Liver Disease-Atrial Fib Connection?

[Jimbo347]

I am a 56 year old male caucasian. In 1975 at age 28 I began having episodes of atrial fib that started in the early morning and lasted around 24 hours and terminated spontaneously. I was in robust good health at the time and taking no medications. I've never used recreational drugs and have never consumed more than a half dozen alcoholic drinks per month.

Since I am such a light drinker it never occured to me that I had a liver problem. Over the years doctors have on several occasions questioned me about my drinking habits which I thought strange, I always ignored them and couldn't imagine why they would ask such a pointless question.

I've seen a dozen different cardiologists. All their various cardiac tests always came out normal. None of the heart drugs they prescribed ever helped, in fact I responded terribly to several (requiring ICU hospitalization). (This unusual sensitivity to meds is yet another symptom of liver problems.)

Now my doctor informs me that my SGOT is high (61) and is referring me to a liver specialist (but since I'm uninsurable due to my atrial fib, I'm forced to depend on the VA for my healthcare so my appointment won't happen for at least six months)

I have gynecomastia with painful breasts and terrible fatigue which causes me to need afternoon naps. (I used to have plenty of excess energy)I have no erectile problems but my libido has all but vanished. From what I've been able to learn from reputable sites on the web, these are all signs of liver disease.

At age 28 I was in very good health. I was highly active, a non-smoker and a very light drinker, only 20 lbs or so overweight.

In the past my doctors must have noticed a problem with my liver test results as they kept asking me about my drinking habits.

But the central question here seems to be - what would cause a healthy young man without bad lifestyle habits to have a liver problem?

My genetics are wonderful, my dad lived to age 81 and worked the last day of his life and my mother is 80, in great health and about to take a two week transatlantic cruise. My grandparents and aunts and uncles all lived long and healthy lives (except the ones who smoked heavily).

I've now come to the conclusion that my liver problem has been the source of my atrial fib bouts all along. But why, and more importantly - what can I do about it?

Could this be (gulp) an autoimmune problem or perhaps a problem with iron overload?

Thanx in advance for any help...

- Jimbo347

[Kevin Pho, MD]

Hello - thanks for asking your question.

There are many causes for elevated liver enzymes.  I am not aware of diseases that link atrial fibrillation with elevated liver enzymes directly.

Causes can include hepatitis, hemochromatosis, fatty liver (either from alcohol or NASH), autoimmune disorders, or medication side effects.

I would first go over any medications that can cause an elevation in liver enzymes.  Tests for hepatitis (using a serum screen), autoimmune disorders (via an ANA level) and hemochromatosis (checking iron and ferritin) would be reasonable.  I would also pursue an abdominal ultrasound to evaluate any anatomical abnormality or fatty liver that can raise the liver enzymes.  

If they come back negative, I would consider either observation or a liver biopsy.  A biopsy is the definitive test, but it is not without its risks.  If the enzymes are less than twofold elevated and the rest of the enzymes and tests were all negative, then observation would be reasonable.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[roxnsox]

Go to the American Liver Foundation website and read about liver diseases like fatty liver and Non-alcoholic Steatohepatitis (NASH).  Your liver enzymes were only mildly elevated so you don't have a bad, bad problem.

[surgeon]

I don't know of a connection between a-fib and liver disease, especially mild disease. As to why you might have some degree of liver disease: hepatitis past or present would be a common explanation. It's also conceivable there's an auto immune disease responsible both for liver problems and heart problems; but I doubt the former is causally related to the latter. As to fatigue and gynecomastia: each could be due to liver disease. However, each is pretty common, each has many causes, and in the case of gynecomastia the most common causes is "idiopathic," meaning no specific cause. Certain medications, and marijuania can do it. Rarely, so can testicular tumors.