Episode 221: High-Output Heart Failure

High-output heart failure, a physiological paradox where a patient is drowning in fluid yet their heart is pumping vigorously, is explored. Dr. Nico Gonzalez joins the discussion to explain how this condition differs from typical heart failure, focusing on the normal cardiac function coupled with decreased systemic vascular resistance. The discussion covers the differential diagnosis, distinguishing between increased metabolic demand (as seen in hyperthyroidism and myeloproliferative disorders) and peripheral vascular changes (like cirrhosis or AV fistulas). The Nicolodony-Brahman sign is presented as a bedside test to confirm the contribution of AV fistulas to cardiac workload. Management strategies, including aggressive diuresis and addressing the underlying cause, are also discussed, with a caution against using nitro due to the already low SVR state.