High-output heart failure: Difference between revisions
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==Background== | ==Background== | ||
*High metabolic | *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, | *Dyspnea, fatigue, exercise intolerance | ||
*Warm | *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== | ||
*[[ | *[[Congestive heart failure]] | ||
*[[ | *[[Hyperthyroidism]] | ||
*[[Anemia]] | |||
*[[Beriberi]] | |||
==References== | ==References== | ||
< | <references/> | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Revision as of 00:37, 21 March 2026
Background
- 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
- Dyspnea, fatigue, exercise intolerance
- Warm, well-perfused extremities (unlike cold/clammy in low-output failure)
- Bounding pulse with wide pulse pressure
- Peripheral edema, pulmonary congestion
- May have signs of underlying cause (goiter, AV fistula bruit, pallor)
Differential Diagnosis
- Hyperthyroidism
- Beriberi
- High-output heart failure from AV fistula
- AVM
- Paget disease
- Anemia
- Pregnancy
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
- 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
- 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
- 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