Take-home pearl: in a patient with jaundice and volume overload, think of constrictive processes and right-sided heart failure cause congestive hepatopathy
- For lots more on congestive hepatopathy (how high can the bili be? can people be jaundiced?) see these previous posts (SFGH and Moffitt)
Constriction vs Restriction: both can lead to elevated L and R filling pressures, diastolic heart failure and similar symptoms, but pathophysiology and treatment are different. They can be distinguished from one another with various tools (echo, history, exam), but another clue can be the BNP! BNP is released with LV wall stretch. Wall stretch increases in restrictive cardiomyopathy, but does not in constrictive pericarditis.
- Elevated BNP suggests restrictive cardiomyopathy
- Low or an abnormally normal BNP (e.g. if volume overloaded and BNP expected to be high) suggests constriction
Osler/Austrian’s triad (pick your favorite eponym depending on your institutional bias)
- Pneumococcal pneumonia
- Pneumococcal meningitis
- Pneumococcal endocarditis
- For more reading about pneumococcal endocarditis, please see this article from Harry!
Evernote link: http://www.evernote.com/l/APjx206390RCwIdLIy1b4C8X4qEtCmA0ZSo/