nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-444Research ArticleШКОЛА НЕФРОЛОГАEDUCATIONAL MATERIALSСердечная недостаточность с высоким сердечным выбросом у пациентки на программном гемодиализе (Наблюдение из практики и краткий обзор литературы)High-output heart failure in a hemodialysis patient (Case Study and Short Review)Зелтынь-АбрамовЕ. М.Zeltyn-AbramovE. M.ezeltyn@mail.ruКотенкоО. Н.KotenkoO. N.noemail@neicon.ruАндрусевА. М.AndrusevA. M.noemail@neicon.ruИсхаковР. Т.IskhakovR. T.noemail@neicon.ruВарясинВ. В.VaryasinV. V.noemail@neicon.ruПодкорытоваО. Л.PodkorytovaO. L.noemail@neicon.ruБелавинаН. И.BelavinaN. I.noemail@neicon.ruЖуковаМ. Е.ZhukovaM. E.noemail@neicon.ruФДПО ГБОУ ВПО РНИМУ им. Н.И. Пирогова МЗ РФ; ГБУЗ «ГКБ №52 Департамента здравоохранения г. Москвы»РоссияPirogov Russian National Research Medical University (RNRMU); Moscow City Hospital 52Russian FederationГБУЗ «ГКБ №52 Департамента здравоохранения г. Москвы»РоссияMoscow City Hospital 52Russian FederationГБОУ ВПО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова»; ГБУЗ «ГКБ №52 Департамента здравоохранения г. Москвы»РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry; Moscow City Hospital 52Russian Federation201619082024183319327Copyright © Зелтынь-Абрамов Е.М., Котенко О.Н., Андрусев А.М., Исхаков Р.Т., Варясин В.В., Подкорытова О.Л., Белавина Н.И., Жукова М.Е., 20242024Зелтынь-Абрамов Е.М., Котенко О.Н., Андрусев А.М., Исхаков Р.Т., Варясин В.В., Подкорытова О.Л., Белавина Н.И., Жукова М.Е.Zeltyn-Abramov E.M., Kotenko O.N., Andrusev A.M., Iskhakov R.T., Varyasin V.V., Podkorytova O.L., Belavina N.I., Zhukova M.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/444

В статье представлен краткий обзор литературы по проблеме сердечной недостаточности с высоким сердечным выбросом (СНВВ) у пациентов с функционирующей артериовенозной фистулой (АВФ), находящихся на программном гемодиализе. Обсуждаются возможные механизмы влияния АВФ на ключевые параметры центральной гемодинамики, а также их роль в формировании симптомокомплекса СНВВ. Отмечается, что распространенность СНВВ в диализной популяции в настоящее время существенно недооценена. Представлен клинический случай развития СНВВ у пациентки с повторно сформированной АВФ с избыточным фистульным кровотоком, внезапно скончавшейся от фибрилляции желудочков. Авторами предложен алгоритм постановки диагноза СНВВ. В качестве метода окончательной верификации диагноза рассматривается зондирование правых отделов сердца с проведением временной окклюзии АВФ. В статье приводятся результаты патологоанатомического исследования, подтверждающие точку зрения, что СНВВ не является самостоятельным заболеванием сердца, развивающимся на фоне диализ-потребной хронической болезни почек, а представляет собой потенциально обратимый патофизиологический феномен.

The article represents brief literature review of the problem of high-output heart failure (HOHF) in patients on maintenance hemodialysis (HD) with arteriovenous fistula (AVF) as dialysis access. The possible mechanisms of AVF influence on central hemodynamic parameters and the role of these mechanisms in formation of HOHF are of broad interest. HOHF is usually an under-diagnosed condition in the dialysis population and its real incidence is underestimated. We present here a case of HOHF in a patient on maintenance HD. The signs of HOHF developed after formation of AVF with excessive flow formation. The patient suddenly died from ventricular fibrillation. A procedure of HOHF diagnostics, which include catheterization of right heart accompanied by temporary AVF occlusion is proposed. Autopsy report confirmed the suggestion that HOHF is not an independent heart disease in patients on MHD, but potentially reversible pathophysiological phenomenon.

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The authors declare that there are no conflicts of interest present.