Of Hearts, Minds, and Guts: Difficulties in Diagnosing Heart Failure in the Young

One year ago, a woman in her early twenties was diagnosed for the first time with dilated cardiomyopathy and low-output state at the emergency room of a city hospital, and was immediately transferred to the intensive care unit of a centre with advanced heart failure treatment and transplantation facilities.Due to refractory cardiogenic shock, she required temporary mechanical circulatory support and underwent emergency heart transplantation after 3 days.The explanted heart showed the typical pathological features of chronic dilated cardiomyopathy, with normal coronary arteries and no signs of recent/acute myocardial injury.Thus, what presented as a fulminant disease was indeed the terminal stage of a previously unrecognized chronic condition.Delaying diagnosis of heart failure exposes patients to the risk of death, and precludes the opportunity for reverse remodelling and clinical improvement that can be observed with guideline-directed therapies in a non-negligible proportion of subjects, especially in women with non-ischaemic heart disease. 1 Timely implementation of recommended management strategies relies largely upon the ability to identify the affected or possibly affected subjects in the primary care setting.We reconsidered the history of this patient, in order to identify factors that may reduce physicians' capability to diagnose heart failure, especially in the young.