MANAGEMENT OF HEART FAILURE OF MIXED ETIOLOGIES: ISCHEMIC CARDIOMYOPATHY AND A RELATIVELY HIGH OUTPUT STATE

Background Patients with ischemic cardiomyopathy from multi vessel coronary artery disease (CAD) benefit from surgical revascularization to improve cardiac function, but the optimal management strategy becomes uncertain when they also have high-output heart failure from an arteriovenous fistula (AVF). After discussing the case with both interventional cardiologists and the surgical teams, the decision was made to revascularize him first to improve cardiac function and contractile reserve prior to a fistula revision, since the sudden increase in systemic vascular resistance from this procedure may worsen his condition.