[HSF] Tricuspid Disease and Jaundice

[prasannasimha]

    Jaundice as a presentation of heart failure

R van Lingen MRCP  ^2    U Warshow MRCP  ^1    H R Dalton DPhil FRCP  ^1 
   S H Hussaini MD FRCP  ^1

* ^1 Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, 
Truro TR1 3LJ, UK
^2 Department of Cardiology, Derriford Hospital, Plymouth PL6 8DH, UK *

*Correspondence to: Dr Hyder Hussaini E-mail: 
hyder.hussaini at rcht.cornwall.nhs.uk 
<mailto:hyder.hussaini at rcht.cornwall.nhs.uk> *

On rare occasions the first manifestation of heart disease is^ jaundice, 
caused by passive congestion of the liver or acute^ ischaemic hepatitis. 
We looked for this presentation retrospectively^ in 661 patients 
referred over fifty-six months to a 'jaundice^ hotline' (rapid access) 
service. The protocol included a full^ clinical history, examination and 
abdominal ultrasound. Those^ with no evidence of biliary obstruction had 
a non-invasive liver^ screen for parenchymal liver disease and those 
with suspected^ heart disease had an electrocardiogram, chest X-ray and 
echocardiogram.^

8 patients (1.2%), bilirubin 31--79 µmol/L, mean^ 46 µmol/L, had a 
primary cardiac cause for their jaundice.^ All had dyspnoea, an 
increased cardiothoracic ratio on chest^ X-ray and an abnormal 
electrocardiogram. The jugular venous^ pressure was raised in the 3 in 
whom it was recorded. In 6 patients^ the jaundice was attributed to 
hepatic congestion and in 2 to ischaemic^ hepatitis. All patients had 
severe cardiac dysfunction.^

Jaundice due to heart disease tends to be mild, and a key feature^ is 
breathlessness. The most common mechanism is hepatic venous^ congestion; 
ischaemic hepatitis is suggested by a high aminotransferase.

Prasanna
^

Michael Firstenberg wrote:
> Just reviewing some SESATS questions (adult cardiac IX) and in a 
> question about tricuspid valve disease the answer is basically 
> stenosis can cause jaundice while TR does not.
>
> Maybe I am missing something obvious (although I do not recall a 
> jaundice patient from TR in the absence of other liver disease, though 
> do see a lot of chirrosis) I dont see much TS.  Can someone shed some 
> light on this?
>
>
> -michael
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