High-Output Heart Failure: Symptoms, Causes, and Recovery Outlook
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
High-output heart failure is a form of heart failure in which the heart pumps about 8 liters of blood per minute, compared with a normal 5 to 6 liters. It is triggered by conditions that widen the blood vessels too much, most commonly a BMI higher than 30. Symptoms include shortness of breath and swelling, and it can be reversible. [1]
What the research says
Obesity, liver disease and shunts lead the causes, and mortality is higher than in controls. In a Mayo Clinic analysis of 120 patients with high-output heart failure (2000 to 2014), the most common causes were obesity (31%), liver disease (23%), arteriovenous shunts (23%), lung disease (16%) and myeloproliferative disorders (8%). Compared with similar controls, mortality was higher (hazard ratio 3.4; 95% CI 1.6 to 7.6), and outcomes were poorest in patients with the lowest systemic vascular resistance. (Reddy et al., J Am Coll Cardiol, 2016)
It is rare, and in-hospital survival was similar to other heart failure. Among 5,080,985 U.S. heart failure hospitalizations (2017 to 2019), 3,897 were high-output heart failure (0.07%). Common associated causes were lung disease (19.8%), morbid obesity (9.9%), sepsis (9.6%) and cirrhosis (8.9%). Mortality was similar to heart failure with reduced ejection fraction (4.3% vs 5.2%), and 30-day readmission was lower (5.7% vs 21.2%). (Uddin et al., Hellenic J Cardiol, 2023)
Obesity-related cases follow standard heart failure care. A 2021 review notes that morbid obesity remains the most common cause of high-output failure, and that with no specific recommendations, management follows conventional heart failure regimens. (Shen et al., Int J Heart Fail, 2021)
What Is High-Output Heart Failure?
High-output heart failure is a condition in which your heart is initially working normally, usually with a normal (preserved) ejection fraction, but cannot keep up with your body's increasing need for more blood. Your heart ultimately becomes weak and can no longer pump blood effectively throughout your body. [1]
Why Is It Called High-Output?
High cardiac output sets this type apart. With most types of heart failure, cardiac output is normal or lower than normal. People with high-output heart failure have a cardiac output of about 8 liters of blood per minute. A normal cardiac output is 5 to 6 liters per minute. [1]
How Common Is It?
Various types of heart failure affect about 6 million people in the U.S. High-output heart failure is much less common. In one study, it made up only 0.07% of medical visits for heart failure. [1]
What Causes High-Output Heart Failure?
Causes of high-output heart failure include: [1]
A BMI higher than 30, which is the most common cause
Liver disease, such as cirrhosis
Arteriovenous fistulas or shunts
Severe anemia
Lung disease
Sepsis
Hyperthyroidism
Rare blood cancers
The risk factors are the conditions that cause it. [1]
What Happens in the Body
Certain medical conditions can make your blood vessels widen too much (vasodilation), which sets off a chain of events leading to higher cardiac output. Higher output can be a good thing during exercise, but this is different because it is not a healthy cause. [1]
Your body may need more blood because it is using more oxygen than normal, or because blood is going around your smallest arteries (arterioles) instead of into them. This sends more blood into your veins, which carry blood back to your heart instead of out to your body, and your body does not get the blood it needs. [1]
What are the symptoms of high-output heart failure?
Symptoms are similar to other types of heart failure. They may include: [1]
Shortness of breath that gets worse when you are on your back
Fatigue
Swelling
Heart palpitations
Fast heart rhythm (tachycardia)
Possible Complications
Pulmonary hypertension
Systolic heart failure
Swelling in the legs
How Is It Diagnosed?
A healthcare provider will give you a physical exam and ask about your medical history, especially any long-term conditions that may be causing it. Tests may include: [1]
Blood tests to check thyroid hormones, hemoglobin, and liver and kidney function
A blood natriuretic peptide test
An electrocardiogram (EKG)
A transthoracic echocardiogram
Cardiac catheterization
A computed tomography (CT) scan
A heart MRI
How Is It Treated?
A provider will first help you breathe better, relieve swelling and make sure you are stable. After that, they address the condition that caused the heart failure. Identifying the cause matters because treatments differ by condition, and treating the cause can improve or resolve high-output heart failure. [1]
In addition to oxygen, you may receive diuretics, inotropes and other medicines specific to the cause. These medicines may cause headaches, dizziness, upset stomach, abnormal heart rhythms, or high or low blood pressure. Diuretics can relieve swelling within an hour or two, but you still need long-term treatment for the cause. [1]
What is the outlook for living with high-output heart failure?
You need an accurate diagnosis of the cause to treat this condition. It lasts as long as the untreated condition causing it, and it can be reversible, depending on the cause. [1]
The outlook varies greatly with the cause. One study showed that people with a BMI above 30 had better five-year survival than those with liver disease. A prompt diagnosis and swift treatment of the cause improve survival. [1]
Follow your provider's instructions for the medicines or other treatment for the condition that caused it.
A provider may ask you to eat foods low in sodium and reduce your fluid intake.
Expect frequent follow-ups for the first month after you go home from the hospital.
To lower your risk, talk to your provider about treating conditions that raise your body's demand for blood, such as a BMI higher than 30, hyperthyroidism, and lung and liver diseases.
Conclusion
High-output heart failure shows that a heart can fail even when it pumps more blood than normal. Because the cause decides the treatment, giving your provider a complete medical history is the most useful step you can take. With the cause treated, many people improve.
Looking for clear answers on tough health questions? Browse plain-language health guides at Rinnit.com.
Frequently Asked Questions
Is high-output heart failure common?
No. It is much less common than other types of heart failure. In one study it made up only 0.07% of medical visits for heart failure. [1]
How is it different from other heart failure?
With most types of heart failure, cardiac output is normal or lower than normal. In high-output heart failure it is about 8 liters per minute or more, yet the heart still cannot meet the body's demand for blood. [1]
What is the most common cause?
A BMI higher than 30 is the most common cause listed by Cleveland Clinic. [1]
Can high-output heart failure be reversed?
Yes, it can be reversible, depending on the cause. [1]
Can severe anemia cause it?
Yes. Severe anemia is one of the listed causes. Treatments differ by condition, so finding and treating the cause is essential. [1]
What do diuretics do?
Diuretics can relieve swelling within an hour or two. You still need long-term treatment for the cause of the heart failure. [1]
What is an arteriovenous fistula?
An arteriovenous fistula is an abnormal connection between an artery and a vein, and it is one possible cause. Blood can go around the smallest arteries instead of into them, so more blood returns to the heart. [1]
What is the ejection fraction in this condition?
The ejection fraction is usually normal (preserved): the heart pumps more blood than usual but still cannot meet the body's demand. [1]
Should I limit salt and fluids?
A healthcare provider may ask you to eat foods low in sodium and to reduce your fluid intake. [1]
How long does it last?
High-output heart failure lasts as long as the untreated condition that causes it. [1]
Can sepsis cause it?
Yes. Sepsis is one of the listed causes. [1]
What can happen if the cause is not treated?
High-output heart failure can lead to pulmonary hypertension, systolic heart failure and swelling in the legs. A prompt diagnosis and swift treatment of the cause improve survival. [1]
Related Reading
Cardiac Output: What It Is, Normal Range, How It's Measured and What Affects It explains how providers measure how much blood the heart pumps each minute.
References
Cleveland Clinic. High-Output Heart Failure. Cleveland Clinic. Last updated January 31, 2023. https://my.clevelandclinic.org/health/diseases/24660-high-output-heart-failure
Reddy YNV, Melenovsky V, Redfield MM, et al. High-Output Heart Failure: A 15-Year Experience. J Am Coll Cardiol. 2016;68(5):473-482. PMID 27470455. https://doi.org/10.1016/j.jacc.2016.05.043
Uddin MM, Mir T, Briasoulis A, et al. Clinical outcomes and 30-day readmissions associated with high-output heart failure. Hellenic J Cardiol. 2023;69:24-30. PMID 36273803. https://doi.org/10.1016/j.hjc.2022.10.004
Shen Q, Hiebert JB, Rahman FK, et al. Understanding Obesity-Related High Output Heart Failure and Its Implications. Int J Heart Fail. 2021;3(3):160-171. PMID 36262639. https://doi.org/10.36628/ijhf.2020.0047
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have about a medical condition. Never disregard professional medical advice or delay seeking care because of something you have read here. If you think you may have a medical emergency, call your doctor or emergency services immediately.
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