Patients with high output heart failure present with dyspnea, tachypnea, non-productive cough, fatigability, pulmonary rales, pleural effusion and peripheral edema, as a result of pulmonary and venous congestion due to neurohormonal activation and increased salt and water retention. Also, they are often tachycardic, with a heart rate between 85 and 105 beats per minute. A third heart sound and bilateral basal crackles are often heard in these patients [1]. Jugular and femoral venous hum may be sometimes observed. Peripheral vasodilatation leads to warm extremities.

High output heart failure is caused by a number of conditions each with their own signs and symptoms, that can sometimes also be found in affected individuals, such as chronic anemia, systemic arterio-venous fistulae, Paget's disease, hyperthyroidism, chronic hypercapnia, obesity, beriberi heart disease and sepsis.

Anemia causes cutaneous pallor and fatigability which overlaps with that induced by the heart failure, peripheral vasodilatation caused by vascular nitric oxide synthase [2] and low systemic vascular resistance [3].

Arteriovenous fistulae are associated with a specific hum on auscultation and may be congenital or acquired. They lead to a decrease in the systemic vascular resistance and thus high output heart failure [4]. Fistulae may be found in the context of certain congenital diseases, such as Osler-Weber-Rendu disease, Parkes-Weber or Klippel–Trénaunay syndrome. They can cause decreased pulse pressure distal to their location [1].

Paget's disease is associated with pain and warmth of the affected area, but a large amount of bone must be involved before heart failure occurs. A similar mechanism for the malfunction of the heart has been described in multiple myeloma, and Albright's disease [5].

Hypercapnia caused by chronic obstructive pulmonary disease may also cause high output heart failure [6]. The pulmonary pathology is recognized by auscultation and symptoms like dyspnea and fatigability.

Hyperthyroidism causes tachycardia-mediated cardiomyopathy and thus high output heart failure [7] and is often accompanied by atrial fibrillation [8].

Sepsis causes systemic vasodilatation, arterial hypotension and heart failure [9] and is recognized most often using laboratory workup, but also by fever, tachycardia, and tachypnea.

Beriberi is associated with chronic alcohol consumption or impaired nutrient absorption, that lead to weight loss and steatorrhea. Heart beriberi causes peripheral edema and fatigability and decreased systemic vascular resistance, leading to high output heart failure.

Obesity leads to systolic and diastolic malfunction of the heart and increased total blood volume, thus causing high output heart failure [10].

• Congestive Heart Failure

  Her symptoms and cardiovascular changes were consistent with congestive heart failure and severe preeclampsia. [ncbi.nlm.nih.gov]

  A rare cause of congestive heart failure includes systemic AV shunting or vasodilation, eventually over time resulting in a high-output heart failure state [2]. [hindawi.com]

  […] systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.3 Diastolic (congestive) heart failure Inclusion term [icd10coded.com]

  Clinical portrait of congestive heart failure. [medical-dictionary.thefreedictionary.com]

  Limitations in physical functioning were “comparable with those of patients with congestive heart failure” End-Stage Congestive Heart Failure Signs and Symptoms Stages of Congestive Heart Failure Early Clues That May Predict Congestive Heart Failure New [pinterest.de]

• Anemia

  These conditions include anemia, hyperthyroidism, and pregnancy. [uofmhealth.org]

  Anemia causes cutaneous pallor and fatigability which overlaps with that induced by the heart failure, peripheral vasodilatation caused by vascular nitric oxide synthase and low systemic vascular resistance. [symptoma.com]

  […] cutoff points have not been employed to define anemia. [revespcardiol.org]

• Fatigue

  Symptoms depend on which part of the heart is fatiguing. Eventually, the heart will fail. In some cases (depending on the reason), digitalis is effective. [ltstherapy.com]

  Fatigue and lethargy occurs due to the compromised CO leading to tissue hypoperfusion. [almostadoctor.co.uk]

  A 54-year-old white man presented with fatigue and a 20-kg weight loss during the previous 6 months. He could walk only two blocks and had noted increasing abdominal girth. [annals.org]

• Asymptomatic

  Back to Top Epidemiology It is difficult to estimate the incidence of PDB because most patients are asymptomatic. [clevelandclinicmeded.com]

  In stage B, patients are asymptomatic but have structural heart disease. Patients in stage C have structural abnormalities and past or present heart failure. [aafp.org]

  He currently is asymptomatic, with age-appropriate development, at 10 months after treatment. [elsevier.es]

  Hepatic AVMs affect up to 75% of HHT patients, the majority of which are asymptomatic [6,7,8]. [ojrd.biomedcentral.com]

  For example, a patient with chronic hypertension and asymptomatic LV hypertrophy (LVH) may be asymptomatic until an MI develops and precipitates heart failure. [emedicine.medscape.com]

• Amyloidosis

  Diastolic dysfunction (preserved EF) General causes Coronary artery disease, myocardial infarction Arterial hypertension Valvular heart disease Diabetes mellitus (diabetic cardiomyopathy) Renal disease Infiltrative diseases (e.g., hemochromatosis, amyloidosis [amboss.com]

  Infiltrative - eg, sarcoidosis, amyloidosis, haemochromatosis, Löffler's eosinophilia, connective tissue disease. Infective - eg, Chagas' disease, HIV. Arrhythmias - tachyarrhythmias or bradyarrhythmias. [patient.info]

  This can be caused by infiltrative disease such as sarcoidosis, amyloidosis, hemachromatosis and endocardial fibrosis. Arrhythmia Bradycardia – CO = HR X SV. [almostadoctor.co.uk]

  Less common Diabetes mellitus Valvular disease Rare Anemia Connective tissue disease Viral myocarditis Hemochromatosis Human immunodeficiency virus infection Hyperthyroidism, hypothyroidism Hypertrophic cardiomyopathy Infiltrative disease (including amyloidosis [aafp.org]

• Dyspnea

  After the procedure, dyspnea was improved and procedure related complication was not seen. [ncbi.nlm.nih.gov]

  Given the high mortality and increasing prevalence of these comorbidities in Western countries, high-output HF must be considered in the differential diagnosis of patients presenting with dyspnea, congestion, and a normal ejection fraction. [mayoclinic.pure.elsevier.com]

• Orthopnea

  He denied orthopnea, paroxysmal nocturnal dyspnea, and lower-extremity swelling. He also denied abdominal pain, hematochezia, melena, diarrhea, and flushing. He was thin, mildly tremulous, and afebrile and had no evidence of sepsis. [annals.org]

  In fact, some physicians will ask patients to use terms such as ‘2 pillow’ or ‘3 pillow’ orthopnea to differentiate how severe their congestion is. [ausmed.com]

  Orthopnea and paroxysmal nocturnal dyspnea are related to congestion of the pulmonary blood vessels and edema of the lung tissues. [medical-dictionary.thefreedictionary.com]

  Orthopnea 3. Fatigue 4. Edema 5. Paroxysmal noctural dyspnea ..Cardiogenic asthma는 발작성 야간 호흡 및 기침과 관련이 있으며 기관지 경 련에 의한 2차적인 천명이 특징이고 특히 밤... [kmle.co.kr]

• Rales

  Rales were heard over both lung bases. An abdominal examination showed a moderately distended abdomen with an enlarged liver. He had trace edema. The skin color was normal with no telangiectasia. [annals.org]

  Patients with high output heart failure present with dyspnea, tachypnea, non-productive cough, fatigability, pulmonary rales, pleural effusion and peripheral edema, as a result of pulmonary and venous congestion due to neurohormonal activation and increased [symptoma.com]

  Abstract Congestive heart failure describes a syndrome with complex and variable symptoms and signs, including dyspnea, increased fatigability, tachypnea, tachycardia, pulmonary rales, and peripheral edema. [ncbi.nlm.nih.gov]

  On physical exam, she has jugular venous distention, pulmonary rales, cardiac S3 sound, and pitting edema. Her electrocardiogram shows sinus tachycardia and chest radiograph shows pleural effusions and cardiomegaly. [medbullets.com]

  A chest examination detected no rales. Heart auscultation demonstrated accentuated first and second heart sounds, and grade 3/6 pansystolic ejection murmur in the mitral and tricuspid area. [circheartfailure.ahajournals.org]

• Exertional Dyspnea

  A 64-year-old woman was admitted with systemic edema and exertional dyspnea. High-output heart failure was diagnosed by right heart catheterization and she was treated with diuretics. [ncbi.nlm.nih.gov]

  Introduction In February, 2012, a 33-year-old man was admitted to our hospital because of exertional dyspnea, chest distress, and fatigue of 1 month duration. On admission, his blood pressure was 124/80 mm Hg and heart rate was 120 beats per minute. [circheartfailure.ahajournals.org]

• Sputum

  Signs and Symptoms of Congestion Dyspnea Orthopnea Paroxysmal nocturnal dyspnea (PND) Cough (recumbent or exertional) Abdominal or epigastric discomfort Abdominal bloating (ascites) Early satiety Hemoptysis, frothy or pink-tinged sputum Pedal/leg swelling [ausmed.com]

  […] features Rapid exacerbation of symptoms of CHF (see symptoms of left heart failure and symptoms of right heart failure) Pulmonary congestion with: Acute, severe dyspnea and orthopnea; worse when supine Cough (occasionally with frothing, blood-tinged sputum [amboss.com]

  Nocturnal cough (± pink frothy sputum) or wheeze. Light-headedness or syncope. Anorexia. [patient.info]

  Symptoms Breathlessness Duration and pattern Presence of orthopnea or paroxysmal nocturnal dyspnea Presence of frothy pink sputum Swelling of ankles Chest pain Ischemic or pleuritic in nature Exacerbating or relieving factors Palpitations Syncope Fatigue [clinicaladvisor.com]

• Nausea

  They can include: Shortness of breath Tiredness or weakness Swelling in your feet, ankles, legs, or abdomen Lasting cough or wheezing Fast or irregular heartbeat Dizziness Confusion Having to go to the bathroom more often at night Nausea Lack of appetite [webmd.com]

  […] or anorexia Dependent edema Signs and Symptoms of Poor Perfusion/Low Cardiac Output Easy fatigability Poor energy level or endurance Decreased exercise tolerance Cachexia (wasting syndrome) Muscle wasting or weakness Nausea or anorexia Early satiety [ausmed.com]

  But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain. [northshore.org]

• Choking

  He also complains of a choking sensation when supine that is relieved by sitting up. His medical history is notable for coronary artery disease, diabetes mellitus, and alcohol abuse. [medbullets.com]

• Vomiting

  Nausea or vomiting. Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms. Lightheadedness or sudden weakness. A fast or irregular heartbeat. [northshore.org]

• Heart Failure

  Often, the diagnosis of high output heart failure requires invasive right heart monitoring in the acute care setting such as a medical or cardiac intensive care unit. [ncbi.nlm.nih.gov]

  High output heart failure is a poorly understood condition characterized by signs and symptoms of heart failure and a resting cardiac index above 4 l/min x m2. Classical heart failure treatment can be detrimental in this instance. [symptoma.com]

  A rare cause of congestive heart failure includes systemic AV shunting or vasodilation, eventually over time resulting in a high-output heart failure state [2]. [hindawi.com]

• Heart Disease

  ICD-10-CM Codes › I00-I99 Diseases of the circulatory system › I30-I52 Other forms of heart disease › I50- Heart failure › High output heart failure 2018 - New Code 2019 Billable/Specific Code I50.83 is a billable/specific ICD-10-CM code that can be used [icd10data.com]

  heart failure Pulmonary edema with heart disease NOS Pulmonary edema with heart failure I50.2 Systolic (congestive) heart failure Inclusion term(s): Heart failure with reduced ejection fraction [HFrEF] Systolic left ventricular heart failure I50.20 Unspecified [icd10coded.com]

  Introduction Pediatric heart failure (HF) is an etiologically diverse disease manifesting a variety of clinical presentations. [pedsinreview.aappublications.org]

  Heart attacks are usually the result of heart disease, so taking steps to delay or reverse coronary artery disease can help prevent a heart attack. [northshore.org]

  Other more uncommon causes are atrial fibrillation, cardiomyopathy, valvular heart diseases, high-output heart failure or pericardial diseases. [lecturio.com]

• Tachycardia

  Hyperthyroidism causes tachycardia-mediated cardiomyopathy and thus high output heart failure and is often accompanied by atrial fibrillation. [symptoma.com]

  Patients may present with the usual signs of high-output heart failure including tachycardia, elevated pulse pressure, hyperkinetic precordium, and jugular venous distension. [ncbi.nlm.nih.gov]

  Her EKG showed sinus tachycardia at 108 beats per minute. ECHO showed a normal ejection fraction with moderate mitral regurgitation. [shmabstracts.com]

  Ventricular Tachycardia [VT] is common in advanced HF, which may evolve into ventricular arrhythmias and cardiac arrest. [almostadoctor.co.uk]

  Patients who have ventricular tachycardia, supraventricular tachycardia or rapid atrial fibrillation with evidence of cardiovascular compromise (hypotension, myocardial ischemia or pulmonary edema/congestion, poor perfusion) should have urgent electrical [clinicaladvisor.com]

• Cardiomegaly

  The chest X-ray showed cardiomegaly and dilatation of the pulmonary artery. Abdominal three-dimensional computed tomography scanning clearly revealed an arteriovenous fistula. [ncbi.nlm.nih.gov]

  As in all heart failure individuals, a chest radiography is useful, as it might show cardiomegaly, pleural effusion or pulmonary congestion. [symptoma.com]

  JVP elevated at rest) I ncreased cardiac shadow on X-ray (cardiomegaly: heart occupies more than ≈50% of chest diameter) C rackles heard in lungs Minor H epatomegaly E ffusion, pleural A nkle oedema bilaterally exe R tional dyspnoea T achycardia Vi tal [almostadoctor.co.uk]

  Her electrocardiogram shows sinus tachycardia and chest radiograph shows pleural effusions and cardiomegaly. She is immediately given a loop diuretic and oxygen. [medbullets.com]

• Palpitations

  “It’s an observation that people who drink a lot may wind up getting admitted to the hospital with palpitations or arrhythmia, often caused by atrial fibrillation,” she says. [health.com]

  The patient may complain of dyspnea, palpitations, chest pain, dizziness, and near syncope or syncope and have signs of alcohol intoxication. [journals.lww.com]

  Heart palpitations – feels like a flutter or quiver in your chest when your heart beats. Racing heart – when your heart beats faster than usual. Sometimes your heart will skip a beat. [northshore.org]

  The most common symptom is terrible heart palpitations. People with A-fib often say they feel like their heart is jumping out of their throat and report feeling short of breath. Dr. [kimt.com]

  Atrial Fibrillation and Holiday Heart Atrial fibrillation is a fairly common heart rhythm disturbance that often produces significant symptoms, especially easy fatiguability and palpitations. [verywellhealth.com]

• Muscular Atrophy

  atrophy Diagnostic markers of cardiac insufficiency are BNP and NT-proBNP in particular, which are released by cardiomyocytes during physical exertion. [lecturio.com]

• Suggestibility

  Several factors including hyperthyroidism, hypervolemia, and the molar state probably contributed to the left ventricular failure in this patient. results of these studies suggest that patients with hydatidiform mole and pulmonary edema need correction [ncbi.nlm.nih.gov]

  The evidence so far suggests that endoglin is required in the blood vessels to regulate vascular resistance which is important for normal heart function. Dr. [curehht.org]

• Oliguria

  These mechanisms are responsible for the symptoms of diaphoresis, cool skin, tachycardia, cardiac arrhythmias, and oliguria. [medical-dictionary.thefreedictionary.com]

  Cachexia (wasting syndrome) Muscle wasting or weakness Nausea or anorexia Early satiety Weight loss, unexplained Malaise Impaired concentration or memory Sleep disturbance Altered mentation (somnolence, confusion) Resting tachycardia (heart rate) Daytime oliguria [ausmed.com]

  […] agitation, confusion and/or reduced levels of consciousness; cold/vasoconstricted peripheries or delayed capillary refill time; hypotension; tachycardia or bradycardia; thready pulse; raised jugular venous pressure; breathlessness and hypoxaemia; and oliguria [oatext.com]

  […] level of consciousness Cool peripheries, mottled peripheries and delayed capillary refill time Hypotension Tachycardia or bradycardia Thready pulse Raised jugular venous pressure Breathlessness and hypoxaemia Evidence of pulmonary and peripheral edema Oliguria [clinicaladvisor.com]

• Renal Insufficiency

  The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility and food intake. [ncbi.nlm.nih.gov]

  Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis. 2001;38:803-12. Medline 31. Hsu CY, McCulloch CE, Curhan GC. [revespcardiol.org]

  The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000 Mar 1. 35 (3):681-9. [Medline]. [medscape.com]

• Somnolence

  Poor energy level or endurance Decreased exercise tolerance Cachexia (wasting syndrome) Muscle wasting or weakness Nausea or anorexia Early satiety Weight loss, unexplained Malaise Impaired concentration or memory Sleep disturbance Altered mentation (somnolence [ausmed.com]

• Lethargy

  Fatigue and lethargy occurs due to the compromised CO leading to tissue hypoperfusion. [almostadoctor.co.uk]

• Insomnia

  Excessive caffeine intake can cause insomnia and trigger an abnormal heart rhythm. Caffeine and alcohol also cause dehydration, which can lead to electrolyte imbalances and heart arrhythmia. [hawaiipacifichealth.org]

Blood workup shows elevated levels of atrial and brain natriuretic peptide in high output heart failure patients [11] [12]. Venous oxygen saturation, if high (above 75%), is an indirect indicator of a high output state. The oxygen content of arterial and mixed venous blood samples is expected to be decreased.

As in all heart failure individuals, a chest radiography is useful, as it might show cardiomegaly, pleural effusion or pulmonary congestion. A diagnosis of pneumonia in a septic patient with high output heart failure should lead the physician to suspect it as the underlying cause of the failure.

The diagnosis is ultimately confirmed with echocardiography showing an increased cardiac index. This investigation may show eccentric remodeling, chamber dilatation, and increased ventricular filling pressures, with a high ejection fraction. Pulmonary hypertension is another common finding in these patients.

Cardiac catheterization confirms increased cardiac filling pressures, high pulmonary artery pressure, stroke volume, ventricular preload, ejection fraction and decreased afterload as a result of low systemic vascular resistance [13].

• Hyperviscosity

  […] multiple myeloma has been associated with certain complications of severe or prolonged disease. 1 Myocardial infiltration with amyloid has been well described as a cause of dilated or restrictive cardiomyopathy and congestive heart failure. 2, 3 The hyperviscosity [nejm.org]

Endovenous laser ablation treatment has become the less invasive therapeutic choice for the treatment of superficial venous insufficiency and varicose veins. [ncbi.nlm.nih.gov]

The prognosis for people with heart failure and preserved LV ejection fraction is a little better than the prognosis for people with heart failure and reduced ejection fraction. Generally, the lower the ejection fraction, the poorer the prognosis. [patient.info]

References:[46][47][48] Prognosis Congestive heart failure Summary Definition Epidemiology Etiology Pathophysiology Underlying mechanism of reduced cardiac output Consequences of systolic and diastolic dysfunction Compensation mechanisms Clinical features [amboss.com]

Symptoms of Congestive Heart Failure Symptoms of Congestive Heart Failure Rehabilitate Your Heart #Save a #Life CONGESTIVE HEART FAILURE (CHF) -- Description, causes, signs & symptoms, risk factors, diagnosis, treatment, prognosis, prevention. | RxList [pinterest.de]

Some patients may develop end-stage liver disease which also has a poor prognosis. [ncbi.nlm.nih.gov]

Objectives This study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high-output HF in the modern era. [mayoclinic.pure.elsevier.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Characteristics of high-output HF etiologies Most hemodynamic and ventricular function findings were fairly uniform among the different etiologies of high-output HF, although there were some notable differences (Table 2). [onlinejacc.org]

OBJECTIVES: This study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high-output HF in the modern era. [ncbi.nlm.nih.gov]

Epidemiology The frequency of Holiday heart syndrome is unclear due to conflicting evidence. [ncbi.nlm.nih.gov]

The underlying pathophysiology was believed to be caused by the high-output state of pregnancy and by the increased peripheral vascular resistance of preeclampsia. [ncbi.nlm.nih.gov]

Some cases may therefore “may need exercise testing with or without invasive evaluation to clarify the pathophysiology”, Anand concludes. [medwirenews.com]

Objectives This study sought to characterize the etiologies, pathophysiology, clinical and hemodynamic characteristics, and outcomes of high-output HF in the modern era. [mayoclinic.pure.elsevier.com]

This case highlights the importance of the identification and treatment of acquired AV fistulas in the pathophysiology of high-output heart failure. References M. W. [hindawi.com]

Regular use of other NSAIDs, such as ibuprofen, may make aspirin less effective in preventing heart attack and stroke. For information on how to prevent a heart attack, see the Prevention section of this topic. [northshore.org]

When addressing the problem of high-output heart failure, the nephrologist is faced with the dilemma of preventing progression of heart failure at the expense of loss of vascular access. [ncbi.nlm.nih.gov]

Preventing 'holiday heart' Tips for preventing holiday heart while still enjoying your holidays include being conscious of the amount of alcohol you are consuming during the event, and staying well hydrated. [edition.cnn.com]

The key to prevention? Says cardiologist Dr. Kevin Campbell: “Moderation in alcohol and eating. Getting plenty of exercise and plenty of sleep. And try to avoid big family discussions until after the holidays.” [vicnews.com]

Treatment of the erythroderma flare can help prevent or treat the serious secondary complications. [shmabstracts.com]

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7. Froeschl M, Haddad H, Commons AS, et al. Thyrotoxicosis-an uncommon cause of heart failure. Cardiovasc Pathol. 2005; 14:24-27.
8. Watanabe H, Okamura K, Chinushi M, et al. Clinical characteristics, treatment, and outcome of tachycardia induced cardiomyopathy. Int Heart J. 2008;49:39-47.
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10. Galinier M, Pathak A, Roncalli J, et al. Obesity and cardiac failure. Arch Mal Coeur Vaiss. 2005;98:39-45.
11. Yakes W, Rossi P, Odink H. How I do it. Arteriovenous malformation management. Cardiovasc Intervent Radiol. 1996:19: 65-71.
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13. Reddy Y, Melenovsky V, Redfield M, et al. High-Output Heart Failure. A 15-Year Experience. JACC. 2016;68(5):473-782.