Understanding the Bidirectional Link: What is the relationship between the liver and the heart?

October 1, 2025 •

4 min read

Did you know heart disease is the leading cause of death in people with fatty liver disease, even more so than liver-related complications? This surprising fact underscores the deep and often-overlooked connection between the two organs and highlights the complexity of the question: what is the relationship between the liver and the heart?

Quick Summary

The heart and liver share a complex, bidirectional relationship, often termed cardiohepatic syndrome, where chronic and acute dysfunction in one organ can cause or worsen disease in the other, mediated by hemodynamic and inflammatory factors.

Key Points

Bidirectional Interaction: The relationship between the liver and the heart is two-way, meaning disease in one organ can cause or worsen disease in the other, a dynamic known as cardiohepatic syndrome.
Impact of Heart Disease: Heart failure can harm the liver through reduced blood flow (ischemic hepatitis) or venous pressure backup (congestive hepatopathy), potentially leading to liver fibrosis or cardiac cirrhosis.
Impact of Liver Disease: Liver conditions like cirrhosis can lead to heart muscle problems (cirrhotic cardiomyopathy) and electrical abnormalities (prolonged QT interval).
Fatty Liver and Heart Risk: Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for heart disease due to shared metabolic issues like inflammation, insulin resistance, and cholesterol dysregulation.
Systemic Mediators: Inflammatory cytokines, metabolic abnormalities, and altered blood clotting factors act as key communication signals between the liver and heart, contributing to disease progression.
Management Implications: Effective treatment requires a multidisciplinary approach that addresses both organ systems, as improving function in one organ can benefit the other and certain medications can affect both.

The liver and heart are not isolated systems but are engaged in a complex, bidirectional crosstalk. This interaction, often referred to as the cardiohepatic axis or cardiohepatic syndrome, reveals that dysfunction in one organ can directly impact the health and function of the other. This relationship is mediated by a complex network of factors, including blood flow, hormonal signals, and inflammatory responses. Understanding this intricate connection is crucial for the effective management of many cardiovascular and hepatic diseases.

How Heart Disease Affects the Liver

Heart conditions can significantly impair liver function, primarily through two mechanisms: reduced blood flow (ischemia) and venous congestion. The liver is particularly vulnerable to circulatory disturbances because it receives about 25% of the body’s total cardiac output.

Acute Heart Failure and Ischemic Hepatitis

In cases of acute heart failure, such as cardiogenic shock, a rapid and severe drop in cardiac output reduces blood flow to the liver. This low-perfusion state leads to oxygen deprivation in liver tissue, causing a condition known as ischemic hepatitis (or 'shock liver'). This leads to a spike in liver enzymes, which can be mistaken for other forms of acute hepatitis.

Chronic Heart Failure and Congestive Hepatopathy

When chronic heart failure, especially right-sided heart failure, impairs the heart's pumping ability over time, it leads to a backup of pressure in the venous system. This increased pressure is transmitted to the liver's veins, causing chronic passive congestion, also known as congestive hepatopathy. Over prolonged periods, this chronic congestion can lead to inflammation, fibrosis, and scarring, potentially progressing to 'cardiac cirrhosis'. A specific type affects patients who have undergone the Fontan procedure, known as Fontan-associated liver disease.

How Liver Disease Affects the Heart

Just as heart disease can harm the liver, chronic liver diseases have a profound and often detrimental impact on cardiovascular health. The liver's vital role in metabolism, inflammation, and circulation means its dysfunction can trigger systemic changes that stress the heart.

Cirrhotic Cardiomyopathy

Patients with end-stage liver disease (cirrhosis) often develop a condition known as cirrhotic cardiomyopathy. This involves functional and structural changes to the heart, including impaired response to stress, diastolic dysfunction, and electrophysiological abnormalities like a prolonged QT interval.

Non-alcoholic Fatty Liver Disease (NAFLD) and Cardiovascular Risk

NAFLD, now often referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), is strongly linked to an increased risk of heart disease due to shared risk factors and systemic effects, including inflammation, oxidative stress, dyslipidemia, and coagulation disorders.

Pulmonary Vascular Complications

In advanced liver disease, two serious pulmonary complications can arise that directly affect the heart: Hepatopulmonary syndrome (HPS), where liver disease causes widening of lung blood vessels and impaired oxygen transfer, and Portopulmonary hypertension (PoPH), where high blood pressure in the portal vein leads to high blood pressure in the lung arteries, straining the right side of the heart.

Comparing the Impact of Liver and Heart Disease on Each Other


Feature	Impact of Heart Disease on Liver	Impact of Liver Disease on Heart
Mechanism	Reduced blood flow (ischemia) and passive venous congestion from heart failure.	Systemic inflammation, metabolic dysregulation, altered fluid dynamics, and cardioactive substances.
Acute Manifestation	Ischemic hepatitis ('shock liver') with a sudden, transient spike in liver enzymes.	Acute-on-chronic liver failure can cause systemic inflammation and hyperdynamic circulation, stressing the heart.
Chronic Manifestation	Congestive hepatopathy, which can progress to cardiac cirrhosis.	Cirrhotic cardiomyopathy (diastolic/systolic dysfunction), NAFLD-related heart disease, PoPH, and HPS.
Cardiovascular Outcome	Liver damage can worsen prognosis in heart failure.	Significant predictor of increased mortality from coronary artery disease, heart failure, and arrhythmias.
Key Pathophysiology	High venous pressure leading to sinusoidal congestion and hepatocyte damage, especially in Zone 3.	Altered lipid metabolism, insulin resistance, oxidative stress, and circulating toxins.
Diagnostic Markers	Liver enzyme tests (aminotransferases, bilirubin) and imaging (ultrasound) showing congestion.	B-type natriuretic peptide (BNP) and troponin I can be elevated.

The Role of Systemic Inflammation and Metabolism

Systemic inflammation and metabolic factors are key mediators of the cardiohepatic connection. A diseased liver can release pro-inflammatory cytokines, contributing to heart disease. The liver also regulates cholesterol and carbohydrate metabolism; impaired liver function can lead to dyslipidemia and insulin resistance, impacting cardiovascular health.

Management and Clinical Considerations

A holistic, multidisciplinary approach involving specialists is essential for managing cardiohepatic conditions, often requiring simultaneous treatment of both organs. Interventions for one organ can benefit the other, such as heart transplantation for cardiac cirrhosis or managing metabolic risk factors in NAFLD. Medication choices must also consider the interplay between liver and heart function.

Conclusion

The bidirectional relationship between the liver and heart is a critical aspect of health. Disease in one organ significantly impacts the other, forming a complex cardiohepatic syndrome. Heart conditions like heart failure can cause liver congestion or ischemia, while liver diseases such as NAFLD and cirrhosis can harm the heart through various pathways. Recognizing this interconnectedness is vital for effective patient care and improving outcomes.

For more in-depth information on cardiohepatic diseases, consult further research and clinical sources. An authoritative resource on cardiac and metabolic health is the American Heart Association.

Frequently Asked Questions

Cardiohepatic syndrome is the term for the bidirectional relationship between the heart and liver, where acute or chronic dysfunction in one organ can cause or exacerbate disease in the other.

Yes, heart conditions can damage the liver. Acute heart failure can cause ischemic hepatitis due to low blood flow, while chronic heart failure, particularly right-sided, can lead to congestive hepatopathy and potentially cardiac cirrhosis from venous pressure backup.

Yes, liver disease can cause heart problems. Chronic liver disease like cirrhosis can lead to cirrhotic cardiomyopathy and heart rhythm issues. Additionally, fatty liver disease is a major independent risk factor for developing various heart diseases.

Fatty liver disease (NAFLD) raises heart disease risk through shared metabolic factors and systemic effects. It drives systemic inflammation, insulin resistance, oxidative stress, and dyslipidemia, which all contribute to plaque buildup in arteries and cardiac damage.

Cardiac cirrhosis is a serious liver disorder caused by prolonged congestive hepatopathy from chronic heart failure. The persistent backup of venous pressure leads to liver scarring and damage over time, which can ultimately lead to cirrhosis.

The liver plays a central role in managing cholesterol, as it synthesizes most of the body's cholesterol and removes excess by converting it to bile salts. When liver function is impaired, this process can fail, leading to elevated cholesterol levels that increase the risk of coronary heart disease.

The long-term prognosis for someone with cardiac cirrhosis depends largely on the severity of the underlying heart failure. The liver damage itself is often a reflection of the cardiac condition's severity, and managing the heart issue is the primary way to improve the liver's health.