alexa The Arteriovenous Fistula: An Often Overlooked Precipitant of High Output Heart Failure | OMICS International | Abstract
ISSN: 2165-7920

Journal of Clinical Case Reports
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Case Report

The Arteriovenous Fistula: An Often Overlooked Precipitant of High Output Heart Failure

Titilayo O Ilori*, Jyothi Pinnaka, Mark Kats and Vandana Dua Niyyar
School of Medicine, Emory University, Atlanta, USA
*Corresponding Author : Titilayo O Ilori
School of Medicine
Emory University, Atlanta, USA
Tel: 404-727-9708
E-mail: [email protected]
Received: Janaury 29, 2016 Accepted: March 08, 2016 Published: March 13, 2016
Citation: Ilori TO, Pinnaka J, Kats M, Niyyar VD (2016) The Arteriovenous Fistula: An Often Overlooked Precipitant of High Output Heart Failure. J Clin Case Rep 6:751. doi:10.4172/2165-7920.1000751
Copyright: © 2016 Ilori TO, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Heart failure usually occurs in the setting of a low cardiac output, however in rare cases it may be associated with a high cardiac output. We present a rare and intriguing case of a patient with end-stage renal disease (ESRD) on hemodialysis that developed high output heart failure from his arteriovenous fistula (AVF). A 36 year old African American male with ESRD secondary to hypertension, on hemodialysis for six years, presented to emergency room with a history of chest pain and shortness of breath. He was diagnosed with congestive heart failure secondary to coronary artery disease. His transthoracic echo showed an ejection fraction of 65% and both the stress test and cardiac enzymes were negative for ischemia. Further workup revealed a cardiac output of 10.6 L/min and access flow of 2.37 L/min. We made a diagnosis of high output heart failure secondary to the AVF. He was taken to surgery for a minimally invasive limited ligation endoluminal-assisted revision (MILLER) procedure after which his symptoms resolved. High output heart failure, though a rare complication of AVF placement is an important differential in hemodialysis patients who present with symptoms of congestive heart failure. An accurate diagnosis will prevent morbidity and unnecessary hospital admissions.

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