Case report: Cardio-renal syndrome with concomitant cardio-hepatic syndrome in a severe aortic stenosis patient

Unstable systemic hemodynamics in acute heart failure causes various detrimental effects on organs. In recent years, the heart-kidney and heart-liver interactions have been investigated under the terms “cardio-renal syndrome (CRS)” and “cardio-hepatic syndrome (CHS)”, respectively [1,2]. Each syndrome is divided into five subtypes based on the combined dysfunction of the heart and the kidney or the heart and the liver. While type 1 CRS is characterized by acute and rapid worsening of the heart leading to acute kidney injury, type 1 CHS describes the relationship between abnormal liver function tests and the the severity of acute heart failure. The main pathophysiological mechanisms of type 1 CRS and CHS are congestion and abnormal reperfusion in the heart, the kidney and the liver. Other compounding effects of type 1 CRS include neurohormonal activation, hypothalamicpituitary stress reaction, inflammation and immune cell signaling, oxidative stress and failure of counter-regulatory mechanisms [3]. Some important mechanisms of CHS have been previously described such as venous congestion, backward failure, decreased hepatic blood flow, decreased arterial saturation and sinusoidal thrombosis [4].