High-Output Heart Failure

Abstract

A 71-year-old man was referred to our intensive care unit for short-term dyspnea associated with hemodynamic instability (systolic blood pressure, 75 mm Hg; heart rate, 115 bpm). He had a history of hypertension, hypercholesterolemia, and intermittent claudication with a maximal walking distance of 50 m and had been smoking 20 cigarettes daily for 30 years. Immediate clinical examination revealed hypotension, hypoxemia, warm extremities, and normothermia. Pulmonary auscultation revealed end-inspiratory crackles. Abdominal physical examination, difficult because of morbid obesity, did not reveal any abnormality. A chest x-ray performed before any fluid resuscitation depicted a pulmonary edema and pleural effusion. Initial white cell count and C-reactive protein level were both elevated (17 …