Clinical exam pearl from YY: an S3 heart sound is usually associated with heart failure, but can be confused with a pericardial knock that occurs with pericardial constriction (pericardial knocks tend to occur slightly earlier than a regular S3)
Usual DDx for systemic causes of infiltrative cardiomyopathy (see attached article from JACC 2010 for longer ddx and discussion)
- Aarious storage diseases (e.g. Fabry’s) and other genetic abnormalities like mucopolysaccharidoses
Infiltrative pattern of LFTs: elevated alk phos/GGT with normal AST/ALT/bili
- Lymphoma (and sometimes other metastatic malignancy may not associated with AST/ALT elevation)
Fabry’s disease: lysosomal storage disease, X-linked, can go undetected later into life. Think of neuropathic/limb pain, angiokeratomas or telangiectasias on the skin, kidney disease and cardiac involvement.