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KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Symptoms and signs of congestive heart failure

  • Echocardiographic or right heart catheterization evidence of high cardiac output and normal systolic function

  • Presence of a stimulus for high cardiac demands (eg, obesity, liver disease, severe anemia, thyrotoxicosis, arteriovenous fistula, beriberi, after liver transplantation)

GENERAL CONSIDERATIONS

  • High demand for cardiac output may not be adequately met, leading to:

    • – Reduced organ perfusion and compensatory mechanisms, such as salt and water retention

    • – Congestion despite normal or elevated cardiac output

  • Left ventricular systolic and diastolic function are usually normal but may be reduced if increased demand is incessant

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Dyspnea, fatigue, edema

PHYSICAL EXAM FINDINGS

  • Typical findings of congestive heart failure

  • Sinus tachycardia frequent

DIFFERENTIAL DIAGNOSIS

  • Diastolic heart failure: normal systolic function, but low cardiac output

  • Systolic dysfunction heart failure

  • Fluid overload, usually iatrogenic

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • Tests of underlying problem: hemoglobin, thyroid hormones, and liver and renal function tests

ELECTROCARDIOGRAPHY

  • Increased voltage may be present

IMAGING STUDIES

  • Echocardiography

    • – Mild chamber enlargement

    • – Doppler evidence of high cardiac output

TREATMENT

CARDIOLOGY REFERRAL

  • Heart failure

HOSPITALIZATION CRITERIA

  • Depends on underlying disease because heart failure is usually mild

MEDICATIONS

  • Eliminate the underlying cause

  • Give diuretics to relieve congestion

MONITORING

  • ECG monitoring in hospital as appropriate

DIET AND ACTIVITY

  • Low-sodium diet

  • Restricted activities

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Resolution of problem

FOLLOW-UP

  • Depends on underlying problem

COMPLICATIONS

  • Eventual systolic dysfunction

PROGNOSIS

  • Excellent with relief of underlying problem

PREVENTION

  • Avoid conditions that excessively increase cardiac demand

RESOURCES

PRACTICE GUIDELINES

  • Echocardiography: indicated for all new cases of congestive heart failure and identifies this subtype

REFERENCES

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Pfitzmann  R, Heise  M, Langrehr  JM,  et al. Liver transplantation for treatment of intrahepatic Osler’s disease: first experiences. Transplantation. 2001;72:237–241.  [PubMed: 11477345]
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Reddy  YN, Melenovsky  V, Redfield  MM, Nishimura  RA, Borlaug  BA. High-output heart failure: a 15-year experience. J Am Coll Cardiol. 2016;68(5):473–482.  [PubMed: 27470455]

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