A variety of vascular disorders can lead to high-output heart failure. A patient who has unexplained intractable heart failure should be evaluated for an occult vascular lesion.


Patient selection: high-output heart failure


Criteria for diagnosis:

(1) presence of an implicated vascular disorder (see below)

(2) exclusion of alternative explanation(s)

(3) correction of heart failure by correction of vascular disorder


Vascular disorders associated with high-output heart failure:

(1) hereditary or acquired arteriovenous fistula (hepatic, renal, aortic, post-traumatic, other)

(2) giant hemangioma

(3) multiple hemangiomas

(4) large hemangioendothelioma


Associated complications may include:

(1) Kasabach-Merritt syndrome

(2) other organ failures


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