Document Detail

Worsening of nose bleeding heralds high cardiac output state in hereditary hemorrhagic telangiectasia.
MedLine Citation:
PMID:  19635281     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hereditary hemorrhagic telangiectasia is characterized by arteriovenous malformations or telangiectasias in multiple organs. Nose bleeding is the most common manifestation of hereditary hemorrhagic telangiectasia and can be debilitating. Cardiac involvement in the form of high-output cardiac failure is a poorly studied complication of hereditary hemorrhagic telangiectasia. The objective of this study is to describe the natural history of high-output cardiac failure in hereditary hemorrhagic telangiectasia and define the relation between bleeding complications and high-output cardiac failure. METHODS: In this case-control study at the Washington University hereditary hemorrhagic telangiectasia center, all patients evaluated for hereditary hemorrhagic telangiectasia and found to have high cardiac output between 1999 and 2006 were enrolled as cases (n = 17) and compared with 17 hereditary hemorrhagic telangiectasia controls without high-output cardiac failure. RESULTS: During lifetime, cases needed more transfusions, emergency department visits, and hospital admission for nose bleeding. Cases experienced significant worsening of nose bleeding immediately before heart failure diagnosis. During the 2 years before study-related evaluation, 16 (94%) cases needed transfusions every month as compared with 2 (12%) controls (P <.001). The number of transfusions required during these 2 years also was higher in cases (median 3, range 0-12) as compared with controls (median 0, range 0-1.5, P <.001). CONCLUSIONS: Hereditary hemorrhagic telangiectasia patients with high-output cardiac failure have significantly greater nose bleeding as compared with patients without high-output cardiac failure. In addition, nose bleeding worsens around the time of development of high-output cardiac failure. Early recognition of the relationship between severe nose bleeding and high-output cardiac failure can lead to earlier diagnosis and provide an opportunity for earlier institution of therapy for high-output cardiac failure.
Sakib K Khalid; James Pershbacher; Majesh Makan; Benico Barzilai; Daniel Goodenberger
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  122     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-28     Completed Date:  2009-08-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  779.e1-9     Citation Subset:  AIM; IM    
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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MeSH Terms
Aged, 80 and over
Arteriovenous Malformations / complications,  pathology
Cardiac Output, High / diagnosis*,  etiology,  physiopathology
Case-Control Studies
Epistaxis / etiology*
Heart Catheterization
Middle Aged
Telangiectasia, Hereditary Hemorrhagic / complications*,  physiopathology
Ventricular Function, Right

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