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[Severe left heart failure long after acquired arteriovenous fistula]
Insights
Acquired arteriovenous fistulas from trauma can cause heart failure. A 64-year-old man developed severe left heart failure due to a gunshot-induced arteriovenous fistula, highlighting the importance of noncardiac findings.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Vascular Surgery
Background:
- Acquired arteriovenous fistulas (AVFs) commonly result from penetrating trauma, such as gunshot wounds.
- High cardiac output in AVFs is influenced by fistula size and systemic vascular resistance.
- Cardiac findings in AVF patients can mimic valvular heart disease or dilated cardiomyopathy.
Observation:
- A 64-year-old male presented with severe left heart failure.
- The patient had a history of a gunshot injury to the left lower quadrant of the abdomen 39 years prior.
- An acquired arteriovenous fistula was identified between the left internal iliac artery and the left common iliac vein.
Findings:
- The arteriovenous fistula led to significant hemodynamic changes, including high cardiac output.
- The fistula's long-standing presence contributed to the development of severe left heart failure.
- Physical examination revealed a continuous murmur and thrill over the abdominal scar, indicative of the AVF.
Implications:
- This case underscores the critical need to consider noncardiac physical findings in diagnosing heart failure.
- Delayed presentation of severe heart failure due to chronic AVFs is possible.
- Early recognition and management of traumatic AVFs are crucial to prevent cardiac complications.
Abstract:
Gunshot wounds and traumatic injuries are the main causes of acquired arteriovenous fistulas. The high cardiac output associated with such fistulas depends mainly on the size of the pathological communication and the degree of reduction in the systemic vascular resistance that results. Since the findings on cardiac examination in these patients may mimic those of valvular heart disease or dilated cardiomyopathy, careful attention should be paid to noncardiac physical findings, such as thrill and/or continuous murmur over the traumatic or surgical scar. We describe a 64-year-old man who developed severe left heart failure 39 years after a gunshot injury in the left lower quadrant of the abdomen. This had led to an acquired arteriovenous fistula between the left internal iliac artery and the left common iliac vein.