The patient, a 58-year-old man, suffers from dilated cardiomyopathies.  The patient is monitored in the cardiology center, constantly taking spironolactone 50 mg/day, amiodarone 200 mg/day, carvedilol 6,25 mg twice a day, sacubitril + valsartan 56,51 mg twice a day. Follows the recommendations for physical activity – walking 5 km/day. There is no history of liver disease.

On one of the days, when returning from a walk, the patient felt weakness, dyspnoea, at home he measured blood pressure, which turned out to be 70/57 mm Hg. and remained at this level for 2 hours. An ambulance was called, and the patient was taken to the hospital.  In the hospital, blood pressure is 90/60, and then 105/75 mm Hg. and it remained at this level throughout the week.  ECG: extrasystoles, paired and group (6) ventricular extrasystoles. Echocardiography: EF of the left ventricle 24% (Teichholz), 20% (Simpson).  The next day, a biochemical blood test was performed: bilirubin 32 μmol/L, AST 420 U/L, ALT 380 U/L, LDH 844 U/L, creatinine 210 μmol/L. Transabdominal ultrasound: no peculiarities. No markers of viral hepatitis have been identified. On the fourth day after intake, bilirubin 32 μmol/L, ASAT 225 U/L, ALT 187 U/L, LDH 434 U/L

Diagnosis: Dilated cardiomyopathy, ventricular extrasystole. NYHA 3. Centrilobular hemorrhagic necrosis of the liver (hypoxic hepatitis).

The presented clinical case illustrates the picture of centrilobular hemorrhagic necrosis (hypoxic hepatitis): 1) a situation of hemodynamic instability, 2) a pronounced and rapidly reversible increase in the activity of blood aminotransferases, 3) the absence of other causes of liver damage. The patient is presented for consideration for a heart transplant.