Paget’s Disease and High-output Cardiac Heart Failure

Paget’s disease of the bone (accelerated bone turnover and remodeling, resulting in impaired bone integrity and overgrowth) is one of the rare causes of high-output cardiac heart failure.

WHY? It causes extensive hyper vascularization of the bone marrow.  This can cause arteriovenous shunting and lower peripheral vascular resistance. Significant bone involvement (>15%) may lead to heart failure.

REFERENCES

1. Heistad DD, Abboud FM, Schmid PG, Mark AL, Wilson WR. Regulation of blood flow in Paget’s disease of bone. J Clin Invest 1975;55:69-74.
2. Arnalich F, Plaza I, Sobrino JA, Oliver J, Barbado J, Pena JM, et al. Cardiac size and function in Paget’s disease of bone. Int J Cardiol 1984;5:491-505.
3. Schneider D, Hofmann MT, Peterson JA. Diagnosis and treatment of Paget’s disease of bone. Am Fam Physician. 2002 May 15;65(10):2069-72.