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Abnormalities in liver function tests have been noted fre-quently in patients with chronic congestive heart failure. They are generally mild and not associated with clinically ap-parent hepatic disease [1, 2]. An occasional patient with heart failure, however, may demonstrate striking evidence of hepatic necrosis, sometimes exhibiting hepatic coma, and often bring-ing about the patient’s death. While vaguely resembling acute viral hepatitis, this condition termed ‘ischaemic hepatitis ’ has quite distinct clinical laboratory and histologic features [3–5]. We have described a variant of ischaemic hepatitis [6, 7], char-acterized by combined cardiogenic hepatic injury and renal im-pairment. This complication occurs in patients with severe chronic congestive heart failure, following an episode of pul-monary oedema or an acute coronary event and in the absence of arterial hypotension. It differs from isolated ischaemic hepa-titis and isolated renal damage by the combined visceral in