Heart Failure Case Raises Awareness of a Rare Liver Complication

The New England Journal of Medicine posted the case on X, describing a patient who arrived at a cardiology clinic after years of worsening abdominal swelling and leg puffiness. The cause of her heart failure had not been identified. What made her case unusual was the development of cardiac cirrhosis — liver scarring caused not by alcohol or hepatitis, but by the heart failing to pump blood efficiently, causing it to back up into the liver over time.

Doctors examining her found an enlarged liver that pulsed visibly — a sign that blood was flowing backwards through it with each heartbeat. That finding, according to the journal, pointed directly to the heart as the root cause of her liver disease rather than any problem originating in the liver itself.

Right-sided heart failure (where the right chamber of the heart struggles to push blood to the lungs) is less discussed than left-sided failure, but it carries serious risks when left undiagnosed. The NHS describes heart failure as a condition where the heart muscle has become too weak or stiff to work properly — it does not mean the heart has stopped.

Cardiac cirrhosis is rare. But this case illustrates how the body’s organs are closely connected: a failing heart can quietly damage the liver over several years before a patient notices anything beyond tiredness or swelling.

If you’re experiencing persistent leg swelling, unexplained abdominal bloating, or shortness of breath, contact your GP. For urgent concerns, call NHS 111. In an emergency, dial 999.

Key information

• Symptoms to discuss with your GP: unexplained leg or ankle swelling, abdominal bloating, breathlessness, or fatigue
• NHS 111 — call for non-emergency health concerns, 24 hours a day, seven days a week
• 999 — for breathing difficulties or chest pain that come on suddenly