Q: What's the exact etiology for hypoalbuminemia in the right heart failure patient?
Answer: The objective of this question is to clarify the precise mechanism of hypoalbuminemia in patients with right heart failure. This occurs due to malnutrition and protein-losing gastroenteropathy secondary to intestinal lymphatic pressure. This gets complicated by low cardiac output.
Clinically this is a significant entity as the degree of hypoalbuminemia does not correlate with the degree of histologic liver damage, but is an independent predictor of death in patients with acute or chronic heart failure.
This also explains why the most common LFT abnormality in these patients has elevated serum bilirubin, although elevated serum aminotransferase levels can be seen too.
#cardiology
#hepatology
Reference:
Samsky MD, Patel CB, DeWald TA, et al. Cardiohepatic interactions in heart failure: an overview and clinical implications. J Am Coll Cardiol 2013; 61:2397.
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