Man's 'puffy face' when he was hungover actually a key sign of rare and life-threatening heart condition

A Chinese man who saw his face swell up after drinking alcohol was actually suffering from a rare and life-threatening heart condition.

The unnamed patient, aged 33, had to wait three months for the real cause of the classic sign of a hangover to be revealed, and only after he suffered heart failure.

Medics who treated the man found he had a rupture of a sinus of Valsalva aneurysm (RSOVA), which they said was likely brought on by exercising after drinking.

RSOVA is a condition where part of the aortic wall — the main artery responsible for carrying oxygen-rich blood from the heart to the rest of the body — swells and then ruptures, with potentially fatal consequences.

These can include heart failure, where the organ struggles to pump enough blood, and even cardiac arrest, a life-threatening condition where the heart stop beating entirely.

Symptoms can also include shortness of breath, tiredness, heart palpitations and chest pain.

However, as in the most recent case, it can also cause bizarre 'atypical' problems like facial swelling, which aren't as commonly linked to heart problems.

While the condition can be congenital, meaning patients are born with it, they can also develop it later in life.

Writing in the Journal of Medical Case Reports, medics suggested their patient's rupture was likely caused by 'strenuous' exercising after drinking alcohol.

The rupture then caused their 'previously healthy' patient to develop swelling around his face and eyelids, known medically, as oedema, they wrote.

While the man did seek help at hospital initial checks on his heart failed to spot anything wrong.

Instead medics focused on high levels of protein in his urine, which medics at the time suspected was the cause of his condition.

However, despite being given a series of drugs to combat this, his symptoms only got worse.

The swelling began to spread to other parts of his body and he also experienced chest tightness, and a swollen abdomen.

After a number of hospital visits the man was eventually seen by medics at the emergency department of Qilu Hospital in Qingdao — the authors of the case report — who uncovered the real cause of his condition.

They said the initial clinician had missed 'key indicators of a ruptured sinus of Valsalva aneurysm' including a background rumbling noise in his heart beat called a 'mechanical murmur'.

'This misdiagnosis delayed appropriate intervention. As the disease progressed, the patient’s symptoms worsened significantly, which posed a serious risk,' they wrote.

'Upon admission to our hospital, he exhibited clear signs of acute right heart failure.'

A physical examination of his heart by medics revealed the organ was significantly enlarged, with an ultrasound scan then confirming he had suffered RSOVA.

Medics specifically found the aneurysm measured 24mm by 27mm and was impacting the right atrium, one of the four chambers of the heart.

Considering the size of the aneurysm and, as well patient's general condition, he was rushed for emergency surgery.

Medics managed to repair the rupture without issue, with the authors adding the patient was well with no complications 18 months after the operation.

Read More

Concluding their report, they said their case demonstrated why medics should more readily consider RSOVA in younger patients with symptoms of heart failure.

'Considering that the age distribution of RSOVA is much younger than that of heart failure, RSOVA should also be suspected in young patients presenting with new-onset heart failure,' they wrote.

'It is therefore important to develop a strategy for the early recognition of aortic sinus aneurysm rupture.'

RSOVA is rare, affecting only about 0.09 per cent of the population — just less than one in every 1,000 people — a fact which experts say means it's often misdiagnosed.

They said symptoms of RSOVA include a continuous mechanical heart murmur, sudden chest pain or shortness of breath after exercise followed by heart palpitations, general shortness of breath and passing out.

Other signs they highlighted also included, like the most recent patient, a slow progression of swelling.

The authors added it was critical medics also consider that symptoms can last for weeks, months, or years before the condition is serious enough to present as heart failure.

They added that while cases of misdiagnosis like their patient experienced were 'unfortunate' they serve as a 'valuable learning opportunity' for medics.

A puffy swollen face after a night on the town is typically caused by a combination of two aspects of how alcohol affects the body.

The first is that drinking causes blood vessels in the face to expand, which can cause a red flush while drinking but also facial swelling.

Secondly is that alcohol is dehydrating which, as a result, activates automatic processes in your body to hold onto water which can manifest as general bloating and puffiness the morning after.