Step II AV fistula

[Oblique]

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This is an AV fistula case in NMS surgery casebook. Can some please help explain the pathophysiology behind this case?
How does an AV fistula cause the following: bilateral rales, jugular venous distention, systolic ejection murmur, and S3 gallop.

I am assuming a left heart failure from high cardiac output failure causing pulmonary congestion (rales), right heart failure (JVD), stiff/hypertrophic left ventricular wall (S3). Please correct me if my thought process is wrong. I still don't know what causes the systolic ejection murmur.

Thanks in advance.

 

[Instatewaiter]

High output heart failure

 

[Instatewaiter]

High output heart failure

Murmur comes from the increased flow, similar to how anemia will cause a murmur

 

[Jabbed]

View attachment 190255
This is an AV fistula case in NMS surgery casebook. Can some please help explain the pathophysiology behind this case?
How does an AV fistula cause the following: bilateral rales, jugular venous distention, systolic ejection murmur, and S3 gallop.

I am assuming a left heart failure from high cardiac output failure causing pulmonary congestion (rales), right heart failure (JVD), stiff/hypertrophic left ventricular wall (S3). Please correct me if my thought process is wrong. I still don't know what causes the systolic ejection murmur.

Thanks in advance.

Not sure if you figured it out already, but the hyperdynamic circulation can cause a mid-systolic ejection murmur across the semilunar valves that is purely related to flow rate.

 

[Oblique]

Thank you for the responses. It makes sense now