A 37 year old patient on dialysis due to polycystic kidney disease presented wirh acute pulmonary oedema. He was experiencing worsening dyspnoea and fatigue 2 months now. The echocardiographic examination demonstrated biatrial enlargement, left ventricular enlargement with globally reduced ejection fraction, features not present 3 years ago, when a left brachiocephalic fistula was created. High output cardiac failure was suspected when the fistula flow was measured to be more[…]