Introduction
Heart failure (HF) is a growing epidemic today as people are living longer with the diagnosis. In 2013, it was estimated that over 550,000 new cases of HF arise annually in the United States.1 Globally, the prevalence of HF is over 23 million.1 The American Heart Association defines heart failure as a syndrome resulting from “any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.” 1 In essence, the heart fails to meet the demands of the heart because of decreased ventricular filling or decreased ejection fraction. When the ventricle fails to fill, it is called diastolic HF and the ventricle hypertrophies concentrically. Systolic HF is when the heart’s ejection fraction is …show more content…
Liver dysfunction is important to address in patient management because HF patients with liver function abnormalities tend to have poorer prognosis.3 When assessing liver function, high values in liver function testing indicate liver abnormalities. Two commonly elevated markers found in HF are bilirubin and γ-glutamyltransferase (GGT). 3,5,7 Bilirubin is a yellow-hued marker present in bile; it is important to monitor because elevated levels are prevalent in HF patients and associated with higher mortality8 and poor prognosis.6 A bilirubin study found 70% of HF patients had elevated levels of total bilirubin with only of 5% presenting with yellowing from associated jaundice,9 making this marker prevalent in HF yet hard to visually detect. Another study found that 62% of HF patients had abnormal levels of direct bilirubin.3 Elevated total bilirubin is associated with high congestion and hypoperfusion in the liver3 and independently predicts development of right HF after left ventricular assist device implantation.7 GGT is an enzyme that is prevalent in CH patients.10 Elevated GGT is linked to progressing HF, increasing NYHA classification, cardiovascular risk factors and mortality,5,11 coronary artery disease, and decreased (liver) transplant-free survival. 7 In healthy study participants without HF, elevated levels of GGT was a predictor of new HF onset.10 High bilirubin and GGT …show more content…
It is important to be aware of symptoms associated with liver dysfunction in patients with HF as they are often disguised as and treated as gastrointestinal issues. 7 Symptoms originating from the liver in HF patients could be: jaundice,3,6-7 abdominal distention, early satiety, 7 intermittent right upper quadrant aching7 (from the liver capsule being stretched),6 nausea, anorexia, 6-7 vomiting, malaise, and oliguria. 6 These symptoms are especially important in HF patients with pulmonary conditions. Pulmonary conditions increase risk of liver involvement in HF because of increased venous congestion and decreased oxygenation.9 By recognizing hepatogenic symptoms, prompt and appropriate care will benefit the patient. Although physical therapists do not prescribe medications, in this population knowing a patient’s medications and their effects is crucial. Since drug clearance is impaired,7 drug side effects like drowsiness may persist and impact safety and success in physical therapy. In inpatient settings, a physical therapist could schedule sessions later than normal for prolonged side effects to subside. Understanding that liver abnormalities in HF have poorer prognosis3 and may interfere with medications6-7 reiterates the significance of addressing liver concerns urgently beyond typical HF management. People with
Heart failure (HF) is a growing epidemic today as people are living longer with the diagnosis. In 2013, it was estimated that over 550,000 new cases of HF arise annually in the United States.1 Globally, the prevalence of HF is over 23 million.1 The American Heart Association defines heart failure as a syndrome resulting from “any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.” 1 In essence, the heart fails to meet the demands of the heart because of decreased ventricular filling or decreased ejection fraction. When the ventricle fails to fill, it is called diastolic HF and the ventricle hypertrophies concentrically. Systolic HF is when the heart’s ejection fraction is …show more content…
Liver dysfunction is important to address in patient management because HF patients with liver function abnormalities tend to have poorer prognosis.3 When assessing liver function, high values in liver function testing indicate liver abnormalities. Two commonly elevated markers found in HF are bilirubin and γ-glutamyltransferase (GGT). 3,5,7 Bilirubin is a yellow-hued marker present in bile; it is important to monitor because elevated levels are prevalent in HF patients and associated with higher mortality8 and poor prognosis.6 A bilirubin study found 70% of HF patients had elevated levels of total bilirubin with only of 5% presenting with yellowing from associated jaundice,9 making this marker prevalent in HF yet hard to visually detect. Another study found that 62% of HF patients had abnormal levels of direct bilirubin.3 Elevated total bilirubin is associated with high congestion and hypoperfusion in the liver3 and independently predicts development of right HF after left ventricular assist device implantation.7 GGT is an enzyme that is prevalent in CH patients.10 Elevated GGT is linked to progressing HF, increasing NYHA classification, cardiovascular risk factors and mortality,5,11 coronary artery disease, and decreased (liver) transplant-free survival. 7 In healthy study participants without HF, elevated levels of GGT was a predictor of new HF onset.10 High bilirubin and GGT …show more content…
It is important to be aware of symptoms associated with liver dysfunction in patients with HF as they are often disguised as and treated as gastrointestinal issues. 7 Symptoms originating from the liver in HF patients could be: jaundice,3,6-7 abdominal distention, early satiety, 7 intermittent right upper quadrant aching7 (from the liver capsule being stretched),6 nausea, anorexia, 6-7 vomiting, malaise, and oliguria. 6 These symptoms are especially important in HF patients with pulmonary conditions. Pulmonary conditions increase risk of liver involvement in HF because of increased venous congestion and decreased oxygenation.9 By recognizing hepatogenic symptoms, prompt and appropriate care will benefit the patient. Although physical therapists do not prescribe medications, in this population knowing a patient’s medications and their effects is crucial. Since drug clearance is impaired,7 drug side effects like drowsiness may persist and impact safety and success in physical therapy. In inpatient settings, a physical therapist could schedule sessions later than normal for prolonged side effects to subside. Understanding that liver abnormalities in HF have poorer prognosis3 and may interfere with medications6-7 reiterates the significance of addressing liver concerns urgently beyond typical HF management. People with