High output heart failure: A review of clinical status - epidemiology, pathophysiology, diagnosis, prognosis and clinical management

Albakri, Aref

doi:10.15761/mca.1000155

Cited by 7 publications

(8 citation statements)

References 55 publications

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“…Management of reduced ejection fraction heart failure (HF) is well supported by many randomized clinical trials and published guidelines; on the contrary, the evidence base for the management of high output HF is scarce and lacks the support of international guidelines [ 16 ]. The use of conventional vasodilators, such as angiotensin receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), and β-blockers with vasodilatory properties (for example, carvedilol and nebivolol), may further aggravate lower systemic vascular resistance observed in high output HF, causing deterioration in clinical status, and are therefore not recommended [ 17 ]. Management in such cases should be targeted at correcting anemia, along with use of diuretics and dietary restriction of salt and water.…”

Section: Discussionmentioning

confidence: 99%

Chronic anemia complicated by cardiac failure, pulmonary hypertension, and pericardial effusion: a case report

et al. 2023

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Background Worldwide, iron deficiency anaemia (IDA) is the most common cause of anaemia. Iron deficiency alone has an association with heart failure and pulmonary hypertension. Chronic iron deficiency anemia triggers various physiologic adjustments, leading to hyperdynamic circulation and enhanced hypoxic pulmonary vasoconstriction. Those mechanisms may result in the development of high output cardiac failure and pulmonary hypertension; however, pericardial effusion remains a rare association. Case presentation A 44-year-old Nepalese man presented with fatigability and swollen ankles. Except for a hemorrhoidectomy 4 years ago, he had no comorbidities. Labs confirmed severe iron deficiency anemia (hemoglobin 1.8 grams per deciliter) likely secondary to hemorrhoids. An echocardiogram revealed high output cardiac failure, pericardial effusion, and severe pulmonary hypertension. He responded well to the correction of anemia and diuretics with the resolution of vascular complications. Conclusion We report a unique presentation of chronic severe iron deficiency anemia complicated by heart failure, pulmonary hypertension, and pericardial effusion. We believe it to be the first-ever such case reported in the literature. These cardiovascular complications seem to result from internal homeostatic mechanisms against the chronic tissue hypoxemia observed in severe anemia. Furthermore, iron deficiency alone has an association with heart failure and pulmonary hypertension. After excluding other potential causes, we confirmed iron deficiency anaemia as the cause of those complications. The correction of anemia led to an excellent recovery without any sequelae. Our case report highlights the fact that management of such a case should be focused on underlying etiology rather than the complications.

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Section: Discussionmentioning

confidence: 99%

Chronic anemia complicated by cardiac failure, pulmonary hypertension, and pericardial effusion: a case report

et al. 2023

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“…Clear diagnostic criteria for obesity-related high-output HF are needed to identify the incidence and prevalence of the disease. Although signs and symptoms of patients with obesity-related high-output HF were reported in the literature, these were based on patients with low-output HF and not on studies of obesity-related high-output HF 5,7 . Specifically, symptom science research is needed in patients with obesity-related high-output HF to discover how symptoms present and the characteristics of their symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Although signs and symptoms of patients with obesity-related high-output HF were reported in the literature, these were based on patients with low-output HF and not on studies of obesity-related high-output HF. 5,7 Specifically, symptom science research is needed in patients with obesityrelated high-output HF to discover how symptoms present and the characteristics of their symptoms. This research will also be beneficial in determining the effectiveness of treatment on reducing symptoms and improving quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Treatments for high-output HF include managing symptoms and treating the underlying conditions. 6,7 Obesity is highly prevalent in HF and research has shown that obesity is associated with an increased risk of cardiovascular disease. 8,9 Obesity has been reported to have cardioprotective effects in HF as individuals who are normal or underweight have a less favorable prognosis.…”

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confidence: 99%

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Obesity-Related High-Output Heart Failure

et al. 2022

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Background: High-output heart failure (HF) is a type of HF characterized by signs and symptoms of HF and a cardiac output of 8 L/min or greater or a cardiac index greater than 3.9 L/min/m 2 . High-output HF occurs secondary to an underlying condition that requires high cardiac output due to an increase in oxygen consumption or decreased systemic vascular resistance. Obesity is a major cause of high-output HF, yet there is limited research on obesity-related high-output HF. Thus, the pathophysiologic mechanisms of this syndrome are not fully understood. Objective: The objectives of this integrative review were to describe the current state of the research regarding obesity-related highoutput HF and to recommend direction for future research. Methods: We conducted an integrative review focusing on the peer-reviewed literature on patients with obesity-related high-output HF using Whittemore and Knafl's methodology. MEDLINE, CINAHL, and EMBASE electronic databases were searched for all publications indexed in the databases as of March 9, 2022. A narrative synthesis of definitions and symptoms, obesity as an underlying condition, pathophysiology, and treatments of obesity-related high-output HF was completed. Results: A total of 6 articles were included in the integrative review, with 1 nonexperimental, retrospective study and 5 literature reviews. Understanding of obesity-related high-output HF is very limited because of scant empirical evidence in the existing literature. Possible pathophysiologic mechanisms include increased pressure in the upper airways, adipokine dysregulation, increased metabolic activity, and insulin resistance. Conclusion: Additional research is needed on the pathophysiologic mechanisms of obesity-related high-output HF to begin investigations on therapeutic interventions to improve health outcomes.

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“…Although heart failure is common, with 500,000 new cases reported annually, the incidence and prevalence of high output failure are much lower [8]. This has been attributed to conditions resulting in a high output state, including an increased metabolism with an associated demand for blood and a bypass of the arterioles and capillary bed, leading to increased oxygen consumption with a low systemic resistance [9,10]. In western countries, there is an increasing prevalence of high output heart failure with high morbidity.…”

Section: Prevalencementioning

confidence: 99%

Underlying Causes of High Output Heart Failure

Shen¹,

Hiebert²,

Pierce³

2020

JICOA

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In the U.S., each year, there are more than 500,000 new cases of all types of heart failure. With high output cardiac failure, there is an elevated cardiac output associated with several conditions and diseases, including obesity, chronic anemia, systemic arterio-venous fistula, hypercapnia, mitochondrial dysfunction, and hyperthyroidism. The underlying pathophysiologic mechanisms relate to a reduction in systemic vascular resistance from arterio-venous shunting or peripheral vasodilation. Often there is a decrease in systemic arterial blood pressure and neurohormonal activation leading to heart failure symptoms of dyspnea and fatigue. In a persistent high output state, patients may experience tachycardia, valvular abnormalities, and ventricular dilatation and/or hypertrophy. In this article, there is a review of high output heart failure, including the prevalence, pathophysiology, and common clinical causes of this disease.

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High output heart failure: A review of clinical status - epidemiology, pathophysiology, diagnosis, prognosis and clinical management

Cited by 7 publications

References 55 publications

Chronic anemia complicated by cardiac failure, pulmonary hypertension, and pericardial effusion: a case report

Chronic anemia complicated by cardiac failure, pulmonary hypertension, and pericardial effusion: a case report

Obesity-Related High-Output Heart Failure

Underlying Causes of High Output Heart Failure

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