Man, 33, who got ‘puffy face when he was hungover’ eventually diagnosed with life-threatening ‘swollen heart’
A MAN whose face swelled up with he was hungover was diagnosed with diagnosed with a rare and life-threatening heart condition.
It took patient, 33, three months to be diagnosed, with his symptoms gradually worsening until he suffered heart failure.
Rupture of a sinus of valsalva aneurysm is a rare but serious condition where a weakened area in the aortic wall – called the sinus of Valsalva – ruptures, potentially leading to life threatening complications.
Patients with an unruptured sinus of Valsalva aneurysm usually don’t have any symptoms, but they may suffer from shortness of breath, tiredness, palpitations, or chest pain.
A ruptured sinus of Valsalva aneurysm may cause severe symptoms including heart failure, myocardial ischemia – when the heart muscle doesn’t get sufficient blood flow – or even cardiac arrest, when the heart stops.
The condition is so rare – affecting 0.09 per cent of the general population – that it’s frequently misdiagnosed.
Its symptoms can also be similar to other, more common conditions.
It took three months for the 33-year-old man to be diagnosed as he suffered from “atypical symptoms”.
The “previously healthy” patient suddenly developed a puffy face and eyelids after “strenuous exercise“, following a night of drinking.
“This event likely triggered the rupture of the non-coronary sinus into the right atrium,” medics wrote in a paper published to the Journal of Medical Reports.
He went hospital, where he was diagnosed with proteinuria – high levels of proteins in his urine – and hyperuricemia, high uric acid levels in the body.
Heart and lungs checks showed nothing out of the ordinary, but symptoms got worse despite being given diuretics and urate-lowering treatment.
Over time, he developed swelling all over his body – caused by buildup of fluid in the tissues called oedema.
The man also started suffering from tightness in his chest and a swollen stomach.
After several unsuccessful hospital visits, he was eventually seen by doctors in the emergency department of Qilu Hospital in Qingdao, three months after his first symptoms appeared.
“The initial clinician missed key indicators of a ruptured sinus of Valsalva aneurysm, such as a continuous mechanical murmur in the precordial region,” medics wrote.
“This misdiagnosis delayed appropriate intervention. As the disease progressed, the patient’s symptoms worsened significantly, which posed a serious risk.
“Upon admission to our hospital, he exhibited clear signs of acute right heart failure.”
The patient told medics his chest felt tight and he experienced shortness of breath when lying down.
A physical examination of his heart showed that both chambers were enlarged.
Doctors also felt an unusual vibration in his chest, near the heart and heard a continuous murmur coming from the left side of his chest.
Signs of heart failure
Heart failure means that the heart is unable to pump blood around the body properly.
It usually happens because the heart has become too weak or stiff.
Heart failure is a long-term condition that tends to get gradually worse over time.
It cannot usually be cured, but the symptoms can often be controlled for many years.
The main symptoms of heart failure are:
- Breathlessness after activity or at rest
- Feeling tired most of the time and finding exercise exhausting
- Feeling lightheaded or fainting
- Swollen ankles and legs
Some people also experience other symptoms, such as a persistent cough, a fast heart rate and dizziness.
Symptoms can develop quickly – in cases of acute heart failure – or gradually over weeks or months, called chronic heart failure.
See a GP if you experience persistent or gradually worsening symptoms of heart failure.
Call 999 for an ambulance or go to your nearest A&E department as soon as possible if you have sudden or very severe symptoms.
Source: NHS
An echocardiography showed that part of the heart’s structure, called the sinus of Valsalva (SVA), had developed an aneurysm that was pushing into the right atrium, one of the heart’s chambers.
The bulge was about 24 mm by 27 mm in size, with a small opening inside it measuring 6 mm.
Additionally, the aneurysm had multiple ruptures at the top, and the heart was larger than normal with fluid around it.
Based on these findings, the patient was diagnosed with a ruptured sinus of Valsalva aneurysm (RSOVA).
He was rushed into surgery to repair the rupture, which took place without a hitch.
Doctors followed up with him one and six months after the op, reporting that he was “recovering well without abnormalities”.
They concluded: “Considering that the age distribution of RSOVA is much younger than that of heart failure, RSOVA should also be suspected in young patients presenting with new-onset heart failure.
“It is therefore important to develop a strategy for the early recognition of aortic sinus aneurysm rupture.”
They shared key signs doctors should look out for that could indicate a RSOVA diagnosis:
- Signs of new-onset heart failure in young patients with no previous history of heart disease
- A continuous heart murmur
- Sudden onset of chest pain or stomach bloating and shortness of breath after strenuous exercise, followed by palpitations and fainting, which may rapidly deteriorate to heart failure;
- Gradually worsening swelling, abdominal distension, shortness of breath after exertion, palpitations and weakness
“Symptoms can last for weeks, months, or years from the remission period and then present as symptoms of heart failure,” the report authors noted.