scholarly journals Overview on Cardiac Cirrhosis and Congestive Hepatopathy - A Review

2021 ◽  
pp. 212-220
Author(s):  
Mohammed Salah Hussein ◽  
Sarah Jamal Almujil ◽  
Ahmed Saeed S. Banheem ◽  
Nasser Naif Alsuhaymi ◽  
Mansour Hemaid Alhelali ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Hepatic Ischemia ◽  
Hemodynamic Therapy ◽  
Cardiac Cirrhosis ◽  
Hepatic Congestion ◽  
Surgical Treatments ◽  
Congestive Hepatopathy

Cardiac cirrhosis (congestive hepatopathy) refers to a group of hepatic abnormalities that develop as a result of right-sided heart failure.  Cirrhosis of the liver can be induced by any right-sided pathology that leads to right-sided heart failure, which leads to increased venous congestion and pressure in the hepatic sinusoids. Because cardiac cirrhosis might be asymptomatic or diagnosed incorrectly due to other types of liver disease, determining its prevalence is difficult. The underlying heart disease, rather than the hepatic congestion and damage, is usually the cause of death in cardiac cirrhosis. The control of the underlying cardiac disease, as well as the optimization of cardiac output, are the mainstays of congestive hepatopathy treatment. Diuresis can help with hepatic congestion, but it must be used with caution to avoid causing hepatic ischemia. Hemodynamic therapy may be able to reverse the early stages of congestive hepatitis. The widespread use of heart transplantation (HT) and considerable breakthroughs in medical and surgical treatments have drastically altered the profile of CH patients. In this overview we will be looking at the disease cause, epidemiology, diagnosis, and treatment.

scholarly journals Congestive Hepatopathy

2020 ◽  
Vol 21 (24) ◽  
pp. 9420
Author(s):  
José Ignacio Fortea ◽  
Ángela Puente ◽  
Antonio Cuadrado ◽  
Patricia Huelin ◽  
Raúl Pellón ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Cardiac Disease ◽  
Term Survival ◽  
Non Invasive ◽  
Surgical Treatments ◽  
Rheumatic Valvular Disease ◽  
Passive Congestion ◽  
Congestive Hepatopathy

Liver disease resulting from heart failure (HF) has generally been referred as “cardiac hepatopathy”. One of its main forms is congestive hepatopathy (CH), which results from passive venous congestion in the setting of chronic right-sided HF. The current spectrum of CH differs from earlier reports with HF, due to ischemic cardiomyopathy and congenital heart disease having surpassed rheumatic valvular disease. The chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis (“cardiac cirrhosis”) and hepatocellular carcinoma after several decades of ongoing injury. Contrary to primary liver diseases, in CH, inflammation seems to play no role in the progression of liver fibrosis, bridging fibrosis occurs between central veins to produce a “reversed lobulation” pattern and the performance of non-invasive diagnostic tests of liver fibrosis is poor. Although the clinical picture and prognosis is usually dominated by the underlying heart condition, the improved long-term survival of cardiac patients due to advances in medical and surgical treatments are responsible for the increased number of liver complications in this setting. Eventually, liver disease could become as clinically relevant as cardiac disease and further complicate its management.

Calcium Channel Blockers

1992 ◽  
Vol 3 (2) ◽  
pp. 437-446
Author(s):  
Pamela White
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Cardiac Disease ◽  
The Other ◽  
Cardiac Conduction ◽  
Channel Blockers ◽  
Clinical Effects ◽  
Conduction Disturbances

Calcium channel blockers are widely used in the treatment of ischemic heart disease, hypertension, and supraventricular tachycardia. The prototype agents, verapamil, nifedipine, and diltiazem, represent three classes of calcium channel blockers, each of which has different pharmacologic effects. Nifedipine and the other dihydropyridines primarily are vasodilators and have no clinical effects on cardiac conduction or contractility. Diltiazem and verapamil also are vasodilators, but they possess, to varying degrees, negative inotropic, chronotropic, and dromotropic effects. Side effects of these drugs are relatively rare and usually not serious, with the exception of potential conduction disturbances and heart failure in patients with underlying cardiac disease. To assess patients taking these medications and provide the necessary teaching, the nurse needs an understanding of the pharmacologic properties, clinical indications, and potential adverse effects of the various drugs

scholarly journals Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across sixteen countries

2021 ◽  
Author(s):  
Marijke Linschoten ◽  
Folkert W. Asselbergs ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Hospital Mortality ◽  
Cardiac Disease ◽  
Severe Heart Failure ◽  
P Value ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
Disease Subtypes ◽  
Multivariable Adjustment

AbstractAimsPatients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.Method and resultsWe used data from the CAPACITY-COVID registry and LEOSS study. Multivariable modified Poisson regression models were fitted to assess the association between different types of pre-existent heart disease and in-hospital mortality. 10,481 patients with COVID-19 were included (22.4% aged 66 – 75 years; 38.7% female) of which 30.5% had a history of cardiac disease. Patients with heart disease were older, predominantly male and more likely to have other comorbid conditions when compared to those without. COVID-19 symptoms at presentation did not differ between these groups. Mortality was higher in patients with cardiac disease (30.3%; n=968 versus 15.7%; n=1143). However, following multivariable adjustment this difference was not significant (adjusted risk ratio (aRR) 1.06 [95% CI 0.98 – 1.15, p-value 0.13]). Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for NYHA III/IV heart failure (aRR 1.43 [95% CI 1.22 – 1.68, p-value <0.001]) and atrial fibrillation (aRR 1.14 [95% CI 1.04 – 1.24, p-value 0.01]). None of the other heart disease subtypes, including ischemic heart disease, remained significant after multivariable adjustment.ConclusionThere is considerable heterogeneity in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with severe heart failure are at greatest risk of death when hospitalized with COVID-19.

Abstract 329: Cholecystalgia: an Atypical Presenting Symptom of Congestive Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Brittany Gilbert ◽  
Stephanie Harter ◽  
Elizabeth Saunders
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ischemic Cardiomyopathy ◽  
Venous Pressure ◽  
Acalculous Cholecystitis ◽  
Gallbladder Wall ◽  
Hepatobiliary Scintigraphy ◽  
Left Heart ◽  
Hepatic Congestion ◽  
Congestive Hepatopathy

Acute acalculous cholecystitis is defined as acute inflammatory disease of the gallbladder without evidence of gallstones or cystic duct obstruction. Imaging studies typically show a distended acalculous gallbladder with thickened walls. Heart failure is well known to cause congestive hepatopathy and can be associated with isolated gallbladder edema which is often difficult to differentiate from acalculous cholecystitis. We present a case of cholecystalgia secondary to isolated gallbladder edema without hepatic congestion in a patient with non-ischemic cardiomyopathy mimicking the presentation of acalculous cholecystitis. A 46-year-old female with a past medical history of recently diagnosed non-ischemic cardiomyopathy during a prior hospitalization. Echocardiogram showed biventricular heart failure with EF of 15 to 20% with severe left and right ventricular dilatation and global hypokinesis. Left heart catherization showed no angiographic evidence of coronary artery disease and right heart catheterization demonstrated pulmonary hypertension secondary to left heart disease. She left against medical advice and was non-compliant with her medications. Approximately one month later, she presented with shortness of breath and orthopnea. On physical examination, jugular venous distention, S3 gallop, diffuse crackles and anasarca were noted. Labs showed BNP of 12,735. Chest CT revealed cardiomegaly and diffuse interstitial edema with bilateral pleural effusions and no signs of pulmonary embolus. Metoprolol and bumetanide were initiated for management of her acutely decompensated congestive heart failure. Several days after admission, she developed severe sharp RUQ pain associated with nausea and vomiting. She was tachypneic, diaphoretic with severe tenderness in the RUQ. Abdominal ultrasound revealed no signs of congestive hepatopathy but revealed a diffuse, edematous thickening of the gallbladder wall without evidence of stones. Hepatobiliary scintigraphy revealed preserved gallbladder function with an EF of 88%. The remainder of her care was focused on optimization of the patient’s congestive heart failure with complete resolution of her symptoms. Acute decompensation of congestive heart failure can result in an increase in pulmonary or systemic venous pressure, which may result in vascular congestion. The vascular distention can lead to isolated distention of the gallbladder wall that can mimic symptoms of acalculous cholecystitis. In such patient’s cholecystectomy or percutaneous cholecystostomy is not warranted. Radiographic evidence and symptoms usually resolve with optimization of congestive heart failure treatment. This case details the under-recognized presentation of secondary cholecystalgia in a patient with acute RUQ pain and underlying congestive heart failure.

scholarly journals Stroke and brain atrophy in chronic Chagas disease patients: A new theory proposition

2009 ◽  
Vol 3 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Jamary Oliveira-Filho
Keyword(s):  
Cardiac Output ◽  
Heart Disease ◽  
Chagas Disease ◽  
Cardiac Disease ◽  
Brain Atrophy ◽  
Structural Heart Disease ◽  
Endothelial Damage ◽  
Low Cardiac Output ◽  
The Brain ◽  
Chronic Chagas Disease

Abstract Chagas disease (CD) remains a major cause of cardiomyopathy and stroke in developing countries. Brain damage in CD has been attributed exclusively to the effects of structural heart disease on the brain, including cardioembolism and low cardiac output symptoms. However, CD patients also develop stroke and brain atrophy independently of cardiac disease severity. Chronic inflammation directed against T. cruzi may act as a trigger for endothelial damage, platelet activation, acceleration of atherosclerosis and apoptosis, all of which lead to stroke and brain atrophy. In the present article, evidence supporting this new theory is presented, along with considerations towards mechanistically-based targeted treatment.

scholarly journals Pregnancy with Heart Disease: Maternal Outcomes and Risk Factors for Fetal Growth Restriction

2019 ◽  
Vol 16 (12) ◽  
pp. 2075 ◽  
Author(s):  
Thang Nguyen Manh ◽  
Nhon Bui Van ◽  
Huyen Le Thi ◽  
Long Vo Hoang ◽  
Hao Nguyen Si Anh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Heart Disease ◽  
Fetal Growth ◽  
Cardiac Disease ◽  
Fetal Growth Restriction ◽  
Septal Defect ◽  
Growth Restriction ◽  
Maternal Outcomes ◽  
Valve Regurgitation

Caring for children and mothers suffering from cardiac disease is highly challenging, with issues including late diagnosis as well as inadequate infrastructure and supply of drugs. We aimed to evaluate maternal outcomes among pregnant women suffering from heart disease with a live birth, and explored the risk factors for fetal growth restriction among these patients. A retrospective study was performed at the National Hospital of Obstetrics and Gynecology (Hanoi, Vietnam) over a 3-year period from 2014 to 2016. A total of 284 patients were enrolled in the study. Overall, most women were aged below 35 years and were diagnosed with heart disease before pregnancy. Of the women experiencing rheumatic heart disease, the prevalence of mitral valve regurgitation was the highest (40.14%), while the figure for aortic valve regurgitation was the lowest (4.23%). Of women with congenital heart defects, the most common defects were ventricular septal defect (VSD) and atrial septal defect (ASD) (19.37% and 16.55%, respectively), while 5.28% of mothers were diagnosed with tetralogy of Fallot and 1.76% with patent ductus arteriosus. Noted clinical presentations of the patients included palpitation (63.38%), breathlessness (23.59%), leg edema (8.45%), and chest pain (8.1%). The common complications in the study population included 16.90% of women having heart failure and 19.37% having arrhythmias. The incidence of fetal growth restriction was 9.15%. Hypertension (odds ratio (OR): 59.75, 95% confidence interval (CI): 9.1–392.17), the heart disease types (ASD (OR: 4.27, 95% CI: 1.19–15.29) and tetralogy of Fallot (OR: 6.82, 95% CI: 1.21–38.55)), and the complications (heart failure (OR: 10.34, 95% CI: 2.75–38.87) and pulmonary edema (OR: 107.16, 95% CI: 4.96–2313.93)) were observed as risk factors for intrauterine growth restriction. This study provides a cornerstone to promote further studies and to motivate people to apply evidence-based medical care for mothers with diagnosed cardiac disease in the antenatal and postnatal periods.

Heart disease in pregnancy

2010 ◽  
pp. 2108-2115
Author(s):  
Catherine E.G. Head
Keyword(s):  
Cardiac Output ◽  
Heart Disease ◽  
Plasma Volume ◽  
Cardiac Disease ◽  
Output Increase ◽  
Heart Disease In Pregnancy ◽  
Diastolic Murmur ◽  
Symptoms And Signs ◽  
In Pregnancy

Pregnancy is a vasodilator state in which plasma volume and cardiac output increase such that many symptoms and signs of cardiac disease can occur physiologically. Disproportionate symptoms or abnormal signs such as a diastolic murmur require investigation as usual; necessary radiological investigations should not be withheld as the risks to the fetus are generally low....

scholarly journals Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC)

2019 ◽  
Vol 40 (47) ◽  
pp. 3848-3855 ◽  
Author(s):  
Jolien Roos-Hesselink ◽  
Lucia Baris ◽  
Mark Johnson ◽  
Julie De Backer ◽  
Catherine Otto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
High Risk ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Cardiac Disease ◽  
Heart Association ◽  
World Health ◽  
Complication Rates ◽  
Maternal Complications

Abstract Aims Reducing maternal mortality is a World Health Organization (WHO) global health goal. Although maternal deaths due to haemorrhage and infection are declining, those related to heart disease are increasing and are now the most important cause in western countries. The aim is to define contemporary diagnosis-specific outcomes in pregnant women with heart disease. Methods and results From 2007 to 2018, pregnant women with heart disease were prospectively enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC). Primary outcome was maternal mortality or heart failure, secondary outcomes were other cardiac, obstetric, and foetal complications. We enrolled 5739 pregnancies; the mean age was 29.5. Prevalent diagnoses were congenital (57%) and valvular heart disease (29%). Mortality (overall 0.6%) was highest in the pulmonary arterial hypertension (PAH) group (9%). Heart failure occurred in 11%, arrhythmias in 2%. Delivery was by Caesarean section in 44%. Obstetric and foetal complications occurred in 17% and 21%, respectively. The number of high-risk pregnancies (mWHO Class IV) increased from 0.7% in 2007–2010 to 10.9% in 2015–2018. Determinants for maternal complications were pre-pregnancy heart failure or New York Heart Association &gt;II, systemic ejection fraction &lt;40%, mWHO Class 4, and anticoagulants use. After an increase from 2007 to 2009, complication rates fell from 13.2% in 2010 to 9.3% in 2017. Conclusion Rates of maternal mortality or heart failure were high in women with heart disease. However, from 2010, these rates declined despite the inclusion of more high-risk pregnancies. Highest complication rates occurred in women with PAH.

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