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Significantly Elevated Alkaline Phosphatase Caused by Congestive Hepatopathy in the Setting of Heart Failure with Preserved Ejection Fraction.

INTRODUCTION
We report a rare case of significantly elevated alkaline phosphatase (ALP) caused by congestive hepatopathy in the setting of heart failure with preserved ejection fraction (HFpEF).


CASE PRESENTATION
A 44-year-old woman with multiple hospitalizations for acute decompensated HFpEF and abdominal pain had an ALP elevation to almost 8 times the upper limit of normal. A negative inflammatory, infectious, and autoimmune workup led to liver biopsy and diagnosis of congestive hepatopathy.


DISCUSSION
The existing literature includes extensive research on the impact of liver function enzymes in heart failure with reduced ejection fraction (HFrEF); however, research on their impact on HFpEF is limited. ALP has been found to be normal or mildly elevated, with very few cases of significantly elevated ALP levels reported in HFrEF patients only.


CONCLUSION
Complex cardiohepatic interactions often result in the coexistence of heart failure and liver disease. Unexplained chronic cholestasis in the setting of congestive heart failure should raise the suspicion for congestive hepatopathy.