The Eye is a Window to the Heart, The Papilledema Secondary to the Intracranial Pressure After The Heart Failure, Case Report Of Bicuspid Aortic Valve (BAV)

Abstract Purpose There is currently a paucity of literature describing bilateral reversible disc edema as an early presenting sign of heart failure in the setting of bicuspid aortic valve disease. There is however a plethora of research indicating congenital bicuspid aortic valve (BAV) as a major risk factor for possible development of infective endocarditis in a patient’s lifetime. Observations A 26-year-old man presented with bilateral blurry vision with severe 4+ bilateral optic disc edema of one month duration and venous engorgement. The patient also complained of coughing when lying down, unintentional weight loss, joint swelling and fatigue. On further testing, the patient was found to have streptococcal bacteremia with aortic valve endocarditis, severe aortic regurgitation, congenital bicuspid aortic valve and decompensated class IV systolic heart failure. Following emergent aortic valve replacement, there was complete reversal of optic disc edema and symptomatic improvement. Conclusions and Importance Our patient’s clinical presentation demonstrates that optic disc edema can be an earlier sign of progressing heart failure and highlights the clinical progression of an increased risk of developing bacterial endocarditis for patients with BAV disease when other causes are not obvious. The life-threatening presentation of our case supports the importance of regular monitoring of valvular status and The observation of the optic disc edema and investigate the cause.