High output cardiac failure in multiple myeloma mm is related to arteriovenous shunting in bone infiltrate disease. Hereditary hemorrhagic telangiectasia presenting as high. High output cardiac failure in patients with multiple myeloma. Cardiac output heart rate x stroke volume stroke volume enddiastolic volume endsystolic volume preload venous return afterload peripheral resistance. The heart and cardiac output managing cardiac emergencies relies heavily on an ability to recognize, understand and respond to altered cardiac output. Anemia systemic arteriovenous fistulas hyperthyroidism beriberi heart disease paget disease of bone glomerulonephritis polycythemia vera carcinoid syndrome obesity heart failure.
Understanding of the applicability and practical relevance of each of these four components is important when interpreting cardiac output values. Hypertension, congestive heart failure and angina toni benton md high blood pressure hypertension definition. The finding of heart failure associated with avf creation was initially published within a few years of. The study authors found that most common etiologies of highoutput hf n 120. High output cardiac failure, defined as symptoms of heart failure in the presence of a higherthannormal cardiac index, is a rare complication of a high flow avfavg. Highoutput cardiac failure due to excessive shunting in a hemodialysis access fistula. High output cardiac failure is another entity characterized by elevated cardiac output in certain medical conditions such as beriberi, hyperthyroidism, and systemic av fistulas. The underlying problem in high output failure is a decrease in the systemic vascular resistance that threatens the arterial blood pressure and causes activation of neurohormones, resulting in an increase in salt and water retention by the kidney. 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. Cardiometry ec electrical cardiometry is a method for the noninvasive determination of stroke volume sv, cardiac output co, and other hemodynamic parameters in adults, children. Classification based on cardiac output high output failure the normal heart fails to maintain normal or increased output in conditions like anemia, hyperthyroidism, pregnancy.
In preterminal heart failure, inadequate bowel perfusion can cause abdominal pain, distention, and bloody stools. Vasoplegia syndrome is a well known complication after cardiac surgery and has a signi. Highoutput heart failure american college of cardiology. Even though the resting cardiac index is elevated, symptoms of heart failure develop because of a failure to compensate for increased requirements. After delivery via cesarean section, the patient was found to have intrahepatic arteriovenous. Jul 15, 2008 high output cardiac failure in patients with multiple myeloma.
B, a parasternal longaxis tte image demonstrating a cardiac tamponade. The study cohort was comprised of 525 hf patients that showed an elevated cardiac index, of whom 120 cases had definite high output hf. Additional testing went on to show a negative bubble echocardiogram for righttoleft intracardiac shunt and a right heart catheterization with borderline pulmonary hypertension, elevated pcwp, and a cardiac output and index of. By understanding the factors that influence cardiac output, memory work becomes unnecessary. Background high output heart failure hf is an unusual cause of cardiac failure that has not been wellcharacterized. High output heart failure request pdf researchgate. High output cardiac failure secondary to hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia hht. Usually right sided failure occurs followed by left sided failure with presence of shortened circulatory time. The finding of heart failure associated with avf creation was initially published within a few years of the first case report of avf creation for hemodialysis. In all high output hf states where the co is increased, such as in chronic severe anemia, chronic obstructive pulmonary disease, and large arteriovenous fistula, the arterial blood pressure is also threatened or is reduced because of severe vasodilatation.
Highoutput heart failure is a heart condition that occurs when the cardiac output is higher than normal due to increased peripheral demand. The heart and cardiac output 911 tactical medicine. Multiple myeloma presenting with high output heart failure. Here we report a 43yearold woman who presented at 29 weeks gestation of her second pregnancy with complications of rightsided heart failure and preterm labor. However, the term is a misnomer because the heart in these conditions is normal, capable of generating very high cardiac output. As previously described, traditional cardiac failure therapy is not effective. Pdf two cases of high output heart failure caused by. Most of the high output patients presented with leftsided hf n 91, 76%, and the remaining presented with right heart failure. High output cardiac failure dr daniel j bell and dr yuranga weerakkody et al. Evidence and guidelines for the treatment of highoutput heart failure are scarce. A high output state may occur in chronic severe anemia, large arteriovenous fistula or multiple small arteriovenous shunts as in pagets bone disease, some forms of severe hepatic or renal disorders, and acutely in septic shock. Highoutput cardiac failure and coronary steal with an.
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. While most patients with heart failure hf, with either reduced or preserved ejection fraction, have low or normal cardiac output accompanied. Congestive heart failure university of california, irvine. This type of heart failure causes systemic or pulmonary edema. A patient with two proximal upper extremity fistulas was found to have progressive depression in his left ventricular function and a high output state. Congestive heart failure describes a syndrome with complex and variable symptoms and signs, including dyspnea, increased fatigability, tachypnea, tachycardia, pulmonary rales, and peripheral edema. Congestive heart failure describes a syndrome with complex and variable symptoms and signs, including dyspnea, increased fatigability, tachypnea, tachycard. Methods we performed a retrospective analysis of all consecutive patients referred to the mayo clinic. Background highoutput heart failure hf is an unusual cause of cardiac failure that has not been wellcharacterized.
Evidence and guidelines for the treatment of high output heart failure are scarce. 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. Objectives this study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of highoutput hf in the modern era. Pathophysiology, risk factors and treatment sabry omar, md, ahmed zedan, md and kenneth nugent, md abstract. This chapter serves as a beginning in the process of. High cardiac output hypotension is most often signaled by a large pulse pressure, a low diastolic pressure, warm extremities with good nailbed return, fever or hypothermia, and leukocytosis or leukopenia. Highoutput cardiac failure in a patient with a history of hereditary hemorrhagic telangiectasia. Learn vocabulary, terms, and more with flashcards, games, and other study tools. School of biomedical science, charles sturt university, specialist in anaesthesia and intensive care, bathurst base hospital, bathurst, nsw, australia. Borlaug, md abstract background highoutput heart failure hf is an unusual cause of cardiac failure that has not been wellcharacterized.
Fracp talk heart failure, cardiomoypathy and cardiac. With the highoutput version, its pumping a normal amount of blood or even more than normal. High blood pressure occurs when the pressure of your blood against the artery walls is higher. Classical heart failure treatment can be detrimental in this instance. References in highoutput cardiac failure and coronary. The study cohort was comprised of 525 hf patients that showed an elevated cardiac index, of whom 120 cases had definite highoutput hf. There is a circulatory overload which may lead to pulmonary edema secondary to an elevated diastolic pressure in the left ventricle.
Cardiac output is defined as the amount of blood your heart pumps. Highoutput cardiac failure, defined as symptoms of heart failure in the presence of a higherthannormal cardiac index, is a rare complication of a highflow avfavg. This type of heart failure occurs when the cardiac output is normal or high, but demand for blood flow is abnormally high and the heart is unable to satisfy the demand. Clinical presentation patients can present with a number of symp. If reading the pdf online, click on the image to view the video. This topic will discuss the causes and pathophysiology of.
Highoutput heart failure definition of highoutput heart. Even though the resting cardiac index is elevated, symptoms of heart failure develop because of a. It is characterized by profound vasodilation and loss of systemic vascular. These individuals usually have a normal systolic function but symptoms are those of heart failure. Hypertension, congestive heart failure and angina toni benton md high blood pressure hypertension.
Reddy and others published highoutput heart failure. Although this syndrome usually is associated with low cardiac output, it may occur in a number of socalled high output states, when the cardiac output is normal or greater than normal. Cardiac output co is the product of the heart rate hr, i. Blood pressure is a measurement of the pressure your blood exerts against the artery walls. High output heart failure is a heart condition that occurs when the cardiac output is higher than normal due to increased peripheral demand. Multiple myeloma presenting with highoutput heart failure. A displaced cardiac apex, a third heart sound, and chest radiography findings of pulmonary venous congestion or interstitial edema are good predictors to rule in the diagnosis of heart failure. Symptoms of high output cardiac failure include breathlessness at rest or on exertion, exercise intolerance, fatigue, fluid retention and signs like tachycardia, tachyp. We describe such a complication in a patient with primary plasma cell leukemia ppcl without bone disease. In the present article, we use a simple analogy comparing cardiac output with the speed of a bicycle to. The syndrome of systemic congestion in a high output state is traditionally referred to as high output heart failure. Highoutput heart failure a 15year experience yogesh n.
Understanding cardiac output critical care full text. Heart failure is a pathophysiological state in which cardiac output is insufficient to meet the needs of the body and lungs. High output cardiac failure is a rare complication of hereditary hemorrhagic telangiectasia hht usually caused by shunting of blood through atriovenous malformations avms in the liver. Causes include anemia, vitamin deficiencies such as beriberi or thiamine deficiency, hyperthyroidism. Arteriovenous shunting in patients with multiple myeloma and highoutput failure. Highoutput cardiac failure statpearls ncbi bookshelf. Functional causes of heart failure are usually high output in nature, characterized by an elevated cardiac index.
However, most of these causes are rarely the sole cause of heart failure and are merely triggers to an underlying pathology. 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. Reddy, md, vojtech melenovsky, md, phd, margaret m. High output cardiac failure that resolves with closure of the av shunt is a welldocumented but rare complication of avgs and autogenous fistulae. Cardiac output co, also known as heart output denoted by the symbols, or. Lowoutput heart failure definition of lowoutput heart. An easily overlooked diagnosis article pdf available in american journal of nephrology 154. Usually, if you have heart failure, your heart isnt pumping enough blood through your body to help it work the way it should. Causes and pathophysiology of highoutput heart failure uptodate. Highoutput cardiac failure radiology reference article. High output cardiac failure associate professor brendan e. Hemodynamic changes in highoutput cardiac failure by. A high cardiac output state has been an infrequent but previously reversible cause of heart failure in patients with hemodialysis fistulas.
Heart failure refers to the syndrome of fluid retention and breathlessness, caused by cardiac disease usually biventricular in children due to ventricular interdependence and child specific pathology cildcauses include. Patients with heart failure and high cardiac output n patients excluded based on exclusion criteria. In a series of six human patients who presented with severe hemodynamic compromise to a critical care setting, right heart catheterization revealed low cardiac index in four patients. Heart failure can be classified as predominantly left ventricular, right. 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. The term congestive heart failure is often used, as one of the common symptoms is congestion, or buildup of fluid in a persons tissues and veins in the lungs or other parts of the body. No dyspnea unlike lhf not until later does dyspnea occur as a. Electrical cardiometry ec electrical cardiometry is a method for the noninvasive determination of stroke volume sv, cardiac output co, and other hemodynamic parameters in adults, children. 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. Acute cardiorenal syndrome acute impairment in cardiac function causing renal dysfunction acute heart failure is defined as a rapid onset or change in signs and symptoms of heart failure, requiring urgent therapy, and subdivided into five types based on clinical presentation. High output cardiac failure refers to a state of cardiac failure that is associated with a higher than normal cardiac output which is still not sufficient for body tissue demands. Learn about the normal output rate, how its measured, and causes of low cardiac output. High output cardiac failure revealing primary plasma cell.
Ecmo will never capture 100% of cardiac output if lv is failing, this can result in lv distention distention results in compression of myocardial capillaries myocardial ischemia. Most of the highoutput patients presented with leftsided hf n 91, 76%, and the remaining presented with right heart failure. The neurohormonal response observed in these high output conditions is almost identical to that seen in low output hf. Objectives this study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high output hf in the modern era. Congestive heart failure and management drugs cardiology. Cardiac output is usually normal or low in patients with heart failure hf, but a minority of patients present in a highoutput state, which has historically been referred to as highoutput hf 1, 2. No dyspnea unlike lhf not until later does dyspnea occur as a consequence of the reduced cardiac output, poor. The study authors found that most common etiologies of high output hf n 120. Arteriovenous shunting in patients with multiple myeloma and high output failure. Usually, if you have heart failure, your heart isnt pumping enough blood through your body to help it.
Management of cardiac arrest following cardiac surgery. Many of the treatments utilized for other forms of heart failure, such as vasodilatators, may worsen hemodynamic. High output failure ci inc, lvedv inc, lvedp n systolic failure. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
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