Liver and cardiovascular diseases: a two-way relationship. Review

Abstract

Diseases of the liver and cardiovascular system often accompany each other. It is pathogenetically prudent to divide the causes of concomitant diseases of the heart and liver into four groups: heart diseases that affect the liver; liver diseases that contribute to the development of heart pathology; alterations in the cardiovascular system and liver that have a common cause; and concomitant diseases of the heart and liver that have multiple causes. Congestive hepatopathy develops as a result of right ventricular heart failure of various etiology, including constrictive pericarditis, tricuspid regurgitation, cardiomyopathy, and cor pulmonale. Venous congestion predisposes to liver injury via three main pathogenetic mechanisms: insufficient hepatic blood flow, decreased arterial oxygen saturation, and increased hepatic venous pressure. Ischemic hepatitis may develop under conditions of severe, protracted hypotension, which impairs visceral perfusion and predisposes to hypoxemia. Hepatopulmonary syndrome is a clinical syndrome characterized by a distinct symptom complex, which may include pathological arteriovenous shunting in the pulmonary vessels, arterial hypoxemia, liver disease, and/or portal hypertension. Portopulmonary hypertension is pulmonary arterial hypertension caused by portal hypertension in the absence of an alternative etiology. Hemochromatosis, chronic alcoholism, and amyloidosis are the most common causes of concomitant heart and liver diseases with a common etiology. Determining the pathogenetic variant of concomitant diseases is essential for deciding on treatment strategies, particularly surgical intervention, or heart or liver transplantation.