# A Case Report of Right Heart Failure: An Uncommon Presentation: A Case Report of Right Heart Failure

## TL;DR

A 53-year-old woman with atypical symptoms was diagnosed with a rare aortic dissection after initial misdiagnosis, highlighting the importance of prompt imaging for accurate treatment.

## Contribution

This case report emphasizes the diagnostic challenges of aortic dissection and the value of cross-sectional imaging in atypical presentations.

## Key findings

- Initial diagnosis of NSTEMI was incorrect; aortic dissection was confirmed via CT aortography.
- Conservative management was followed by surgical intervention after recurring symptoms.
- Multidisciplinary approach and timely imaging improved patient outcomes.

## Abstract

Aortic dissection poses diagnostic challenges due to its varied symptoms.
Prompt diagnosis and intervention are essential to reduce mortality and
morbidity.

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.

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.