Ver el código de «High-output heart failure»

==Background==
*High-output heart failure occurs when cardiac output is elevated but cannot meet the body's increased metabolic demands
*Unlike typical heart failure, the heart itself may be structurally normal initially
*Extremities are typically warm and well-perfused (distinguishing feature from low-output heart failure)
*Can progress to low-output failure if untreated

==Clinical Features==
*Dyspnea, fatigue, exercise intolerance
*Warm, well-perfused extremities (unlike cold/clammy in low-output failure)
*Bounding pulse with wide pulse pressure
*Peripheral edema, pulmonary congestion
*May have signs of underlying cause (goiter, AV fistula bruit, pallor)

==Differential Diagnosis==
{{Template:High-output heart failure DDX}}

===Common Causes===
*Severe [[anemia]] (Hgb <5-7 g/dL)
*[[Hyperthyroidism]] / [[thyroid storm]]
*AV fistula (dialysis access, traumatic, congenital)
*[[Sepsis]]
*Paget's disease of bone
*[[Thiamine]] deficiency (wet [[beriberi]])
*Pregnancy
*Cirrhosis
*Morbid obesity

==Evaluation==
*[[CBC]]: anemia
*[[TSH]]: hyperthyroidism
*[[BNP]]: elevated (not as reliable for distinguishing high vs. low output)
*[[Thiamine]] level if suspected deficiency (alcoholism, malnutrition)
*[[ECG]]: tachycardia, may show strain pattern
*[[CXR]]: cardiomegaly, pulmonary congestion
*[[Echocardiography]]: elevated EF (early), dilated chambers; eventually may show reduced EF
*Assess for AV fistula bruit (dialysis patients)

==Management==
*Treat underlying cause — this is definitive management
**Anemia: transfuse
**Hyperthyroidism: beta-blockers, antithyroid medications
**Sepsis: antibiotics, source control
**Thiamine deficiency: IV [[thiamine]] 500 mg before glucose
**AV fistula: may need ligation if causing heart failure
*Standard heart failure management for acute symptoms: diuretics for congestion, oxygen
*Avoid excessive volume removal in AV fistula-related heart failure

==Disposition==
*Admit: new diagnosis of heart failure, hemodynamic compromise, severe underlying cause (thyroid storm, sepsis, severe anemia)
*Discharge: mild symptoms with correctable cause identified and treated (e.g., anemia transfused, thyroid medication adjusted) with close follow-up

==See Also==
*[[Congestive heart failure]]
*[[Hyperthyroidism]]
*[[Anemia]]
*[[Beriberi]]

==References==
<references/>

[[Category:Cardiology]]