When Fever Masks Heart Failure: A Case Report of Ischemic Cardiomyopathy in an Elderly Woman

Background: Heart failure is a leading cause of morbidity and mortality in the elderly, but its diagnosis can be challenging due to overlapping symptoms with other common conditions, such as pneumonia. Fever and elevated inflammatory markers can mask the underlying cardiac pathology, leading to delayed recognition and treatment. Case: We report the case of a 73-year-old woman with no prior comorbidities who presented with fever, chest pain, and fatigue. Initial evaluation revealed leukocytosis and elevated C-reactive protein, leading to a presumptive diagnosis of bacterial pneumonia and antibiotic treatment. However, the patient’s symptoms persisted, and her clinical condition deteriorated with worsening dyspnea and orthopnea. Further investigations, including echocardiography and cardiac imaging, revealed a dilated left ventricle, reduced ejection fraction (40%), and chronic total occlusion of the left anterior descending artery. A cardiac PET scan confirmed extensive myocardial scarring, consistent with ischemic cardiomyopathy. The patient was initiated on guideline-directed medical therapy with significant clinical improvement at follow-up. Conclusion: This case highlights the diagnostic difficulty in differentiating heart failure from infections in elderly patients presenting with nonspecific symptoms and inflammatory markers. It underscores the importance of a high index of suspicion and the role of multimodal imaging in diagnosing ischemic cardiomyopathy, even in the absence of classic cardiac risk factors.