Hfsa 2010 comprehensive heart failure practice guideline. Understanding of the applicability and practical relevance of each of these four components is important when interpreting cardiac output values. Objectives this study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high output hf in the modern era. Highoutput cardiac failure in a patient with a history of hereditary hemorrhagic telangiectasia. Lowoutput heart failure the inability of the heart to pump sufficient blood out to the tissues, which produces severe weakness and fatigue. High output heart failure definition of high output heart. High output cardiac failure associate professor brendan e. High output heart failure occurs when the normally functioning heart cannot keep up with an unusually high demand for blood to one or more organs in the body.
While most patients with heart failure hf, with either reduced or preserved ejection fraction, have low or normal cardiac output accompanied by elevated systemic vascular resistance, a minority of patients with hf present with a highoutput state with low systemic vascular resistance. Congestive heart failure and management drugs cardiology. In the present article, we use a simple analogy comparing cardiac output with the speed of a bicycle to. Three major mechanisms for highoutput heart fail ure include large extracardiac lefttoright shunt, body metabolism overstimulation. The syndrome of systemic congestion in a high output state is traditionally referred to as high output heart failure. Its also very different from other types of the disorder. Seventyfive percent of hf cases have antecedent hypertension. High output heart failure hohf can be caused by chronic conditions, including severe anemia, hypoxia, obesity, acutely by septic shock, and hemorrhage.
Heart failure mat maurer, md associate professor of clinical medicine objectives at the conclusion of this seminar, learners will be able to. The heart may be working well otherwise, but it cannot pump out enough blood to keep up with this extra need. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Patients global assessment of symptoms change in serum creatinine over 72h baseline characteristics evenly matched diuretic strategies in patients with acute decompensated heart failure dose study felker gm, lee kl, bull da, et. School of biomedical science, charles sturt university, specialist in anaesthesia and intensive care, bathurst base hospital, bathurst, nsw, australia. Cardiac output heart rate x stroke volume stroke volume enddiastolic volume endsystolic volume preload venous return afterload peripheral resistance. Additional studies were identified through a manual search of the list of. High output heart failure is a poorly understood condition characterized by signs and symptoms of heart failure and a resting cardiac index above 4 lmin x m2.
Congestive heart failure knowledge for medical students and. High output cardiac failure secondary to a surgically constructed arteriovenous fistula avf is a rare entity that is usually underdiagnosed in the dialysis population. Cardiac output is usually normal or low in patients with heart failure hf, but a minority of patients present in a high output state, which has historically been referred to as high output hf 1, 2. See causes and pathophysiology of highoutput heart failure. Dilated cardiomyopathy is the most common cause of heart failure. Highoutput congestive heart failure successfully treated with transcatheter coil embolization of a large renal arteriovenous fistula. Patients with highoutput heart failure demon strate higher ejection fraction and eccentric remodeling of the ventricle, including greater ventricular mass and size. These individuals usually have a normal systolic function but symptoms are those of heart failure. Progressive heart failure secondary to a high output state. Heart failure can be brought on by many conditions that damage the heart. There is a circulatory overload which may lead to pulmonary edema secondary to an elevated diastolic pressure in the left ventricle. High output cardiac failure is another entity characterized by elevated cardiac output in certain medical conditions such as beriberi, hyperthyroidism, and systemic av fistulas. No dyspnea unlike lhf not until later does dyspnea occur as a consequence of the reduced cardiac output, poor. Heart failure develops when the heart, via an abnormality of cardiac function detectable or not, fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure.
Multiple myeloma presenting with highoutput heart failure. High output heart failure is a heart condition that occurs when the cardiac output is higher than normal due to increased peripheral demand. Some authors suggest the term high output heart failure is a misnomer as the heart is intrinsically normal and capable of generating a high cardiac output. Highoutput cardiac failure is a less common form of heart failure, and although it. Symptoms and signs in patients with highoutput hf include general findings related to the. Hypertension, congestive heart failure and angina toni benton md high blood pressure hypertension definition. Basically, the heart cant keep up with its workload. By understanding the factors that influence cardiac output, memory work becomes unnecessary. An unusual cause of highoutput heart failure circulation. The code is valid for the year 2020 for the submission of hipaacovered transactions. Distinguishing rightsided chf from hepatic failure is often clinically difficult. We herein present a case of a 35yearold female who was diagnosed with high output cardiac failure secondary to an avf and later managed with surgical division of the fistula. High blood pressure occurs when the pressure of your blood against the artery walls is higher. Highoutput heart failure american college of cardiology.
Blood pressure is a measurement of the pressure your blood exerts against the artery walls. Even though the resting cardiac index is elevated, symptoms of heart failure develop because of a failure to compensate for increased requirements. Methods we performed a retrospective analysis of all consecutive patients referred to the mayo clinic. Congestive heart failure describes a syndrome with complex and variable symptoms and signs, including dyspnea, increased fatigability, tachypnea, tachycard. Highoutput heart failure happens when the bodys need for blood is unusually high, so heart failure symptoms happen even though the heart is working well. Highoutput heart failure is a heart condition that occurs when the cardiac output is higher than normal due to increased peripheral demand. While most patients with heart failure hf, with either reduced or preserved ejection fraction, have low or normal cardiac output accompanied by elevated systemic vascular resistance, a minority of patients with hf present with a high output state with low systemic vascular resistance. A high cardiac output state has been an infrequent but previously reversible cause of heart failure in patients with hemodialysis fistulas.
Nonrecoverable heart function and not a candidate for transplant or vad. Cardiac output is the amount of blood the heart pumps in 1 minute, and it is dependent on the heart rate, contractility, preload, and afterload. Basically, the heart is normal and theres no pump failure. A patient with two proximal upper extremity fistulas was found to have progressive depression in his left ventricular function and a high output state. High output heart failure definition of high output. The study cohort was comprised of 525 hf patients that showed an elevated cardiac index, of whom 120 cases had definite high output hf. Heart failure that occurs in spite of high cardiac output, for example, in severe anemia, thyrotoxicosis, arteriovenous fistulae, or other diseases. Causes of highoutput cardiac failure can be simplified into two main. Nonrecoverable respiratory disease and not a candidate for transplant. Jul 15, 2008 a less recognized mechanism is high output heart failure. Clinical manifestations, diagnosis, and management of highoutput. High output cardiac failure is a recognized complication of hepatic 20 and other systemic avms 3, 4, 8. Decompensated heart failure paradigms epidemiology heart failure. Understanding cardiac output critical care full text.
In contrast to low output heart failure, clinical trial data in this area are lacking. Furthermore, effective pharmacotherapy has not been established. Lowoutput heart failure lohf is an uncommon form of heart failure hf but one that. This topic will discuss the causes and pathophysiology of. Define and employ the terms preload, afterload, contractilty, remodeling, diastolic dysfunction, compliance, stiffness and capacitance. An inability of the heart to pump blood at a sufficient rate to meet the metabolic demands of the body e. Borlaug, md abstract background highoutput heart failure hf is an unusual cause of cardiac failure that has not been wellcharacterized. This chapter serves as a beginning in the process of. That feeling when your hearts hard work is not enough. Most of the high output patients presented with leftsided hf n 91, 76%, and the remaining presented with right heart failure.
Classical heart failure treatment can be detrimental in this instance. We report two patients with multiple myeloma and high output heart failure who failed diuretic therapy. Highoutput heart failure a 15year experience yogesh n. Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the bodys needs for blood and oxygen. M4a crunch time em heart individual mp3 files 164 mb zip crunch time em heart written summary 326 kb pdf. The main problem is the underlying decrease in systemic vascular resistance,that drives low blood pressure, and activation of neurohormonal mechanisms.
Usually, if you have heart failure, your heart isnt pumping enough blood through your body to help it. Highoutput cardiac failure statpearls ncbi bookshelf. The inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body forward failure, or the ability to do so only if cardiac filling pressures are abnormally high backward failure, or both. Background high output heart failure hf is an unusual cause of cardiac failure that has not been wellcharacterized. High output failure ci inc, lvedv inc, lvedp n systolic failure. In the final model, cardiac failure was strongly associated with blood transfusion. Heart failure can be classified as predominantly left ventricular, right ventricular or. The heart and cardiac output 911 tactical medicine. The heart and cardiac output managing cardiac emergencies relies heavily on an ability to recognize, understand and respond to altered cardiac output. Diastolic dysfunction refers to relatively stiff heart muscle, which makes it difficult for the heart to fill with. In preterminal heart failure, inadequate bowel perfusion can cause abdominal pain, distention, and bloody stools. Coronary artery disease is a problem with the arteries that supply blood and oxygen to your heart.
Pdf heart failure is a major public health concern. In rare cases, highoutput chf may occur as a result of conditions that increase. How to define it, when to treat it, and how to treat. Diuretic therapy in this setting has little efficacy in treating the congested state.
212 312 18 1435 289 1531 458 809 860 229 62 509 501 1050 925 218 441 1181 245 1246 405 452 453 213 237 837 1386 580 98 10 897 129 88 674 532 596 108 170 795