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Harwani YP, Kumar A, Chaudhary A, et al. Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation. J Clin Exp Hepatol. 2014;4(1):63-5doi: 10.1016/j.jceh.2013.10.003.
Harwani, Y. P., Kumar, A., Chaudhary, A., Kumar, M., Choudeswari, P. R., Kankanala, V. V., Joshi, N., Kansagra, C., Shah, S., & Tripathi, A. (2014). Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation. Journal of clinical and experimental hepatology, 4(1), 63-5. https://doi.org/10.1016/j.jceh.2013.10.003
Harwani, Yogesh P, et al. "Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation." Journal of clinical and experimental hepatology vol. 4,1 (2014): 63-5. doi: https://doi.org/10.1016/j.jceh.2013.10.003
Harwani YP, Kumar A, Chaudhary A, Kumar M, Choudeswari PR, Kankanala VV, Joshi N, Kansagra C, Shah S, Tripathi A. Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation. J Clin Exp Hepatol. 2014 Mar;4(1):63-5. doi: 10.1016/j.jceh.2013.10.003. Epub 2014 Jan 02. PMID: 25755536; PMCID: PMC4017173.
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J Clin Exp Hepatol. 2014 Mar;4(1):63-5. doi: 10.1016/j.jceh.2013.10.003. Epub 2014 Jan 02.

Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation.

Journal of clinical and experimental hepatology

Yogesh P Harwani, Ajit Kumar, Akash Chaudhary, Manoj Kumar, Padmavathi R Choudeswari, Vishnu V Kankanala, Nayana Joshi, Chintan Kansagra, Sandip Shah, Abhisheka Tripathi

Affiliations

  1. Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.

PMID: 25755536 PMCID: PMC4017173 DOI: 10.1016/j.jceh.2013.10.003

Abstract

Hemorrhage from downhill varices is a rare manifestation. The etiology of downhill varices is due to superior vena cava obstruction while uphill varices are secondary to portal hypertension. We report a rare case of 55-year-old female with bleeding downhill varices not associated with obstruction or compression of superior vena cava, but was due to severe pulmonary artery hypertension secondary to chronic rheumatic heart disease.

Keywords: ALT, alanine transferase; AST, aspartate aminotransferase; CRHD, chronic rheumatic heart disease; LA, left atrium; LV, left ventricular; MDCT, multidetector computed tomography; PAH, pulmonary artery hypertension; RA, right atrium; RCS, red colour signs; RVH, right ventricular hypertrophy; SVC, superior vena cava; TR, severe tricuspid regurgitation; downhill varices; pulmonary artery hypertension; rheumatic heart disease; uphill varices

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