Dissecting heart failure.

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Genetics

Background:

• Ascending aorta dissection is a life-threatening condition typically presenting with acute chest pain and hemodynamic instability.
• Aneurysms of the ascending aorta can predispose individuals to dissection.
• Heart failure is an uncommon presentation for aortic dissection.

Observation:

• A 46-year-old man presented with symptoms of new-onset heart failure, including dyspnea and orthopnea.
• Physical examination revealed a diastolic murmur, prompting further cardiac evaluation.
• Echocardiography identified a large ascending aortic aneurysm (8.6x9.7 cm) with dissection, severe aortic regurgitation, and left ventricular dysfunction.

Findings:

• The patient's presentation mimicked typical heart failure, masking the underlying aortic emergency.
• Surgical repair of the ascending aortic aneurysm and dissection was successfully performed.
• The patient had a family history of aortic dissection, with a brother who died from the condition.

Implications:

• Ascending aorta dissection can present atypically as heart failure, highlighting the importance of comprehensive diagnostic evaluation.
• Aortic dissection in young individuals warrants consideration of genetic predisposition and screening of first-degree relatives.
• Prompt surgical intervention is critical for managing ascending aortic aneurysms with dissection to improve patient outcomes.