Cardiac cirrhosis is a serious liver disorder that can be triggered by cardiac (heart) circulation issues such as heart failure. The key to managing it is to effectively treat the underlying heart condition.
The term “cardiac cirrhosis” refers to any of the liver disorders that can develop when heart problems lead to congestion or fluid buildup in your liver. Your liver relies on healthy circulation to function properly. When a heart condition reduces blood flow, serious liver problems can occur.
Cardiac cirrhosis is usually associated with heart failure. It can be difficult to diagnose because other conditions, such as hepatitis and fatty liver disease, may be affecting liver health and function.
Treating cardiac cirrhosis involves managing the heart problem at the root of the liver disorder. If you have cardiac cirrhosis, your outlook will depend largely on the health and status of your heart.
This article takes a closer look at the symptoms, causes, diagnosis, and treatment of cardiac cirrhosis.
Heart health and liver health are linked. If you have liver disease, it means toxins are not being filtered out of your blood effectively. This can ultimately harm your heart and other organs.
If your heart isn’t consistently pumping oxygenated and nutrient-rich blood to your liver, your liver can develop problems such as cardiac cirrhosis.
A diagnosis of cardiac cirrhosis, also known as congestive hepatopathy, means that the pressure is increasing in the veins running through your liver. This is usually due to heart failure and the weakening of your heart’s ability to pump blood throughout your body.
Problems with the veins in your liver can cause fluid buildup within your liver. This, in turn, results in scarring and injury to hepatocytes — the cells that make up most of your liver tissue. In time, this can negatively affect your liver’s many functions.
The primary risk factor for cardiac cirrhosis is right sided heart failure. This is because this type of heart failure increases pressure in the right atrium, the upper right chamber of your heart.
The right atrium receives blood from the rest of your body via a network of large and small veins. Increased right atrial pressure causes pressure to increase in the veins serving your liver and the vena cava. The vena cava is the large vein that takes in filtered blood from your liver and delivers it to the right atrium.
Several heart conditions, including left sided heart failure, can eventually cause right sided heart failure. Other conditions that may lead to right sided heart failure include:
- chronic lung disease (cor pulmonale)
- pulmonary hypertension
- pulmonary embolism
- valvular disease (especially mitral valve stenosis and tricuspid valve regurgitation)
- high blood pressure
- constrictive pericarditis
Certain types of congenital heart disease may also lead to cardiac cirrhosis.
Cardiac cirrhosis often has no symptoms. If liver dysfunction continues, you may experience some pain in your upper right abdomen and possibly mild jaundice (yellowing of your skin).
However, if you have right sided heart failure, you are likely to have symptoms such as:
- abdominal pain and swelling due to fluid buildup (ascites)
- nausea and lack of appetite
- weight gain (more than 5 pounds in 1 week despite a lack of appetite)
- swelling in your lower limbs
If you’ve received a diagnosis of heart failure or another serious heart condition, a healthcare professional should also evaluate you for other complications, including liver dysfunction.
This involves a physical examination to check for liver swelling or tenderness and a review of any possible symptoms, such as jaundice, abdominal pain, or changes in the appearance of stool or urine.
The other important diagnostic tool is a blood test that checks your liver enzyme levels. Elevated levels can indicate some type of disorder. If it appears that you may have some liver dysfunction, your doctor may order one or more imaging tests. Standard liver imaging includes:
A 2020 study suggests that cardiac cirrhosis is largely underdiagnosed, in part because standard imaging scans can miss the condition.
The researchers suggest that doctors consider performing a liver biopsy, in which a small portion of liver tissue is removed and analyzed in a lab. This is especially helpful in cases where a heart transplant may be necessary to treat severe heart failure.
Treatment for cardiac cirrhosis involves addressing the underlying cause of the right sided heart failure. The American Heart Association provides the following
| Potential cause | Potential treatment |
|---|---|
| cor pulmonale | |
| pulmonary embolism | |
| heart valve disorders | valve repair or replacement |
| electrical delays between the heart’s left and ride side (bundle branch block) | biventricular pacemaker or cardiac resynchronization therapy |
| left ventricle failure | guideline-directed medical therapy (beta-blockers, ARNI, MRA, SGLT2 inhibitors) |
Directed medications that may be used for right sided and left sided heart failure include:
- Beta-blockers: a class of medications used to lower blood pressure and ease the burden on the heart muscle
- Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) or angiotensin receptor–neprilysin inhibitors (ARNI), such as Entresto: used to treat high blood pressure and prevent kidney damage that occurs with heart failure
- Mineralocorticoid receptor antagonists (MRA), such as spironolactone (Aldactone): used to reduce swelling from liver disease and to treat high blood pressure and heart failure
- Sodium-glucose co-transporter 2 (SGLT2) Inhibitors, such as empagliflozin (Jardiance): used to manage blood sugar levels and lower the risk of death in adults with diabetes and heart vessel disease
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If you have cardiac cirrhosis, you should also try to adopt heart- and liver-healthy lifestyle habits, including:
- consuming little or no alcohol, as advised by a doctor
- exercising regularly
- seeking support to quit smoking, if you smoke
- attempting to lose weight, if appropriate
Liver dysfunction may be reversible if healthy heart function can be restored.
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Improvements in the management of heart failure have led to reduced mortality rates.
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Cardiac cirrhosis is one of several potential complications of heart failure or congenital heart disease. It can affect your liver’s ability to filter toxins and waste material from your blood and perform many of its other vital functions.
Working with a doctor to manage your heart failure and taking steps to support healthy heart muscle function may take the pressure off your liver and help reverse some of the scarring and injury brought on by your cardiac complications.