When a 53-year-old man presented with chest pain, shortness of breath on exertion, and pedal oedema, all signs pointed toward heart failure. His ECG showed ventricular bigeminy, and a previous 2D echo report diagnosed him with dilated cardiomyopathy, revealing an ejection fraction (EF) of just 25%. On paper, it seemed like a classic case of advanced cardiac dysfunction.

To investigate further, Dr. Priya Palimkar’s team performed a coronary angiography—expecting to find significant blockages. Instead, his coronary arteries were completely normal. The result was surprising, given the severely reduced heart function.

Sensing a mismatch between the clinical presentation and imaging, the team went back to basics. A fresh 2D echocardiogram conducted in-house revealed what had been missed for decades: a Patent Ductus Arteriosus (PDA)with a left-to-right shunt, and intact interatrial and interventricular septa.

This congenital condition had likely gone undetected for over 50 years, silently contributing to the progressive decline in heart function. The focus now shifted to determining whether the long-standing PDA was the primary driver of heart failure or if a superimposed condition like myocarditis was also contributing.

Without delay, the team proceeded with PDA closure, and the patient was started on dobutamine infusion to support his cardiac output. Over the following days, his heart failure symptoms began to improve, and he showed signs of stabilization.

This case is a powerful reminder: when the findings don’t match the story, always look again. Sometimes, the real diagnosis has been waiting quietly—for decades—to be uncovered.