APCU25CR30 Hypoxemia in heart failure: diagnosing and managing pulmonary arteriovenous malformation

Introduction The coexistence of Heart Failure and Pulmonary Arteriovenous Malformations (PAVMs) presents a unique diagnostic and therapeutic challenge. PAVMs, abnormal vascular connections leading to right-to-left shunting, often cause chronic hypoxaemia that standard Heart Failure treatments may not effectively address. This complexity necessitates a multidisciplinary approach to ensure proper diagnosis and management.Case Presentation A 66-year-old male with a history of Ischaemic Heart Disease (IHD) and Heart Failure presented with worsening breathlessness and persistent hypoxaemia. Despite standard Heart Failure treatment, his symptoms persisted. Further diagnostic workup using CT angiography revealed a Pulmonary Arteriovenous Malformation (PAVM) in the right lower lobe, complicating his clinical picture. The case was discussed in a multidisciplinary team meeting, where it was decided that the risks of transcatheter embolisation outweighed the potential benefits due to the patient’s significant comorbidities.Discussion Hypoxaemia is a common complication in Heart Failure patients and can be exacerbated by the presence of Pulmonary Arteriovenous Malformations (PAVMs), which are abnormal connections between pulmonary arteries and veins that bypass the capillary beds. Diagnosing PAVMs in these patients is challenging due to the overlap of symptoms with other respiratory conditions, but thorough clinical assessment and advanced diagnostic tests like contrast echocardiography and CT angiography are crucial for identification. Management typically involves supplemental oxygen therapy and, in severe cases, transcatheter embolisation or surgical resection to restore normal oxygenation. Additionally, effective treatment of the underlying Heart Failure and multidisciplinary care, including vigilant nursing, is essential for improving patient outcomes.Conclusion The presence of PAVMs in Heart Failure patients requires careful consideration in the differential diagnosis of persistent hypoxaemia. A multidisciplinary approach is essential for managing these coexisting conditions effectively, with a focus on accurate diagnosis and tailored treatment strategies to improve patient outcomes.