High Output Heart Failure, A Lethal and Forgotten Cause of Heart Failure

Introduction Cardiac output (CO) is usually low or normal in patients with heart failure. However, some patients have a high CO deemed high-output heart failure (HOHF). HOHF is not well characterized and continues to be under-recognized clinically. At the Detroit VA, we conducted a quality improvement project to define the characteristics of this unique patient population, identify predictors and increase awareness of this entity. Methods Patients with HOHF were compared to patients with heart failure with preserved ejection fraction (HFpEF) and normal CO. HOHF was defined as CO \u3e8 L/minute on right heart catheterization performed between 2008-2021. Retrospective data regarding hemodynamics, comorbidities, and mortality were collected and compared using descriptive and univariate analyses. Results There were no significant differences in age or race between the groups or in the rate of comorbidities analyzed except for tobacco smoking and CKD which were higher in the HOHF group. Majority of the patients in the HOHF group had preserved EF (91%). Patients had a similar mean wedge pressure, but the HOHF group had significantly lower pulmonary vascular resistance and systemic vascular resistance. Mortality among patients with HOHF was 48.6% compared to the comparative group of 18.9% (p Conclusion In this single center study comparing HOHF to HFpEF, the HOHF group had significantly higher mortality compared to the HFpEF group, despite similar co-morbidities, wedge pressure and demographics. The diagnosis of HOHF was not made in majority of the cases, suggesting under recognition. We aim to create awareness of this entity among providers and highlight the need for early referral for right heart catheterization, given that HOHF can be erroneously diagnosed as HFpEF without invasive measurements. Clinical trials allocated towards management of this entity is overdue

Revisão acerca da tuberculose genitourinária com foco na insuficiência renal crônica terminal

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss.A tuberculose (TB) é um problema atual de saúde pública, persistindo como a causa mais comum de óbito por doenças infecciosas. Estudos recentes indicam que a TB genitourinária é a terceira forma mais comum de doença extra-pulmonar. O diagnóstico da TB renal pode ser suspeito na presença de cistite bacteriana não-específica associada a falha terapêutica ou com exame de urina apresentando leucocitúria persistente na ausência de bacteriúria. Relatamos o caso de um paciente de 33 anos, sexo masculino, que apresentou na admissão insuficiência renal crônica terminal secundária à TB renal, que tinha história prévia de TB pulmonar, com importantes achados radiológicos. O diagnóstico foi baseado nos achados clínicos apesar de todas as culturas terem sido negativas. Tratamento empírico com drogas tuberculostáticas foi iniciado e o paciente evoluiu estável. Foi de alta assintomático, mas sem recuperação da função renal. Ele encontra-se em hemodiálise três vezes por semana. A TB é uma causa importante de doença renal e pode levar à perda irreversível da função renal