Unveiling Congenital Heart Disease in an Octogenarian: A Case of Late Diagnosis of Patent Ductus Arteriosus Presenting With Heart Failure With a Preserved Ejection Fraction

We present the case of an 88-year-old female with a history of chronic obstructive lung disease, atrial fibrillation, and type 2 diabetes mellitus, initially investigated for iron deficiency anemia. Despite inconclusive endoscopic and radiological investigations for occult bleeding, the subsequent evaluation revealed pulmonary hypertension and right heart enlargement on CT of the thorax. Further assessment by echocardiography unveiled dilated pulmonary arteries, right ventricle enlargement, and a left-to-right shunt, consistent with patent ductus arteriosus (PDA), a rare finding in the elderly. Remarkably, the patient recalled being informed of a "weak heart" at birth, suggesting undiagnosed congenital heart disease. Management commenced with heart failure therapy, resulting in significant improvement in dyspnea. This case highlights the importance of considering congenital heart anomalies in elderly patients presenting with heart failure symptoms, emphasizing the value of thorough history-taking and advanced imaging techniques in diagnosis and management.