Cardiohepatic Syndrome Presenting as Large-Volume Ascites in Acute Decompensated Heart Failure: A Case Report
Abstract
Congestive hepatopathy is an underrecognized manifestation of elevated cardiac filling pressures and systemic venous congestion in heart failure. Although acute decompensated heart failure often presents with pulmonary edema and respiratory compromise, advanced diastolic dysfunction may also produce hepatic congestion, ascites, pleural effusions, and cardiorenal syndrome. We present the case of a 48-year-old male with hypertension, hyperlipidemia, type 2 diabetes mellitus, and recently diagnosed heart failure with preserved ejection fraction (HFpEF) who presented with progressive dyspnea, orthopnea, bilateral lower extremity edema, and declining exercise tolerance. Laboratory evaluation demonstrated hypervolemic hyponatremia, acute kidney injury, hyperbilirubinemia, and cholestatic-predominant liver injury. Echocardiography revealed preserved ejection fraction with severe concentric left ventricular hypertrophy and findings suggestive of elevated right-sided filling pressures, including a dilated inferior vena cava with reduced inspiratory collapse. Left heart catheterization demonstrated significantly elevated left ventricular end-diastolic pressure despite nonobstructive coronary artery disease. Abdominal imaging showed hepatomegaly, ascites, mesenteric congestion, pleural effusion, and gallbladder wall thickening without biliary obstruction. The patient improved with aggressive intravenous diuresis and guideline-directed therapy. The combined clinical, laboratory,…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.