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Clinical "Pearls" for the Internist:
Permissive Hypercreatininemia: When aggressively diuresing a Cardiorenal syndrome (CRS Type 1) patient, creatinine may bump. If the patient is clinically decongesting (exam improving) and Hct is rising (hemoconcentration), continue diuresis. This bump often represents hemodynamic shifts rather than tubular injury.
Warfarin Management: Patients with congestive hepatopathy are hypersensitive to Warfarin. The congested liver synthesizes Vitamin K-dependent factors slowly, and gut edema reduces Vit K absorption. Start with lower doses.
The "Dense Liver" Sign: On non-contrast CT, the congested liver may appear hyperdense compared to the spleen due to blood stagnation (stasis).
Pseudo-Infarct on ECG: Massive right-sided dilation (Cor Pulmonale / acute overload) can cause Q-waves in V1-V2, mimicking an anterior infarction or old septal infarct. Check the Echo before calling the cath lab.
