A Case Report of Right Heart Failure: An Uncommon Presentation

Abstract

Background: Aortic dissection poses diagnostic challenges due to its varied symptoms. Prompt diagnosis and intervention are essential to reduce mortality and morbidity. Case Report: A 53-year-old woman presented with dyspnoea, palpitations, Epigastric and right upper quadrant pain, following recent chest tightness. She initially was diagnosed with a non-ST elevation myocardial infarction (NSTEMI) based on the electrocardiogram (ECG) and cardiac enzymes. The transthoracic echocardiogram (TTE) showed right heart impairment, mild aortic regurgitation, and significant tricuspid regurgitation. A coronary angiogram showed normal left coronary vessels but failed imaging of the right coronary artery which raised suspicion of aortic dissection due to an abnormal aortic root shape and a history of hypertension. Urgent CT aortography (CTA) confirmed acute Stanford type A aortic dissection with false lumen supplying the RCA ostia. Initially, conservative management was chosen due to right ventricular dysfunction. The patient then presenting with recurring symptoms 8 days later, after a multidisciplinary team meeting surgical intervention was decided. Comprising of full aortic root, aortic arch, and aortic valve replacement, plus tricuspid valve repair and annuloplasty. The patient was discharged post successful surgery. Conclusion: This case highlights the challenges of diagnosing and managing acute aortic syndromes, especially with atypical symptoms. Having a low threshold for cross sectional imaging techniques in such cases is likely to prompt accurate diagnosis and treatment in critical cases.