Biventricular Heart Failure With Reduced Ejection Fraction in a Young Male: A Case Report

A 33-year-old male with a past medical history of nonischemic cardiomyopathy with a reduced ejection fraction (HFrEF) and hypertension presented with worsening dyspnea and chest pain. This had started over the past three days but had not improved, prompting him to come to the emergency department. His vitals were unremarkable on presentation. Initial evaluation due to his history of HFrEF was obtaining an echocardiogram, which revealed an ejection fraction of 15%-20%, similar to the previous echocardiogram. He underwent cardiac MRI later, which showed an ejection fraction of 6% for the left ventricle and 17% for the right ventricle. Multidisciplinary teams optimized guideline-directed medical therapy (GDMT) during this hospitalization, including uptitration of sacubitril-valsartan, metoprolol succinate, spironolactone, and initiation of empagliflozin and digoxin. Right heart catheterization guided management, and a wearable defibrillator bridged to future implantable cardioverter-defibrillator placement. Severe obstructive sleep apnea was diagnosed and treated with continuous positive airway pressure (CPAP). The patient was discharged home in stable condition after one week with an optimized regimen, with advanced therapy evaluation including transplant workup. This case highlights GDMT optimization in young patients with advanced HFrEF, potential for recovery, and bridging strategies, addressing a complex and tenuous disease status in an increasingly more common patient population.