Cardiac Syndromes in Liver Disease: A Clinical Conundrum

Understanding the interaction between the heart and liver is pivotal for managing patients in whom both organs are af-fected. Studies have shown that cardio-hepatic interactions are bidirectional and that their identification, assessment, and treatment remain challenging. Congestive hepatopathy is a condition that develops in the setting of long-standing systemic venous congestion. If left untreated, congestive hepatopathy may lead to hepatic fibrosis. Acute cardiogen-ic liver injury develops as a combination of venous stasis and sudden arterial hypoperfusion due to cardiac, circula-tory, or pulmonary failure. The treatment of both conditions should be directed toward optimizing the cardiac substrate. Hyperdynamic syndrome may develop in patients with ad-vanced liver disease and lead to multiorgan failure. Cirrhotic cardiomyopathy or abnormalities in pulmonary vasculature, such as hepatopulmonary syndrome and portopulmonary hy-pertension may also develop. Each complication has unique treatment challenges and implications for liver transplanta-tion. The presence of atrial fibrillation and atherosclerosis in liver disease brings another layer of complexity, particularly in terms of anticoagulation and statin use. This article pro-vides an overview of cardiac syndromes in liver disease, fo-cusing on current treatment options and future perspectives.