Cirrhosis and Atherosclerosis

[rpooo]

Age:41
Height: 5' 10"
weight: 210lb.

I have cirrhosis with symptoms of decompensation. Diagnosed 3 1/2 yrs ago. During my recent CT scan of the abdomen to monitor for HCC the impression was mild renal scarring suggestive of atherosclerotic disease. This led to a calcium score test.

Coronary calcium scan of my heart reveals:

Coronary Calcium Score, Total: 570.6 Anything over 400 puts me in the high risk category for coronary disease. The summary also concluded the following quote: “Coronary calcium score suggests high risk of significant coronary disease. Based on the calcium score, the estimated coronary arterial age (in years) is: 85.”

My platelets are normally 67K with an INR of 1.3, My question is how serious is this for someone without cirrhosis and if anyone is familiar how much more serious is it for someone in my circumstance? What is the best thing I can do for myself?

I have not been seen by a coronary specialists but I am working on getting setup with a doctor at the transplant center where I am treated for cirrhosis so they may find it easier to collaborate my treatment or any required procedures.

Like I wasn't already having enough challenges with the cirrhosis right?! As more and more things develop maybe someday I can be a doctor! ha ha

Really though, thank you so much for your help.

Randy

[rpooo]

You are very kind to take the time to respond, thank you so much.

I have a MELD of 12 and symptoms of decompensation include, grade 3 varices, a small amount of ascites and occasional hepatic encephalopathy/no hospitalization required. Further advancement of my cirrhosis has not been expected now that the cause has been removed with this being said transplantation is not expected according to my hepatologists at the transplant center.

If it had not been for the scarring on my kidneys this evidence of cardiovascular disease would not have been expected and easily overlooked since my most recent lipid panel (less than one year ago) reveals my total cholesterol to be 149. Triglycerides 61, HDL 37 actually two points below range and LDL 100 only one point high.

These don't sound like the numbers from someone with cardiovascular disease to me. Is there something else other than diet that could be causing it? How accurate and reliable is a Coronary calcium scan?

Randy

[Bhupinder Kaur, MD]

Hello,
PT and INR rise in people with severe liver disease because the liver fails to make normal amounts of certain clotting factors. Low platelet count in a patient with liver cirrhosis may mean that hypersplenism is setting in which is a complication.

Cirrhosis is irreversible and initially we try to compensate the liver function with medicine sand prevent complications due to cirrhosis but the final answer lies in liver transplantation. Moreover your coronary calcium is elevated for which you require to consult a cardiologist as you may need balloon angioplasty or coronary stenting which can be evaluated by a coronary examination only.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.