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Fulminant liver failure: an indicator of silent myocardial rupture

¹ Department of General Medicine, Leicester General Hospital, Leicester, UK
² Department of Cardiology, Glenfield Hospital, Leicester, UK
³ Department of Cardiology, Leicester General Hospital, Leicester, UK

Correspondence to:
Correspondence to:
Dr Penelope R Sensky
King’s Mill Hospital, Sutton-in-Ashfield NG17 4JL, UK; pen.sensky{at}ntlworld.com

A 56 year old man presented with an atypical chest infection. Remote inferoposterior myocardial infarction was noted on electrocardiography and transthoracic echocardiography. Hepatic failure developed with sudden gross elevation of liver aminotransferases and coagulopathy. No primary hepatic cause could be identified. Subsequent right heart failure led to transoesophageal echocardiography that revealed a large inoperable ventricular septal defect. Histopathological data showed ischaemic hepatitis and reinfarction of the inferoposterior myocardial wall. Acute cardiac events may be silent and precipitate misleading severe hepatic dysfunction.

Keywords: ischaemic hepatitis; ventricular septal defect; cardiac failure; fulminant liver failure