From the Guidelines
Ascites is strongly associated with cardiac conditions, particularly in patients with Fontan-type circulation, where it can result from decreased oncotic pressure due to hypoalbuminemia secondary to protein-losing enteropathy (PLE) or Fontan circulatory failure 1.
Key Factors
- Cardiac function optimization is crucial in managing ascites, alongside diuretic therapy with loop diuretics and anti-aldosterone drugs 1.
- Heart catheterization is recommended to address stenosis or thrombosis across the Fontan pathway and exclude PLE 1.
- Transcatheter treatment (stenting or dilatation) may be necessary for patients with ascites and Fontan circuit obstruction, even without a measurable pressure gradient 1.
- Heart transplantation should be considered for patients with Fontan circulatory failure and no pathway obstruction 1.
Management
- Diuretic therapy is essential in managing symptomatic fluid overload, including ascites, with daily diuretics promoting decongestion 1.
- Advanced heart failure consultation should be considered for patients with symptomatic, chronic fluid overload that persists despite new or increasing diuretic therapy 1.
- Large-volume paracentesis can be a rescue treatment for patients with tense ascites, improving systemic hemodynamics, and repeated paracentesis can be useful for patients with recurrent ascites 1.
From the FDA Drug Label
Edematous states in which secondary aldosteronism is usually involved include congestive heart failure, hepatic cirrhosis, and nephrotic syndrome By competing with aldosterone for receptor sites, spironolactone provides effective therapy for the edema and ascites in those conditions.
The relationship between ascites and cardiac conditions is that congestive heart failure is one of the edematous states in which secondary aldosteronism is usually involved, and ascites can be a symptom of this condition. Spironolactone can provide effective therapy for ascites in this context by competing with aldosterone for receptor sites 2.
- Key points:
- Ascites is associated with congestive heart failure
- Spironolactone can treat ascites in this context
- Secondary aldosteronism is involved in congestive heart failure and ascites
From the Research
Relationship between Ascites and Cardiac Conditions
The relationship between ascites and cardiac conditions is complex, with several studies highlighting the connection between the two.
- Ascites can be a symptom of right heart failure, which can lead to increased accumulation of fluid in the pericardial space 3.
- Pericardial effusion, a condition characterized by the accumulation of fluid in the pericardial space, can be caused by various factors, including cardiac or renal failure, trauma, surgical complications, and myocardial infarctions 4.
- Cardiac tamponade, a condition where the accumulation of pericardial fluid under pressure can lead to hemodynamic compromise, can be a complication of pericardial effusion 5, 6.
Causes of Ascites in Cardiac Conditions
The causes of ascites in cardiac conditions include:
- Right heart failure, which can increase the accumulation of ascites and decrease the preload of the heart and cardiac output 3.
- Pericardial effusion, which can be caused by various factors, including cardiac or renal failure, trauma, surgical complications, and myocardial infarctions 4.
- Constrictive pericarditis, a condition where the pericardium becomes scarred and inelastic, can lead to effusive-constrictive pericarditis, a condition characterized by the concurrence of a tense pericardial effusion and constriction of the heart by the visceral pericardium 6.
Treatment of Ascites in Cardiac Conditions
The treatment of ascites in cardiac conditions includes:
- Aggressive paracentesis, which may be a definitive solution for patients with massive ascites due to right heart failure 3.
- Large-volume paracentesis (LVP) associated with intravenous albumin, which is the initial treatment of choice in patients with refractory ascites 7.
- Transjugular intrahepatic portosystemic shunts (TIPS), which can be beneficial for some patients with refractory ascites 7.