High-output heart failure - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:10Z

Strip excess bold text

← Older revision		Revision as of 09:24, 22 March 2026
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	*High-output heart failure occurs when cardiac output is elevated but cannot meet the body's increased metabolic demands		*High-output heart failure occurs when cardiac output is elevated but cannot meet the body's increased metabolic demands
	*Unlike typical heart failure, the heart itself may be structurally normal initially		*Unlike typical heart failure, the heart itself may be structurally normal initially
	*Extremities are typically ~~'''~~warm and well-perfused~~'''~~ (distinguishing feature from low-output heart failure)		*Extremities are typically warm and well-perfused (distinguishing feature from low-output heart failure)
	*Can progress to low-output failure if untreated		*Can progress to low-output failure if untreated

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	*Dyspnea, fatigue, exercise intolerance		*Dyspnea, fatigue, exercise intolerance
	*Warm, well-perfused extremities (unlike cold/clammy in low-output failure)		*Warm, well-perfused extremities (unlike cold/clammy in low-output failure)
	*Bounding pulse with ~~'''~~wide pulse pressure~~'''~~		*Bounding pulse with wide pulse pressure
	*Peripheral edema, pulmonary congestion		*Peripheral edema, pulmonary congestion
	*May have signs of underlying cause (goiter, AV fistula bruit, pallor)		*May have signs of underlying cause (goiter, AV fistula bruit, pallor)
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	===Common Causes===		===Common Causes===
	*~~'''~~Severe [[anemia]]~~'''~~ (Hgb <5-7 g/dL)		*Severe [[anemia]] (Hgb <5-7 g/dL)
	*~~'''~~[[Hyperthyroidism]] / [[thyroid storm]]~~'''~~		*[[Hyperthyroidism]] / [[thyroid storm]]
	*~~'''~~AV fistula~~'''~~ (dialysis access, traumatic, congenital)		*AV fistula (dialysis access, traumatic, congenital)
	*~~'''~~[[Sepsis]]~~'''~~		*[[Sepsis]]
	*~~'''~~Paget's disease of bone~~'''~~		*Paget's disease of bone
	*~~'''~~[[Thiamine]] deficiency (wet [[beriberi]])~~'''~~		*[[Thiamine]] deficiency (wet [[beriberi]])
	*~~'''~~Pregnancy~~'''~~		*Pregnancy
	*~~'''~~Cirrhosis~~'''~~		*Cirrhosis
	*~~'''~~Morbid obesity~~'''~~		*Morbid obesity

	==Evaluation==		==Evaluation==
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	==Management==		==Management==
	*~~'''~~Treat underlying cause~~'''~~ — this is definitive management		*Treat underlying cause — this is definitive management
	**Anemia: transfuse		**Anemia: transfuse
	**Hyperthyroidism: beta-blockers, antithyroid medications		**Hyperthyroidism: beta-blockers, antithyroid medications

Danbot: Expanded with concise EM-focused content: warm extremities distinction, common causes, evaluation, treat underlying cause, disposition

2026-03-21T00:37:44Z

Expanded with concise EM-focused content: warm extremities distinction, common causes, evaluation, treat underlying cause, disposition

← Older revision		Revision as of 00:37, 21 March 2026
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	==Background==		==Background==
	*High metabolic ~~state or shunting of blood increasing cardiac demand~~		*High-output heart failure occurs when cardiac output is elevated but cannot meet the body's increased metabolic demands
			*Unlike typical heart failure, the heart itself may be structurally normal initially
			*Extremities are typically '''warm and well-perfused''' (distinguishing feature from low-output heart failure)
			*Can progress to low-output failure if untreated

	==Clinical Features==		==Clinical Features==
	*Dyspnea, fatigue, ~~[[Bilateral pedal edema\|peripheral edema]]~~		*Dyspnea, fatigue, exercise intolerance
	*Warm ~~and~~ well-perfused extremities		*Warm, well-perfused extremities (unlike cold/clammy in low-output failure)
	*Bounding pulse with wide pulse pressure		*Bounding pulse with '''wide pulse pressure'''
			*Peripheral edema, pulmonary congestion
			*May have signs of underlying cause (goiter, AV fistula bruit, pallor)

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Template:High-output heart failure DDX}}		{{Template:High-output heart failure DDX}}

			===Common Causes===
			*'''Severe [[anemia]]''' (Hgb <5-7 g/dL)
			*'''[[Hyperthyroidism]] / [[thyroid storm]]'''
			*'''AV fistula''' (dialysis access, traumatic, congenital)
			*'''[[Sepsis]]'''
			*'''Paget's disease of bone'''
			*'''[[Thiamine]] deficiency (wet [[beriberi]])'''
			*'''Pregnancy'''
			*'''Cirrhosis'''
			*'''Morbid obesity'''

	==Evaluation==		==Evaluation==
			*[[CBC]]: anemia
			*[[TSH]]: hyperthyroidism
			*[[BNP]]: elevated (not as reliable for distinguishing high vs. low output)
			*[[Thiamine]] level if suspected deficiency (alcoholism, malnutrition)
			*[[ECG]]: tachycardia, may show strain pattern
			*[[CXR]]: cardiomegaly, pulmonary congestion
			*[[Echocardiography]]: elevated EF (early), dilated chambers; eventually may show reduced EF
			*Assess for AV fistula bruit (dialysis patients)

	==Management==		==Management==
			*'''Treat underlying cause''' — this is definitive management
			**Anemia: transfuse
			**Hyperthyroidism: beta-blockers, antithyroid medications
			**Sepsis: antibiotics, source control
			**Thiamine deficiency: IV [[thiamine]] 500 mg before glucose
			**AV fistula: may need ligation if causing heart failure
			*Standard heart failure management for acute symptoms: diuretics for congestion, oxygen
			*Avoid excessive volume removal in AV fistula-related heart failure

	==Disposition==		==Disposition==
	*Admit		*Admit: new diagnosis of heart failure, hemodynamic compromise, severe underlying cause (thyroid storm, sepsis, severe anemia)
			*Discharge: mild symptoms with correctable cause identified and treated (e.g., anemia transfused, thyroid medication adjusted) with close follow-up

	==See Also==		==See Also==
	*[[~~Heart~~ failure]]		*[[Congestive heart failure]]
	*[[~~In-Training Exam Review~~]]		*[[Hyperthyroidism]]
			*[[Anemia]]
			*[[Beriberi]]

	==References==		==References==
	<~~References~~/>		<references/>

	[[Category:Cardiology]]		[[Category:Cardiology]]

Elcatracho: /* Clinical Features */

2021-03-09T20:46:44Z

Clinical Features

← Older revision		Revision as of 20:46, 9 March 2021
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	==Clinical Features==		==Clinical Features==
	*Dyspnea, fatigue, peripheral edema		*Dyspnea, fatigue, [[Bilateral pedal edema\|peripheral edema]]
	*Warm and well-perfused extremities		*Warm and well-perfused extremities
	*Bounding pulse with wide pulse pressure		*Bounding pulse with wide pulse pressure

Elcatracho: /* See Also */

2021-02-20T19:08:23Z

Elcatracho: /* Differential Diagnosis */

2021-02-11T00:38:09Z

Differential Diagnosis

← Older revision		Revision as of 00:38, 11 February 2021
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Hyperthyroidism]]		{{Template:High-output heart failure DDX}}
	*[[Beriberi]]
	*[[High-output heart failure ~~from AV fistula]]~~
	*[[AVM]]
	*[[Paget disease]]
	*[[Anemia]]
	*[[Pregnancy]]

	==Evaluation==		==Evaluation==

Elcatracho: /* Disposition */

2021-02-11T00:31:18Z

Disposition

← Older revision		Revision as of 00:31, 11 February 2021
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	==Disposition==		==Disposition==
			*Admit

	==See Also==		==See Also==

Elcatracho: /* Clinical Features */

2021-02-11T00:30:01Z

Clinical Features

← Older revision		Revision as of 00:30, 11 February 2021
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	==Clinical Features==		==Clinical Features==
			*Dyspnea, fatigue, peripheral edema
			*Warm and well-perfused extremities
	*Bounding pulse with wide pulse pressure		*Bounding pulse with wide pulse pressure

Aganapathy: /* Clinical Features */

2018-01-28T10:17:56Z

Clinical Features

← Older revision		Revision as of 10:17, 28 January 2018
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	==Clinical Features==		==Clinical Features==
			*Bounding pulse with wide pulse pressure

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T02:03:43Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 02:03, 24 July 2016
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	*[[Pregnancy]]		*[[Pregnancy]]

	==~~Diagnosis~~==		==Evaluation==

	==Management==		==Management==

Alvarez13 at 23:56, 18 May 2016

2016-05-18T23:56:35Z

← Older revision		Revision as of 23:56, 18 May 2016
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	*[[Beriberi]]		*[[Beriberi]]
	*[[High-output heart failure from AV fistula]]		*[[High-output heart failure from AV fistula]]
			*[[AVM]]
	*[[Paget disease]]		*[[Paget disease]]
	*[[Anemia]]		*[[Anemia]]

← Older revision		Revision as of 19:08, 20 February 2021
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	==See Also==		==See Also==
	*[[Heart failure]]		*[[Heart failure]]
			*[[In-Training Exam Review]]

	==References==		==References==