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 than 2800 cc/min. Temporary restriction of the fistula inflow provoked a prompt 10 beats/min reduction of his resting heart rate and 25 mmHg rise in his systolic blood pressure (Nicoladoni-Branham sign). He was sent for surgical fistula restriction (banding) with favourable outcome.