title: Combined uphill and downhill varices as a consequence of rheumatic heart disease: a unique presentation.
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.
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Yogesh P
authors.initials: YP
authors.lastname: Harwani
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Akash
authors.initials: A
authors.lastname: Chaudhary
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Padmavathi R
authors.initials: PR
authors.lastname: Choudeswari
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Vishnu V
authors.initials: VV
authors.lastname: Kankanala
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Nayana
authors.initials: N
authors.lastname: Joshi
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Chintan
authors.initials: C
authors.lastname: Kansagra
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Medical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh 500082, India.
authors.forename: Abhisheka
authors.initials: A
authors.lastname: Tripathi
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