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QJM Advance Access originally published online on December 12, 2006
QJM 2007 100(2):139; doi:10.1093/qjmed/hcl127
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© The Author 2006. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

An uncommon cause of heart failure

Dr. A.C. Church and Dr. T. Quinnell

Papworth Hospital, Papworth Everard, UK. email: colinchurch{at}doctors.org.uk

This 64-year-old woman with a background of hereditary haemorrhagic telangiectasia (HHT) presented with increasing dyspnoea over a few months. A chest radiograph (a) showed a right-sided pleural effusion, which was drained and found to be a transudate. A CT scan revealed multiple large hepatic arteriovenous malformations (AVM) (b). An echocardiogram demonstrated normal ventricular function. Haemoglobin and serum albumin were normal. Liver function tests revealed a cholestatic picture.

High-output cardiac failure is a recognized complication of HHT. It results from the hyperdynamic circulation induced by left-to-right shunting through AVMs, in this case hepatic. Arteriovenous malformations are seen in 8–31% of cases, and can also lead to portal hypertension and biliary obstruction. Treatment is generally conservative unless the liver disease becomes severe enough for liver transplantation to be considered. Arterial embolization has been advocated as a treatment, but recent experience suggests this can lead to severe hepatic necrosis.

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
100/2/139    most recent
hcl127v1
Right arrow Alert me when this article is cited
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Right arrow Articles by Church, A.C.
Right arrow Articles by Quinnell, T.
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PubMed
Right arrow PubMed Citation
Right arrow Articles by Church, A.C.
Right arrow Articles by Quinnell, T.
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