RESUMO
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. Therefore, it is crucial in clinical practice to identify complex interactions between heart and liver, in order to provide the best treatment for both. In this review, we sought to summarize principal evidence explaining the mechanisms and supporting the existence of this complicate cross-talk between heart and liver. Hepatic involvement after heart failure, its pathophysiology, clinical presentation (congestive and ischemic hepatopathy), laboratory and echocardiographic prognostic markers are discussed; likewise, hepatic diseases influencing cardiac function (cirrhotic cardiomyopathy). Several clinical conditions (congenital, metabolic and infectious causes) possibly affecting simultaneously liver and heart have been also discussed. Cardiovascular drug therapy may present important side effects on the liver and hepato-biliary drug therapy on heart and vessels; post-transplantation immunosuppressive drugs may show reciprocal cardio-hepatotoxicity. A heart-liver axis is drafted by inflammatory reactants from the heart and the liver, and liver acts a source of energy substrates for the heart.
Assuntos
Insuficiência Cardíaca/complicações , Coração/fisiopatologia , Hepatopatias/complicações , Fígado/fisiopatologia , Fármacos Cardiovasculares/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas , Insuficiência Cardíaca/terapia , Humanos , Hepatopatias/terapiaRESUMO
Alcoholic patients who consume >90 g of alcohol a day for >5 years are at risk of developing asymptomatic alcoholic cardiomyopathy (ACM). Those patients who continue to drink may become symptomatic and develop signs and symptoms of heart failure (HF). This distinct form of congestive HF is responsible for 21-36% of all cases of non-ischaemic dilated cardiomyopathy in Western Society. Without complete abstinence, the 4 year mortality for ACM is close to 50%. This short review summarizes the experimental and clinical evidence regarding the role of alcohol in the pathophysiology of ACM and HF.
Assuntos
Alcoolismo/complicações , Insuficiência Cardíaca , Animais , Cardiomiopatia Alcoólica/complicações , Cardiomiopatia Alcoólica/epidemiologia , Cardiomiopatia Alcoólica/fisiopatologia , Ecocardiografia , Eletrocardiografia , Saúde Global , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologiaRESUMO
Excessive and chronic ethanol consumption exerts deleterious and diffused effects on the myocardium, independent of coronary atherosclerosis, arterial hypertension, valvular disease or congenital heart disease. Although the effects of chronic alcoholism on systolic cardiac function are well known, diastolic involvement has been evaluated only partially. This short review summarizes the experimental and clinical evidence for alcohol-induced cardiac disease.
