Subtype - High-output HF

heart failure secondary to conditions associated with a high-output state, in which cardiac output is elevated to meet the peripheral tissue oxygen demands

conditions that lead to an increased cardiac demand (high-output state): Conditions that result in a high-output state are rarely the sole cause of CHF; patients usually have a preexisting cardiac condition that reduces ventricular reserve. In a high-output state, the heart cannot meet the additional demand, leading to heart failure.

• Physiological causes

  • Pregnancy

  • Fever

  • Exercise

• Other causes

  • Class III obesity

  • Advanced cirrhosis

  • Anemia

  • Systemic arteriovenous fistulas

  • Paget disease of bone

  • Hyperthyroidism

  • Wet beriberi (vitamin B1 deficiency)

  • Sepsis

  • Multiple myeloma

  • Glomerulonephritis

  • Polycythemia vera

  • Carcinoid heart disease

peripheral vasodilation or arteriovenous shunting → ↓ in systemic vascular resistance → ↑ heart rate and stroke volume → ↑ cardiac output

• Symptoms shared with low-output CHF

  • Dyspnea, tachypnea

  • Tachycardia

  • Peripheral edema

  • Fatigue

  • Low blood pressure

• Symptoms specific to high-output CHF

  • Midsystolic murmur, S3 gallop

  • Jugular distention with an audible hum over the internal jugular vein

  • Pulsatile tinnitus

  • Bounding peripheral pulses

  • Laterally displaced apex beat

• Primarily a clinical diagnosis

• X-ray and echocardiography: cardiomegaly

• Heart failure management

  • Symptom relief

  • Hemodynamic stabilization

• Treatment of the underlying condition