Key result
Correcting arteriovenous shunts resolves high-output heart failure symptoms in case series.
Why the study?
High Output Heart Failure is a rare curable disorder that shares signs and symptoms with the more dangerous low output heart failure, leading to potential mischaracterization.
Case Report (n=3)
High Output Heart Failure is a rare, often curable condition that shares symptoms with Low Output Heart Failure but can be distinguished by clinical signs like warm extremities and a wide pulse pressure.
May support AV shunting correction in select high-output HF; leaves open need for prospective validation before practice change.
High Output Heart Failure (HOHF) is a rare curable disorder that shares signs and symptoms with the more dangerous and lethal low output heart failure (LOHF or congestive heart failure -CHF).The rarity of HOHF, and similar symptoms shared between HOHF and LOHF may lead to inappropriately characterize dyspnea on exertion and peripheral edema as LOHF.HOHF occurs in patients with normal hearts.These patients are challenged with an increased blood return to the right heart, stretching the right atrium and right ventricle which compensate with an increase in heart rate and stroke volume to fill the arterial tree which is "underfilled" because of the rapid return of blood to the right heart.Contrary to the cardiomyopathy of LOHF most causes of HOHF are curable [1,2].Symptoms common to both HOHF and LOHF include dyspnea on exertion, decreased exercise tolerance, cough, edema, orthopnea, tachycardia, palpitations, and hypotension.Subtle differences such as "warm extremities" and a "bounding pulse" with wide pulse pressure imply the presence of HOHF, whereas the extremities in LOHF are cold and dry, and the hypotension has a narrow pulse pressure.HOHF can occur in obesity, liver disease, hyperthyroidism, thiamine deficiency (Beriberi) [3], severe anemia [4], arterio-venous fistulas (A-V fistulas) [5], septic shock, Paget's disease, lung disease and pregnancy.
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Louis J. Imbriano (2021) conducted a case report in High Output Heart Failure (n=3). Correction of arterio-venous shunting was evaluated on Resolution of heart failure symptoms.
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