Congestive Heart Failure Revealing Takayasu's Disease: About Two Cases at the University Teaching Hospital of Brazzaville

Introduction : Takayasu's disease (TD) is a rare chronic large-vessel vasculitis of unknown etiology that preferentially affects the aorta and its branches. Clinical manifestations are usually dominated by ischemic and vascular signs, and cardiac involvement, although rare, marks an important turning point in the course of the disease.) We report two cases of TD that showed up as congestive heart failure. Case presentations : the first with a four-year history of heart failure previously attributed to hypertensive heart disease, and the second with acute pulmonary edema in the context of a one-year history of intermittent lower-limb claudication. Transthoracic echocardiography showed a dilated cardiomyopathy with severely reduced ejection fraction and moderate aortic and mitral regurgitation in the first patient, and concentric hypertensive heart disease with moderate aortic regurgitation in the second. CT angiography of the aorta and its branches showed arterial wall thickening and occlusive lesions of the supra-aortic and/or iliac arteries in both patients, raising suspicion of TD. The diagnosis was confirmed using the 2022 ACR/EULAR classification criteria, with scores of 6 and 12 points, respectively. Both patients received standard heart failure therapy together with oral corticosteroid therapy. The first patient also received an oral anticoagulant following a transient ischemic stroke and remains on the waiting list for vascular surgery. Clinical signs of heart failure regressed with treatment in both patients. Conclusion: Cardiac involvement can be the presenting feature of Takayasu's disease. This diagnosis should be considered in a young woman presenting with heart failure associated with blood pressure asymmetry or absent peripheral pulses, so as to enable earlier diagnosis and treatment.