A patient with a cardiomyopathy may develop fulminant hepatic failure due to hypoxic/ischemic injury. Sometimes the cardiomyopathy is unrecognized prior to the onset of the fulminant hepatic failure, with the patient failing to show any sign or symptom of congestive heart failure.


Features of fulminant hepatic failure in the setting of a cardiomyopathy:

(1) presence of a cardiomyopathy

(2) presence of congestive hepatopathy

(3) acute hypotensive episode or significant reduction in cardiac output

(4) exclusion of other causes of fulminant hepatic failure

(5) usually the hepatic dysfunction resolves after successful management of the cardiomyopathy


It is important to exclude cirrhosis since hepatic failure can also be triggered in these patients by acute hypotension.


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