Low Output Heart Failure

Low-output heart failure represents a high-acuity, heterogeneous physiologic state marked by end-organ hypoperfusion and substantial morbidity and mortality. The clinical symptoms and exam findings vary widely, and it may manifest subtly with non-specific features of fatigue or sinus tachycardia, or present dramatically with altered sensorium, marked hypotension, and multi-organ failure. The diverse presentation of low-output heart failure highlights the importance of its prompt recognition and subsequent risk stratification. Treatment goals are focused on initial stabilization of systemic blood pressure and improved tissue and end-organ perfusion, and may be achieved through a combination of veno- and vasodilators, inotropic agents, and in severe cases, mechanical circulatory support. The following case presentation illustrates the complex findings seen in low-output heart failure, and offers a systematic approach to its evaluation and management.