Thank you to Dr. Thetford for presenting a rare case of TIPS induced high output heart failure.

A few take away points:

• HOHF is a rare form of heart failure caused by increased CO and decreased SVR
• Common causes:
  • Obesity, liver disease, AV shunts, lung disease, myeloproliferative disorders, severe anemia
• In this patient, an oversized TIPS increased venous return from the splanchnic system leading to elevated CO and low SVR
• Physical exam pearl from the faculty:
  • When differentiating between cardiac vs cirrhosis etiology of volume overload, make sure to assess JVP. In cirrhosis, expect a non-elevated JVP as there is lower intravascular volume.