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Arch Hellen Med, 37(2), March-April 2019, 151-165


The cardiohepatic syndrome

Ι. Dimitroglou, I. Mani, S.P. Dourakis
Second Department of Internal Medicine with Research Laboratory, School of Medicine, National and Kapodistrian University of Athens, "Hippokration" General Hospital, Athens, Greece

The term cardiohepatic syndrome covers a complex series of interactions between the heart and the liver. It can be divided into five types, according to which organ presents the primary damage, and the time of its establishment. Specifically, type 1 cardiohepatic syndrome is characterized by acute heart failure. Left heart failure leads to ischemic hepatitis in the context of generalized tissue hypoxia. In contrast, deficiency of the right chambers of the heart results in increase in hydrostatic pressure in the liver, leading to congestion of the sinusoids. This finally results in both hepatocellular hypoxia and compression of the intrahepatic bile ducts. In type 2 cardiohepatic syndrome, chronic heart failure is accompanied by chronic congestion of the liver leading to characteristic persistent histological damage. In type 3 cardiohepatic syndrome the primary disorder is acute hepatic failure. This situation is closely related with systematic inflammation, and leads to an increase in cardiac work subsequent to hyperdynamic circulation. Sometimes symptoms of heart failure can be present, especially in case of underlying cardiomyopathy. Type 4 cardiohepatic syndrome is traditionally described as "cirrhotic cardiomyopathy". In this case, chronic hepatic failure leads to dysfunction of the cardiac cells and imbalance of the adrenergic system. The final result is diastolic and systolic heart failure, with a variety of cardiac arrhythmias. Finally, type 5 cardiohepatic syndrome includes conditions that affect the heart and liver simultaneously, including amyloidosis, sarcoidosis and hemochromatosis, as well as certain hepatotoxic drugs used in the treatment of cardiological conditions. For all of the types, the therapeutic approach is focused on treatment of the underlying cause and amelioration of the symptoms.

Key words: Cardiac liver, Cardiohepatic syndrome, Cirrhotic cardiomyopathy, Heart failure, Liver cirrhosis.

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