title: Fulminant liver failure: an indicator of silent myocardial rupture.
abstract: A 56 year old man presented with an atypical chest infection. Remote inferoposterior myocardial infarction was noted on electrocardiography and transthoracic echocardiography. Hepatic failure developed with sudden gross elevation of liver aminotransferases and coagulopathy. No primary hepatic cause could be identified. Subsequent right heart failure led to transoesophageal echocardiography that revealed a large inoperable ventricular septal defect. Histopathological data showed ischaemic hepatitis and reinfarction of the inferoposterior myocardial wall. Acute cardiac events may be silent and precipitate misleading severe hepatic dysfunction.
authors.affiliation: Department of General Medicine, Leicester, Heneral Hospital, Leicester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Szawarski
authors.forename: P R
authors.initials: PR
authors.lastname: Sensky
authors.forename: M
authors.initials: M
authors.lastname: Doshi
authors.forename: I
authors.initials: I
authors.lastname: Hudson
mesh_terms: D001778:Blood Coagulation Disorders / Q000209:etiology; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D017809:Fatal Outcome; D006333:Heart Failure / Q000209:etiology; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000175:diagnosis; D006352:Heart Ventricles; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged