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Progressive heart failure secondary to a high output state
C W Ingram1, L F Satler, C E Rackley
1Department of Medicine, Georgetown University Hospital, Washington, DC 20007.
Chest
|December 1, 1987
Summary
High cardiac output from hemodialysis fistulas can cause heart failure. In one case, this led to irreversible left ventricular dysfunction, even after fistula removal.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- High-output cardiac failure is a known complication of arterio-venous fistulas used for hemodialysis.
- These conditions have historically been reversible with fistula ligation.
Observation:
- A patient presented with worsening left ventricular (LV) function and a high-output state attributed to two proximal upper extremity fistulas.
- Surgical removal of the primary fistula did not improve the patient's cardiac function.
Findings:
- The patient's condition suggests that chronic volume overload from high-output fistulas may lead to irreversible myocardial damage.
- This contrasts with previous understandings of the condition's reversibility.
Implications:
- Clinicians should consider the potential for irreversible cardiac damage in patients with long-standing high-output states from hemodialysis fistulas.
- Further research is needed to understand the mechanisms of irreversible myocardial depression in this context.