# Delirium as an Atypical Presentation of Severe Aortic Stenosis in a Cognitively Intact Nonagenarian With Atrial Fibrillation: A Case Report

## TL;DR

An elderly woman with no prior cognitive issues developed delirium due to severe heart valve disease, which resolved after treatment.

## Contribution

Highlights delirium as an atypical sign of severe aortic stenosis in elderly patients with atrial fibrillation.

## Key findings

- Delirium resolved within 72 hours after diuretic treatment for heart failure.
- Severe aortic stenosis was identified as the underlying cause of delirium.
- Common delirium triggers like infection or metabolic issues were ruled out.

## Abstract

Delirium is a common, multifactorial neuropsychiatric syndrome, especially prevalent among older adults. While infection, metabolic disturbances, and medication effects are frequent causes, cardiac etiologies, particularly cerebral hypoperfusion secondary to valvular heart disease, may be under-recognized. We report the case of a 90-year-old woman with severe aortic stenosis and chronic atrial fibrillation who presented with acute delirium despite preserved baseline cognition. The initial evaluation excluded common precipitants of delirium, including infection, metabolic derangements, polypharmacy, and structural central nervous system pathology. Investigations revealed evidence of acute decompensated heart failure, including volume overload, elevated N-terminal pro B-type natriuretic peptide (NT-proBNP), and a severely stenotic aortic valve on transthoracic echocardiogram (TTE). Conservative treatment with intravenous diuretics led to the rapid resolution of delirium within 72 hours. This case highlights an atypical presentation of severe aortic stenosis and underscores the importance of considering cardiac causes in elderly patients presenting with delirium in the absence of other identifiable factors.