High-Output Heart Failure

High-output heart failure is a rare type of heart failure that doesn’t have the low blood output of the other types. But like the others, it’s a condition in which your heart can’t pump enough blood to meet your body’s demand for it. Finding the cause quickly is important so you can get the treatment specific to that cause. Outlook varies by cause.


What is high-output heart failure?

High-output heart failure is a condition in which your heart is initially working normally (either with reduced or preserved ejection fraction) but can’t keep up with your body’s increasing need for more blood. Your heart ultimately becomes weak and can no longer pump blood effectively throughout your body.

Why is it called high-output heart failure?

High cardiac output sets high-output heart failure apart from the other types of heart failure. With most types of heart failure, cardiac output is normal or lower than normal. People with high-output heart failure have a cardiac output of 8 liters (about 2 gallons) of blood per minute. A normal cardiac output is 5 to 6 liters (1.3 to 1.6 gallons) of blood per minute.

How common is high-output heart failure?

Various types of heart failure affect about 6 million people in the U.S. High-output heart failure is much less common than other types of heart failure. In one study, it made up only 0.07% of medical visits for heart failure.


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Symptoms and Causes

What are the high-output heart failure symptoms?

High-output heart failure symptoms are similar to other types of heart failure. Symptoms may include:

What causes high-output heart failure?

High-output heart failure causes include:

What happens in high-output heart failure?

Certain medical conditions can make your blood vessels widen too much (vasodilation). This sets off a chain of events leading to higher cardiac output. Higher cardiac output can be a good thing when exercise creates the need for more blood flow. But this is different because it’s not a healthy cause.

Your body may need more blood because it’s using more oxygen than normal or your blood is going around your smallest arteries (arterioles) instead of into them. This makes more blood go into your veins, which take blood back to your heart instead of out to your body. When that happens, it keeps your body from getting the blood it needs.

What are the risk factors for high-output heart failure?

Risk factors for high-output heart failure are the conditions that cause it, such as:

  • A BMI higher than 30.
  • Liver disease, such as cirrhosis.
  • Arteriovenous fistulas or shunts.
  • Severe anemia.
  • Lung disease.
  • Sepsis.
  • Hyperthyroidism.
  • Rare blood cancers.

What are the complications of high-output heart failure?

High-output heart failure can lead to:

Diagnosis and Tests

How is high-output heart failure diagnosed?

A healthcare provider will give you a physical exam. They’ll ask you about your medical history, especially any long-term conditions that may be causing high-output heart failure.

What tests will be done to diagnose high-output heart failure?

Tests to diagnose high-output heart failure may include:


Management and Treatment

How is high-output heart failure treated?

A healthcare provider will help you breathe better, relieve your swelling and make sure you’re in stable condition. After that, they can address the condition that caused your high-output heart failure.

Identifying the cause of high-output heart failure is important because treatments differ by condition. Providers use treatments specific to each condition. This, in turn, can improve or resolve high-output heart failure.

Specific medicines used

In addition to oxygen, a provider will give you:

Side effects of the treatment

High-output heart failure medicines may cause:

How soon after treatment will I feel better?

Diuretics can help relieve swelling within an hour or two. However, you still need long-term treatment for the cause of your high-output heart failure. The length of time this takes varies by condition and treatment.


How can I lower my risk of high-output heart failure?

To lower your risk of high-output heart failure, talk to your provider about treating medical conditions that increase your body’s demand for blood. These conditions include a BMI higher than 30, hyperthyroidism and lung and liver diseases.

Outlook / Prognosis

What can I expect if I have high-output heart failure?

Healthcare providers can help you manage your symptoms of high-output heart failure. However, you need an accurate diagnosis of the cause of this condition to treat it.

How long high-output heart failure lasts

High-output heart failure lasts as long as the untreated condition causing it.

Is high-output heart failure reversible?

Yes, high-output heart failure can be reversible. It depends on the cause.

Outlook for high-output heart failure

The outlook for high-output heart failure varies greatly, depending on what caused the condition. One study showed that people with a BMI above 30 had better five-year survival rates than those with liver disease, for example.

In any case, a prompt diagnosis — and swift treatment for the cause — improves survival.

Living With

How do I take care of myself?

Follow your provider’s instructions for taking medicines or getting other treatment for the condition that caused your high-output heart failure.

What can’t I eat/drink with high-output heart failure?

A healthcare provider may ask you to eat foods that are low in sodium and reduce your fluid intake.

When should I see my healthcare provider?

You may have frequent follow-ups with a healthcare provider for the first month after you go home from the hospital. Some conditions that cause high-output heart failure can lead to another hospital stay.

What questions should I ask my doctor?

Questions you can ask your provider include:

  • What condition caused my high-output heart failure?
  • What’s my prognosis?
  • How often do I need follow-up appointments with you?

A note from Cleveland Clinic

When you experience the fatigue and shortness of breath that high-output heart failure brings, you know something’s wrong. Finding the cause of it is what makes this condition tricky. Giving a complete history of your medical conditions can help healthcare providers figure out the cause and treat you promptly. Even if you don’t think a medical issue is related, mention it to your provider.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 01/31/2023.

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