Dilated cardiomyopathy of toxic etiology: a potentially reversible entity

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Rangel I (Author) Other; Amorim M (Author) Other; Gonçalves A (Author) Other; Sousa C (Author) Other; Macedo F (Author) Other; Bettencourt P (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P1038

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Introduction: Dilated cardiomyopathy is a prevalent entity with different causes, which include the toxic etiology, secondary to drugs, such as cocaine and heroin. Case report: We describe the case of a 46 year-old woman, active heroin and cocaine addict since her 23 years, hepatitis C virus carrier and with a history of hepatitis B (cured) and pulmonary tuberculosis (7 years ago). Admitted in the emergency room with congestive heart failure, with 4 months of evolution, and progressive worsening. At the objective examination, she was hemodynamically stable, afebrile, with decreased breath sounds at the lung bases, hepatomegaly. She didn't show significant alterations of cardiac auscultation. Analytically, it's worth to accentuate the elevated levels of BNP (3600 pg/mL) and transaminases. A chest computed tomography angiography was performed and showed signs of pulmonary congestion with right pleural effusion, with no signs of pulmonary thromboembolism. No significant changes were observed in abdominal ultrasound. Electrocardiogram showed sinus tachycardia and left bundle branch block. For further evaluation, echocardiography was done and showed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (LVSD), with ejection fraction (EF) of 11%, mild right ventricular dysfunction and 2 small apical thrombi have been identified. Given these findings, a diagnosis of congestive heart failure was made in a patient with dilated cardiomyopathy and ventricular dysfunction of toxic etiology. Anticoagulant therapy was initiated and diuretic therapy was optimized, with favorable evolution. She was discharged on the 5th day of hospitalization, oriented to Internal Medicine and Infectiology consultations and to the Center for Assistance to Drug Users. After six months of total drugs abstinence, she was asymptomatic and with BNP levels <10 pg/mL. The echocardiography revaluation showed normal cardiac chamber size and recovery of biventricular systolic function (EF of 62%). Conclusion: This case shows the importance of recognizing the toxic etiology associated with dilated cardiomyopathy, since, when properly treated, it is potentially reversible and may have an excellent prognosis.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Amorim M, Gonçalves A, Sousa C, Macedo F, Bettencourt P, Maciel MJ. Dilated cardiomyopathy of toxic etiology: a potentially reversible entity. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P1038. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012