Background <p>Takayasu arteritis, a chronic inflammatory disease predominantly affecting the aorta and major arterial branches, can lead to serious complications such as myocardial infarction and heart failure.</p> Case presentation <p>This case report details a rare initial presentation of a 24-year-old female with acute left heart failure, leading to a diagnosis of Takayasu arteritis. Initial misdiagnosis as viral myocarditis was reconsidered after comprehensive examinations, including echocardiography, vascular ultrasound, and imaging studies, which revealed the disease’s characteristic vascular involvement. The patient was treated with a combination of prednisone acetate, tocilizumab, and supportive therapies, resulting in symptomatic and laboratory improvement by the three-year follow-up.</p> Conclusions <p>The case emphasizes the need for clinicians to recognize atypical presentations of Takayasu arteritis to avoid misdiagnosis and to consider its multifactorial impacts on heart failure.</p>