# An Unexpected Diagnostic Twist in an Elderly Patient: No Heart Failure With Preserved Ejection Fraction

## TL;DR

An elderly patient with symptoms of heart failure was found to have a rare anatomical heart defect instead of typical heart failure with preserved ejection fraction.

## Contribution

Highlights the importance of considering rare anatomical defects in elderly patients with dyspnea and suspected pulmonary hypertension.

## Key findings

- Right heart catheterization revealed abnormal oxygen saturation suggesting an anatomical defect.
- Cardiac MRI identified a partial anomalous pulmonary venous return and atrial septal defect.
- The findings emphasize the need for a multiparametric diagnostic approach in atypical cases.

## Abstract

Heart failure with preserved ejection fraction (HFpEF) is considered to be the dominant cause of dyspnea and pulmonary hypertension (PH) in elderly patients with preserved left ventricular systolic function and cardiovascular comorbidities. However, it is important to keep in mind that left ventricular diastolic dysfunction is not the only possible cause of PH in cases of late-onset clinical manifestation. A multiparametric approach is essential for accurate diagnosis and therapeutic decision-making. A 74-year-old patient was admitted due to progressive dyspnea and suspicion of PH. Given the patient's risk profile, HFpEF and concomitant post-capillary PH were anticipated. Despite negative findings on CT angiography and transesophageal echocardiography, right heart catheterization was performed, revealing discrepant oxygen saturations in the superior vena cava and right atrium. A partial anomalous pulmonary venous return and an atrial septal defect were identified through cardiac magnetic resonance imaging.