Acute Decompensated Heart Failure with Severe Left Ventricular Systolic Dysfunction of Undetermined Etiology in a 26-Year-Old Male: A Case Report

Abstract

Heart failure with reduced ejection fraction HFrEF is rare in young adults but may develop when multiple uncontrolled cardiovascular risk factors are present. The diagnosis of an underlying cause of heart failure among younger patients is difficult due to multiple possible etiologies of LV systolic dysfunction, which might have similar clinical manifestations and imaging features. A 26-year-old man with a past medical history of uncontrolled hypertension and smoking, who came to hospital with complaints of sudden onset of dyspnea and chest pain on the left side, was investigated further to have sinus tachycardia with abnormal R-wave progression on electrocardiogram, cardiomegaly with pulmonary congestion on chest X-ray, and significantly impaired global systolic function of the left ventricle with ejection fraction of 25% on transthoracic echocardiogram. Troponins showed no dynamic change in their rise-and-fall pattern, ruling out acute coronary syndrome. He was stabilized on CPAP breathing and IV nitroglycerine and loop diuretics, with marked relief in symptoms. Following hemodynamic stabilization, guideline-directed medical therapy for HFrEF was initiated. In this case, there is acute decompensated heart failure with reduced ejection fraction (HFrEF) characterized by severe systolic dysfunction occurring in a relatively young individual suffering from numerous risk factors for cardiovascular disorders. The etiology of the condition could not be precisely determined due to the unavailability of coronary angiography and other advanced diagnostic methods. Ischemic cardiomyopathy is just one of the potential causes that also include hypertensive cardiomyopathy, idiopathic dilated cardiomyopathy, toxic cardiomyopathy, and inflammatory cardiomyopathy. The present report highlights the need for careful etiologic assessment of patients presenting with recently developed ventricular dysfunction, appropriate diagnosis in the absence of evidence of coronary disease, and prompt initiation of appropriate therapy