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SKIN DISEASE AND HEART FAILURE

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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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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