P4863 - Takotsubo Cardiomyopathy Resulting in Hypoxic Hepatitis

Jamil Qarqash, MBBS¹, Devon Pyykkonen, DO², Olga Brushaber, DO^3
1Corewell Health, Dearborn, MI; ²Corewell Health, Royal Oak, MI; ³Corewell Health, Farmington Hills, MI

Introduction: Elevated liver enzymes are frequently observed in hospital settings, requiring a high level of suspicion for shock liver. In this report, we present a rare case of shock liver induced by Takotsubo cardiomyopathy. After other common causes of aminotransferase levels exceeding 1000 U/L were excluded, the focus shifted to managing the patient’s hemodynamics. This approach resulted in significant improvement, with liver transaminase levels returning to normal.

Case Description/Methods: We present a case of an 82-year-old female admitted due to nausea, vomiting, and abdominal pain, who was found to have markedly elevated transaminases along with elevated cardiac biomarkers caused by Takotsubo cardiomyopathy, which was confirmed by cardiac angiography. The transaminase levels returned to normal after properly managing the hemodynamics and cardiac condition.

Discussion: Hypoxic hepatitis (shock liver) is a severe condition characterized by a massive, rapid rise in serum aminotransferases resulting from hepatic cellular hypoxia. Takotsubo cardiomyopathy (TCM) is a noteworthy yet uncommon cause characterized by a transient left ventricular systolic dysfunction that is usually triggered by emotional or physical stress. TCM can mimic acute coronary syndrome but without an underlying obstructive coronary artery disease. The pathophysiology of ischemic hepatitis in the context of TCM is due to hepatic hypoperfusion as a result of a combination of reduced cardiac output and systemic hypotension. Clinically, patients present with significantly elevated serum transaminases with signs of acute heart failure. The diagnosis is primarily clinical and typically does not require a liver biopsy. Diagnostic workup includes cardiac biomarkers, electrocardiography, echocardiography, and coronary angiography to confirm TCM, as well as liver function tests to assess hepatic injury. Other causes of elevated liver enzymes should be excluded. Imaging modalities such as ultrasound or CT with contrast may be used to rule out other causes of hypoxic liver injury. Management is tailored to focus on supportive care and addressing the underlying cardiomyopathy. This involves hemodynamic stabilization, optimizing cardiac function, and monitoring liver function. In conclusion, diagnosing and treating hypoxic hepatitis secondary to TCM is challenging. Therefore, early detection and treatment can prevent irreversible hepatic damage, reduce unnecessary testing, and improve patient outcomes.


Disclosures:


Jamil Qarqash, MBBS¹, Devon Pyykkonen, DO², Olga Brushaber, DO³. P4863 - Takotsubo Cardiomyopathy Resulting in Hypoxic Hepatitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.