Today we discussed a case of a young woman with Lupus, Lupus Nephritis leading ESRD with recent transition from HD via AV Fistula to Peritoneal Dialysis, who presented with peritonitis with course complicated by afib RVR s/p dilt/metop w/ associated hypotension/bradycardia concerning for cardiogenic sock, found to have with new RV dilation, severe TR, and new HF. She was diagnosed with high output heart failure, AV access was ligated, with reversal of HF and TR!