014
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Follow-up

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, creatinine, 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.

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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.

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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
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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
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Complications

Possible complications include acute renal failure secondary to overdiuresis.

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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.

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Patient Education

Additional patient information may be found at Heart Failure Online and Health Central.

For patient education resources, see the Heart Health Center, as well as Congestive Heart Failure.

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