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Cardiac Ascites — RACP Adult Medicine MCQ

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HardCardiologyCardiac AscitesRACP Adult Medicine

A patient with severe HFrEF has ascites, raised JVP and dilated hepatic veins. Ascitic fluid has SAAG 14 g/L and protein 30 g/L. What is the most likely mechanism?

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Correct answer: C — Congestive hepatopathy causing portal hypertension with protein-rich cardiac ascites

The best answer is “Congestive hepatopathy causing portal hypertension with protein-rich cardiac ascites”. Right-sided venous congestion raises hepatic sinusoidal pressure, producing a high SAAG; relatively permeable congested sinusoids retain a higher ascitic protein than established cirrhotic ascites. Raised JVP, high BNP and dilated hepatic veins support cardiac ascites. Treatment targets decongestion and the underlying heart disease while avoiding renal hypoperfusion.

Reference: Heart Foundation: Heart failure clinical guidelines: https://www.heartfoundation.org.au/for-professionals/heart-failure-clinical-guidelines