High-output heart failure from AV fistula

Background

• High-output heart failure that occurs when >20% of cardiac output is diverted through the dialysis access

Clinical Features

• Branham sign (drop in HR after temporary access occlusion) is diagnostic

Differential Diagnosis

AV Fistula Complications

• Clotting of AV fistula
• Infection of AV fistula
• Hemorrhage of AV fistula
• Vascular insufficiency from AV fistula
• AV fistula aneurysm/pseudoaneurysm
• High-output heart failure from AV fistula

High-output heart failure

• Hyperthyroidism
• Beriberi
• High-output heart failure from AV fistula
• AVM
• Paget disease
• Anemia
• Pregnancy

Workup

• Doppler ultrasound can accurately measure access flow rate and establish the diagnosis

Management

• Surgical banding of the access

Disposition

• Admit

See Also

• Dialysis complications