High-output heart failure
High-output heart failure is congestion occurring despite an elevated cardiac output, driven by reduced systemic vascular resistance or increased metabolic demand from causes such as severe anemia, thyrotoxicosis, arteriovenous shunts, and thiamine deficiency. Treatment is directed at the underlying cause, since correcting it reverses the failure.
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What this article covers
- Overview
Definition: high-output heart failure is a state of congestion and heart failure symptoms occurring despite a cardiac output that is elevated (rather than reduced), from a low systemic vascular resistance or high metabolic demand.
- Epidemiology
Uncommon relative to low-output heart failure.
- Risk factors
Chronic severe anemia (including hemolytic and nutritional).
- Pathophysiology
Reduced afterload or increased demand: low systemic vascular resistance (shunts, thyrotoxicosis, sepsis) or high metabolic demand increases required cardiac output.
- Clinical features
Congestion: exertional dyspnea, orthopnea, and edema.
- Differential diagnosis
Low-output heart failure: cool extremities and narrow pulse pressure (Heart failure).
- Diagnosis
Establish by demonstrating congestion with an elevated cardiac output and identify the cause: the diagnostic basis is heart failure symptoms and signs with an elevated cardiac output and low systemic…
- Management
First-line, treat the underlying cause: transfuse or treat severe anemia, render the patient euthyroid in thyrotoxicosis (for example a beta-blocker such as propranolol 10 to 40 mg PO every 8 hours…
- Complications
Progressive ventricular dilation and dysfunction with chronic high demand.
- Prognosis
Often reversible when the cause is corrected.
- Prevention
Treat anemia and thyroid disease promptly, with periodic monitoring at least annually in at-risk patients.
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