Clinical evaluation of liver function in congestive heart failure in Cuddalore District

ABSTRACT

Background: Abnormal liver enzymes and liver function in congestive cardiac failure has long been recognized and occurs quite frequently in acute and chronic failure. Heart failure (HF) is characterized by the inability of systemic perfusion to meet the body's metabolic demands and is usually caused by cardiac pump dysfunction and may occasionally present with symptoms of a non-cardiac disorder such as hepatic dysfunction. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Aim of the study The present study was undertaken to identify alterations in the liver biochemical profiles in relation to congestive heart failure and also to show their significance with respect to the duration of heart failure. Materials and methods: Totally Sixty cases with heart failure of various etiologies and twenty healthy controls who got admitted at medicine ward of Sri Rajah Mutaiah Medical College and Hospital in the year 2019 March-August were included in the study. The higher number of cases was found within the age group of 40 to 50 years followed by the age group of 50 to 60 years. Laboratory tests measured only a limited number of these functions. No one test enabled the clinician to accurately assess the liver's total functional capacity. To increase both the sensitivity and specificity of laboratory tests in the detection of liver disease, it is best to use them as a battery. Results: Present study has found a strong relationship between liver function derangements and heart failure cases. The study observed 20% of cases with jaundice. Among sixty cases liver enlargement was seen in 63% of cases. Increased liver size is strongly correlated with hyperbilirubinemia. Though the conjugated fraction of bilirubin was also elevated, the levels of unconjugated fraction were higher. Mathew Jeraud. Clinical evaluation of liver function in congestive heart failure in Cuddalore District . IAIM, 2019; 6(9) 43- 48. Page 44 Serum aminotransferases were elevated in 78% of cases, unlike serum alkaline phosphatase which was increased only in 25% of cases. There found to be a significant correlation between rise in unconjugated bilirubin and elevation of serum aminotransferases. Conclusion: Study revealed marked alterations in liver function with acute heart failure and during hypotension when compared to chronic heart failure. Low serum proteins and serum albumin levels are seen in many of the cases. Various factors play in causing these changes which have already been discussed. Serum prothrombin time, though prolonged in 88% of cases, the changes were only mild.