Misdiagnosis of restrictive cardiomyopathy averted by a stethoscope: A case report

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ID: 320930
2026
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Abstract
Abstract Background Iatrogenic arteriovenous (AV) fistula is a rare but treatable cause of high-output heart failure that can mimic restrictive cardiomyopathy and may lead to inappropriate listing for heart transplantation. Case summary A 37-year-old man presented with seven months of progressive pedal edema, tense ascites and exertional dyspnea. The baseline ECG showed sinus tachycardia with right axis deviation and chest radiograph revealed cardiomegaly with right pleural effusion. Transthoracic echocardiography and cardiac MRI demonstrated right atrial and ventricular enlargement, severe functional tricuspid regurgitation with preserved biventricular systolic function. A provisional diagnosis of restrictive cardiomyopathy was considered and the patient was referred for transplant evaluation. Bedside examination identified a continuous murmur loudest over the left iliac fossa. Contrast CT aortogram confirmed a large iliocaval communication between the left common iliac artery and the inferior vena cava. Surgical closure with vascular grafting was performed. At one-month follow-up, the symptoms resolved and echocardiography showed normalization of right heart size with disappearance of tricuspid regurgitation. Discussion This case highlights the enduring value of focused history and physical examination in detecting extracardiac, reversible causes of heart failure.
Reference Key
openalex_W7168291349 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Shyam S Kothari, Sagar Ghetiya, Vishal Sharma, Prarthi Shah, Nirav Panchal
Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag505
URL
https://doi.org/10.1093/ehjcr/ytag505
Keywords Keywords not found

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