JAMA. 1963;185(12):964. doi:10.1001/jama.1963.03060120074029.
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When signs of cardiac failure recently appeared in a 44-year-old housewife who had no history of heart disease, it was hypothesized that the patient's psoriasis was responsible for the cardiovascular findings.1 Large confluent areas of psoriasis on the limbs and trunk were bright red and hot. The patient's hands were warm and capillary pulsations were observed in the fingers. These findings, together with tachycardia, elevated venous pressure, and hepatomegaly, suggested high-output heart failure. The supposition that the skin lesions initiated hemodynamic abnormalities was verified in subsequent weeks when physical signs of cardiac failure regressed as the rash disappeared. Shuster 1 has described similar findings in four other patients. A full or collapsing pulse with increased pulse pressure, edematous but warm extremities, tachycardia, and elevated venous pressure were found in each instance, and there was amelioration of cardiac failure coincident with improvement of the skin disease. Increased blood flow through


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