A 34-year-old man with a history of Becker Muscular Dystrophy presented because of near syncope and with signs and symptoms of acute liver failure. He was subsequently found to be in acute heart failure with an estimated left ventricular ejection fraction (LVEF) of 10-15%. We discuss the rare presentation that is acute liver failure precipitated by acute heart failure, and we discuss the ongoing development in understanding of the pathophysiology of this occurrence. A review of the dystrophin deficient cardiomyopathies (primarily Duchene and Becker muscular dystrophy) is presented along with general guidelines for the treatment of these conditions.