High-output cardiac failure is a less common form of heart failure, and although it may sound contradictory at first, in the simplest form, it is still the heart's inability to provide sufficient blood for the body’s demand. Most patients with heart failure are either classified as a systolic or diastolic dysfunction with increased systemic vascular resistance, however, patients with high output cardiac failure have normal cardiac function and decreased systemic vascular resistance, either secondary to diffuse arteriolar dilation or possible bypass of the arterioles and capillary beds, leading to activation of neurohormones. The problem lies with an increase in the body’s demand for perfusion that the heart is not able to provide, even with a normal cardiac function. In terms of cardiac output, a high cardiac output state is defined as a resting cardiac output greater than 8 L/min or a cardiac index of greater than 4.0/min/m2 , and heart failure occurs when that cardiac output is insufficient to supply the demand. High-output cardiac failure is more of a consequence of an underlying disease process. The underlying etiology of this type of cardiac failure largely dictates the presenting symptoms and signs, evaluation, and treatment.
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