Arteriovenous Fistula Masquerading as Valvular Heart Disease

Nancy L. Cantelmo, MD; Joseph S. Alpert, MD; Bruce S. Cutler, MD; Joel S. Neuschatz, MD; Luis Romero, MD; Ira S. Ockene, MD
JAMA. 1981;245(19):1936-1937. doi:10.1001/jama.1981.03310440036020.
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ARTERIOVENOUS (AV) fistula in a patient after laminectomy is a well-recognized cause of congestive heart failure.1,2

In most patients with this surgical complication, the clinical syndrome of high-output heart failure is recognized and the diagnosis made without difficulty. We recently cared for a woman with this condition in whom the diagnosis of AV fistula was not made despite examination by numerous physicians. The patient had a loud systolic murmur, which misled her physicians into thinking that severe, acute mitral regurgitation was the cause of her heart failure.

Report of a Case  A 54-year-old woman with no history of cardiac problems reported having seven months of dyspnea on exertion, ankle swelling, and weight gain.The patient had undergone a lumbar laminectomy at the L5-S1 level six years previously. On physical examination, blood pressure was 150/55 mm Hg; there was no jugular venous distention. The point of maximal impulse was in


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