Table 2.
Comparison between acute and chronic hepatic complications of cardiac failure
| Chronic congestive hepatopathy | Acute ischemic hepatitis | |
| Aetiology | Chronic heart failure | Acute heart failure |
| Pathophysiology | Perisinusoidal edema | Tissue hypoxia |
| Increased lymph flow | Zone 3 necrosis | |
| Zone 3: alternating necrosis and hemorrhage | ||
| Sinusoidal thrombosis | ||
| Manifestations | Right hypochondrial pain | Asymptomatic or nonspecific |
| Edema, ascites, jaundice | (nausea, vomiting, jaundice, right hypochondrial pain) | |
| Laboratory data | ||
| Bilirubin | Mild increase | Marked elevation |
| ALT and AST | Normal mild elevation | Marked elevation |
| LDH | Normal or mild elevation | Marked elevation |
| Prothrombin time | Prolonged | Normal or prolonged |
| ALP | Normal or mild elevation | Increased |
| Albumin | Hypoalbuminemia | Normal |
| Traetment | ACE inhibitors | Oxygen therapy |
| b-blockers | Avoid precipitating factors | |
| Diuretic | Inotropic agents with caution | |
| Amiodarone | Vasopressor with caution | |
| Statins with caution | Diuretics in hypervolemia | |
| Prognosis | Slowly progressive course | Benign and usually self limited |
ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; LDH: Lactic dehydrogenase; ALP: Alkaline phosphatase; ACE: Angiotensin-converting enzyme.