Abstract
Heart failure usually occurs in the setting of a low cardiac output, however in rare cases it may be associated with a high cardiac output. We present a rare and intriguing case of a patient with end-stage renal disease (ESRD) on hemodialysis that developed high output heart failure from his arteriovenous fistula (AVF). A 36 year old African American male with ESRD secondary to hypertension, on hemodialysis for six years, presented to emergency room with a history of chest pain and shortness of breath. He was diagnosed with congestive heart failure secondary to coronary artery disease. His transthoracic echo showed an ejection fraction of 65% and both the stress test and cardiac enzymes were negative for ischemia. Further workup revealed a cardiac output of 10.6 L/min and access flow of 2.37 L/min. We made a diagnosis of high output heart failure secondary to the AVF. He was taken to surgery for a minimally invasive limited ligation endoluminal-assisted revision (MILLER) procedure after which his symptoms resolved. High output heart failure, though a rare complication of AVF placement is an important differential in hemodialysis patients who present with symptoms of congestive heart failure. An accurate diagnosis will prevent morbidity and unnecessary hospital admissions.
Highlights
Heart failure usually occurs in the setting of a low cardiac output; in rare cases it may be associated with a high cardiac output
We present a rare and intriguing case of a patient with renal failure on hemodialysis that developed heart failure from his arteriovenous fistula (AVF)
The creation of the AVF sets up a cascade of events beginning with a reduction in peripheral resistance, causing an increase in cardiac output
Summary
Heart failure usually occurs in the setting of a low cardiac output; in rare cases it may be associated with a high cardiac output. This discussion focuses on high-output heart failure in the dialysis population secondary to arteriovenous fistula (AVF) creation. When a dialysis patient with an AVF presents repeatedly with volume overload not improved with medical therapy or dialysis, it is imperative to consider high output heart failure secondary to increased blood flow from the access as a possible etiology.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have