Clinical manifestations of cardiogenic cirrhosis. In patients with congestive heart failure with passive hepatic stasis, most of the signs and symptoms are due to severe cardiac failure, while the manifestations of hepatic involvement are secondary. Mild right upper abdominal discomfort may be present, and 10-20% have jaundice. Physical examination may show congestive heart failure, including jugular venous distension, positive hepatic jugular venous reflux sign, hepatomegaly in most of the patients, and a few of them may be highly enlarged, with more than 5cm below the rib margin in 50% of the patients, and distended liver pulsation may be palpable in patients with secondary tricuspid valve insufficiency, and the liver may retract to normal with the formation of hepatic fibrosis. 15% of the patients may have ascites, and 25% of the patients may have splenomegaly. How to effectively prevent distended liver pulsation? The main thing is to correct or reduce heart failure with diuretics, cardiotonic drugs and drugs that reduce cardiac afterload. However, some of the symptoms in this group of patients are caused by the liver, such as intractable hypoglycemia and impaired consciousness, the latter of which is also associated with reduced cardiac output. Cardiogenic cirrhosis itself does not cause severe portal hypertension or rupture of the varices at the base of the esophagus, but can result in splenomegaly and ascites. Liver palms, spider nevi and “sea serpent’s head” are rare. Clinically, improvement of cardiac function, such as prosthetic valve replacement, relief of pericardial stenosis in constrictive pericarditis and correction of anatomical anomalies in congenital heart disease, can gradually or even quickly improve hepatocellular function. Hepatic puncture biopsy is the indicator of diagnosis, but the pressure of hepatic vein increases in congestive heart failure, therefore, hepatic puncture is prone to bleeding, and it is necessary to correct the heart failure and liver function is normalized before hepatic puncture biopsy is performed. However, if puncture is urgently needed to clarify the diagnosis, liver puncture biopsy is also feasible when the indicators such as prothrombin time and platelets permit.