High-Output Heart Failure Associated With Arteriovenous Fistula

BACKGROUND: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis, but they can cause high-output heart failure (HOHF) by imposing significant hemodynamic stress. Despite its clinical significance, AVF-related HOHF remains under-recognized in hemodialysis patients. CASE SUMMARY: during manual AVF compression. Two AVF flow-reduction procedures resulted in a reduction in left ventricular size and symptomatic improvement. DISCUSSION: This case highlights the need to consider HOHF in hemodialysis patients presenting with unexplained heart failure. Hemodynamic assessment-echocardiography or cardiac catheterization with AVF compression-can confirm the diagnosis and guide management. TAKE-HOME MESSAGE: In suspected AVF-related HOHF, echocardiography with transient AVF flow reduction during hemodynamic testing can reverse the high-output state and support the diagnosis.