Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jul 28;7(8):ytad360.
doi: 10.1093/ehjcr/ytad360. eCollection 2023 Aug.

A case report of high-output heart failure due to arteriovenous shunt without bowel: how to address?

Zarina Habibi  1   2 , Johanna Abma-Kramer  1   3 , Hans-Peter Brunner-La Rocca  1
Affiliations
Case Reports

A case report of high-output heart failure due to arteriovenous shunt without bowel: how to address?

Zarina Habibi et al. Eur Heart J Case Rep. .

Abstract

Background: High-output heart failure (HF) is a form of HF where patients present with a high-output state with low systemic vascular resistance. This report presents the case of high-output HF in a patient with an arteriovenous shunt and no options for oral-administered drugs.

Case summary: A 70-year-old male with a terminal jejunostomy fully depending on parenteral feeding through a vena saphena magna shunt presented with symptoms of shortness of breath. Echocardiography revealed eccentric hypertrophy with reduced left ventricular ejection fraction (LVEF) and atrial fibrillation with a heart rate of 70-100 b.p.m. Cardiac magnetic resonance imaging, endomyocardial biopsy, and cardiomyopathy lab revealed no cause of HF. High-output HF based on right heart catheterization due to the arteriovenous shunt or related to irregularity due to atrial fibrillation were potential causes. As a result of his malfunctioning gastrointestinal system, the pharmacological options were limited. He was treated with captopril sublingual, initially 6.25 mg three times daily (TID) and later 12.5 mg TID, which reduced blood pressure. Electrical cardioversion to sinus rhythm was successful but did not improve LVEF. Therefore, the patient was opted for surgically reducing the blood flow through the shunt, resulting in normalization of LVEF.

Discussion: High-output HF is an uncommon form of HF with an uncertain prevalence. The most common aetiologies reported in the literature are obesity, cirrhosis, and arteriovenous shunts. Sublingual administration of captopril can be an effective treatment option for HF patients unable to absorb oral-administered drugs.

Keywords: Arteriovenous shunt; Captopril—sublingual administration; Case report; High-output heart failure; Short-bowel syndrome.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
X-ray from the procedure when the vena saphena magna shunt was first installed in 2009.
Figure 2
Figure 2
Late gadolinium enhancement image in the short-axis view (A) and four-chamber view (B) showing no focal fibrosis.
See this image and copyright information in PMC

References

    1. Reddy YNV, Melenovsky V, Redfield MM, Nishimura RA, Borlaug BA. High-output heart failure: a 15-year experience. J Am Coll Cardiol 2016;68:473–482. - PubMed
    1. Givertz M. Clinical manifestations, diagnosis, and management of high-output heart failure 2020 [updated April 6th, 2020. Available from: https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-....
    1. Kotecha D, Holmes J, Krum H, Altman DG, Manzano L, Cleland JG, et al. . Efficacy of beta blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014:384:2235–2243. - PubMed
    1. Shen Q, Hiebert J, Rahman F, Kreuger K, Gupta B, Pierce J. Understanding obesity-related high output heart failure and its implications. Int J Heart Fail 2021;3:160–171. - PMC - PubMed
    1. Shin WJ, Song JG, Jun IG, Moon YJ, Kwon HM, Jung K, et al. . Effect of ventriculo-arterial coupling on transplant outcomes in cirrhotics: analysis of pressure-volume curve relations. J Hepatol 2017;66:328–337. - PubMed

Publication types

LinkOut - more resources