We found a high prevalence of ICP among pregnant women infected with HCV, and those with ICP had a higher HCV viral load. Women with suspected ICP should be tested for the presence of HCV.

Introduction: Cirrhotic cardiomyopathy (CCM) is a clinical syndrome in patients with liver cirrhosis characterized by an abnormal and blunted response in cardiac output and contractility to physiologic, pathologic, or pharmacologic stress but a normal to increased cardiac response at rest [1-4]. Information on the epidemiology and natural history of CCM is limited. Methods: All patients with a diagnosis of cirrhosis (N = 451) seen at gastroenterology clinic over the four years were evaluated. CCM was defined using echocardiogram (ECHO) and electrocardiogram (ECG) criteria [1]. Patients with structural or ischemic heart disease or incomplete information were excluded (N = 220). Results: Among the 231 patients with cirrhosis, 118 (51.1%) met criteria for CCM, and no patient had this problem documented in their medical record. Those with CCM were older (62.7 vs 57.8 years; p < 0.001) and more likely to be female (55.8 vs 40.2%; p = 0.02) compared to those without CCM. The likelihood of CCM increased with each quartile of age (OR 1.6 per quartile; 95% CI 1.2 -2.0). Patients with alcoholic and unknown causes of cirrhosis are more likely to have CCM , (p < 0.001). CCM was more commonly associated with alcohol abuse in men than women (49.1 vs 21.3%; p = 0.002). Conclusion: CCM, a diagnosis of exclusion, defined by ECHO and ECG criteria is a common problem among cirrhotic patients attending a gastroenterology practice. Advancing age and female gender were associated with a higher prevalence of CCM, but the cause of cirrhosis was not possibly limited by smaller sample size within cause-specific categories. CCM was not recognized by our clinicians, and routine screening tests were not performed. Provider awareness of CCM is needed since implementation of angiotensin receptor blocker and beta-blocker therapy early in the course of cirrhosis may modify the changes in cardiac function [5,6].

A man who had evidently taken an overdose of lisinopril had multiorgan dysfunction in the absence of hypotension. The abnormalities resolved after he was treated for acidosis and hyperkalemia and received hemodialysis to remove the lisinopril.

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