Navigating Diagnostic Delays: A Case of Takayasu Arteritis Complicated by Acute Heart Failure and Vascular Compromise in a 37-Year-Old Woman From Cameroon

Takayasu arteritis (TAK) is a rare form of large-vessel vasculitis that significantly impacts cardiovascular health, leading to severe complications such as acute heart failure (AHF). Its rarity in Cameroon may be attributed to limited awareness, underdiagnosis, and a lack of published data on the condition. We report the case of a 37-year-old female patient who presented with AHF and secondary hypertension, chest pain, and AHF after undergoing umbilical hernia repair two weeks prior. Initial symptoms included dyspnea at rest (New York Heart Association (NYHA) stage 4), orthopnea, paroxysmal nocturnal dyspnea, body swelling, and chest pain. Her medical records indicated mildly elevated blood pressure and an inter-arm blood pressure discrepancy, which previous healthcare providers had overlooked. On examination, she exhibited signs of respiratory distress, jugular venous distention, and a notable discrepancy in blood pressure between her arms. Investigations revealed elevated inflammatory markers (CRP: >200 mg/L), and significant findings on imaging, notably, a point-of-care bedside cardiac ultrasound showed a left ventricular ejection fraction of 30%. An arterial duplex ultrasound demonstrated complete occlusion of the left common carotid artery and severe stenosis of the left subclavian artery, supporting a diagnosis of AHF complicating TAK during the pulseless phase. The patient also met four of the minor Ishikawa criteria, including elevated erythrocyte sedimentation rate (ESR) and significant aortic insufficiency. Treatment was promptly initiated with furosemide for AHF management, followed by lisinopril and bisoprolol as her hypervolemic state improved. High-dose corticosteroids were prescribed to address the vasculitis. The patient showed clinical improvement, with dyspnea at rest resolving and her functional status improving to NYHA stage 3. However, she later developed renal impairment attributed to cardiorenal syndrome and requested transfer to a closer medical facility. While plans for further management and control of inflammatory markers were made, she unfortunately passed away a few weeks after discharge. This case underscores the challenges in diagnosing and managing TAK, especially in regions where the disease is rare, highlighting the need for heightened clinical suspicion in similar presentations.