# Persistent Hematuria With Late Diagnosis of Cardiac Origin: A Case Report

## TL;DR

A case of dark urine caused by heart issues was misdiagnosed for months, highlighting the need for broader evaluations beyond urology.

## Contribution

Highlights the importance of considering cardiac causes in undiagnosed persistent hematuria.

## Key findings

- Dark-colored urine was misattributed to urologic causes despite cardiac origin.
- Systemic evaluation and attention to hematologic indices are crucial when urologic causes are inconclusive.

## Abstract

Dark-colored urine is often referred to as hematuria; however, this is an assumption that can often be misleading. In the evaluation of dark-colored urine, distinguishing between true hematuria, hemoglobinuria, and myoglobinuria is essential, as each indicates different underlying pathologies and requires targeted diagnostic and management strategies. Visualization of dark-colored urine often leads to an isolated urologic evaluation, and assessment for more infrequent causes of this phenomenon may be obscured. Clinicians tend to anchor on common urologic causes of dark-colored urine or rely on dipstick analysis alone, thus failing to perform a more systemic evaluation. We present a case of persistent hematuria with cardiac origins that remained undiagnosed for many months. A detailed history and attention to hematologic indices should be pursued when urologic causes of hematuria prove to be unrevealing.