Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ 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 + +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] + +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] GET ACCESS TO THIS RESOURCE Sign In Username Please enter User Name Password Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options