Abstract

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disease with manifestations of epistaxis, mucocutaneous telangiectasias, and arteriovenous malformations of multiple organs, including the lungs, liver, and brain. It can also lead to fatal events such as high-output cardiac failure, respiratory failure, stroke, sepsis, and other hemodynamic complications. Therefore, early awareness of HHT is essential. We describe a 55-year-old man highly suspected of HHT with a rare initial presentation of atrial fibrillation (AF) and remarkable varicose veins at an unusually young age. AF occurring at a young age and refractory varicose veins caused by high-output heart failure might be a whistleblower for HHT, and early awareness may help diagnosis and appropriate management.