#HFpEF pearl of the day: Evaluation of motion of the interventricular septum can be helpful to determine etiology/pathophys in HFpEF pts. Case: 58 yo man w/SOB, ascites, 2+ LE edema. EF 50%. Initially referred to hepatology for poss. liver failure. What did liver biopsy show?
What was the histologic finding on liver biopsy?
@BridonneauV was the 1st to reply with the correct answer. Liver biopsy histopathology showed marked sinusoidal dilation. No fibrosis, steatosis, or inflammation. Sinusoidal dilation is indicative of liver outflow obstruction, which can be caused by ⬆️⬆️CVP from R-sided HF.
At time of transjugular liver biopsy, RA pressure = 18. Referred to me before liver biopsy result came back. ⬆️⬆️JVP w/Kussmaul's sign. Echo had been misread as abnl septal motion due to IVCD. This an obvious, clear-cut case of constriction causing diastolic septal bounce.
Mitral inflow Doppler and TDI classic for constriction. 
Dilated, non-collapsing IVC.
Hepatic vein diastolic flow reversal during expiration
I saw him at 5p in clinic on a Wednesday, admitted him, diuresed, R/LHC + CMR next day (Thursday). R/LHC showed discordance.
CMR showed thickened pericardium:
Went to the OR the following day (Friday) for pericardial stripping.
When evaluating #HFpEF we can't afford to miss the Dx of constrictive pericarditis, a treatable cause of HFpEF. This pt did extremely well. and all signs of HF and fluid overload resolved post-op. Tomorrow we will continue with a more challenging case of abnormal septal motion :)
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