Jaundice in Heart Disease
Jaundice not infrequently occurs in patients with advanced stages of heart disease. The patients for your consideration today illustrate the diversity of mechanisms responsible for the development of icterus in various cardiac disorders and the importance of the sign in accurate diagnosis, prognosis, and treatment.
In a recent excellent review Rich1 has divided all cases of jaundice into two groups: retention jaundice and regurgitation jaundice. Jaundice of the retention type develops whenever the liver becomes functionally unable to excrete bilirubin in the amounts presented by the blood for disposal. In this form of icterus, the blood plasma gives the indirect van den Bergh reaction, and the urine does not contain bilirubin or bile salts. On microscopic examination of the liver, the bile ducts are patent, but the liver cells usually show atrophy or cloudy swelling. Jaundice of the regurgitation type results from pathologic changes in the liver which permit the escape of whole bile from bile canaliculi into the blood stream. In this form of icterus, the blood plasma gives the direct van den Bergh reaction, and the urine contains bilirubin and bile salts. On pathologic examination, there is rupture of the bile canaliculi resulting from obstruction of the ducts or from necrosis of the hepatic cells. I shall follow this classification in discussing today's cases.
Jaundice in Nonvalvular Heart Disese with Congestive Myocardial Failure. The bilirubin content of the blood is increased in practically all cases of congestive myocardial failure,2 and occasionally this increase is sufficient to produce visible. . .