Mesenteric Hypoperfusion Mimicking Acute Abdomen in Heart Failure with Combined Aortic Valve Disease

We report the case of an 83-year-old woman with a history of severe aortic double valve lesion and atrial fibrillation who presented to the emergency department with generalized, high-intensity abdominal pain. Initial evaluation revealed hemodynamic instability, rapid ventricular response atrial fibrillation, and signs of heart failure with preserved ejection fraction (HFpEF). Echocardiography demonstrated severe concentric left ventricular hypertrophy, advanced left atrial dilation, and a degenerative aortic valve lesion with severe stenosis predominance. The abdominal pain was attributed to transient mesenteric hypoperfusion due to acute hemodynamic compromise. The patient was managed with prophylactic anticoagulation, rate control using beta-blockers, and supportive care, with complete symptom resolution within 72 hours.

This case highlights an atypical presentation of HFpEF in an elderly woman, where abdominal pain was the initial and predominant symptom. In the context of advanced valvular disease and atrial fibrillation, ischemic or embolic complications such as mesenteric hypoperfusion must be considered. Acute mesenteric ischemia is a life-threatening condition often presenting with nonspecific findings and delayed diagnosis. In geriatric patients, abdominal pain may obscure the underlying cardiac pathology, further complicating the diagnostic process.

This report underscores the importance of maintaining high clinical suspicion for cardiovascular causes in patients presenting with unexplained abdominal pain and multiple comorbidities. Early diagnosis and a multidisciplinary approach were essential to achieving hemodynamic stabilization and clinical recovery. The case illustrates how early electrocardiography and echocardiography can aid in identifying critical cardiac conditions with atypical presentations.