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May 15, 1981

Arteriovenous Fistula Masquerading as Valvular Heart Disease

Author Affiliations

From the Department of Surgery and the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, Mass; and the Department of Medicine, Burbank Hospital, Fitchburg, Mass.

JAMA. 1981;245(19):1936-1937. doi:10.1001/jama.1981.03310440036020

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