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In Paget's disease, the extensive bone turnover underlies an increase in blood flow. The increased vascularity in pagetic bone can lead to the development of an AV shunt and this is what leads to the high ouput cardiac failure. If you think about Paget's it's defined by excessive and disorganized bone remodeling, so as a consequence you can end up with small arteriovenous fistulas in the vascularity of the involved bone that eventually amount to an AV shunt.
 
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MudPhud20XX

MudPhud20XX

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In Paget's disease, the extensive bone turnover underlies an increase in blood flow. The increased vascularity in pagetic bone can lead to the development of an AV shunt and this is what leads to the high ouput cardiac failure. If you think about Paget's it's defined by excessive and disorganized bone remodeling, so as a consequence you can end up with small arteriovenous fistulas in the vascularity of the involved bone that eventually amount to an AV shunt.
Ah... thanks! So this is another quesiton. A high-put HF is basically your heart is fine but it's not pumping well enough to oxygenate the blood such is in AV shunt? Is that the def of high-put HF? In what other pathology would you see high-put HF?
 

dfib slim

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Ah... thanks! So this is another quesiton. A high-put HF is basically your heart is fine but it's not pumping well enough to oxygenate the blood such is in AV shunt? Is that the def of high-put HF? In what other pathology would you see high-put HF?
It's like your heart is working on overdrive to meet the increased demand for blood flow and eventually it burns out. You see it classically in hyperthyroidism, beriberi, anemia, or an AV fistula caused by trauma, like a healed knife wound, or dialysis shunt.
 

Jabbed

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Decreased after load and increased venous return = increased cardiac output at the expense of increased oxygen/energy consumption. Bonus points: what murmur would you hear in a Paget's patient with compensated HF?
 
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MudPhud20XX

MudPhud20XX

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So you will hear systolic murmurs right?

Or S3? like in CHF?
 
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