Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Inflammatory cardiomyopathy in a young patient: when recovery beats the investigation
Session:
Sessão Speaker's Corner - Casos clínicos desafiantes… em Insuficiência Cardíaca
Speaker:
Mariana Silva Brandão
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
---
Subtheme:
---
Session Type:
Sessão de Casos Clínicos
FP Number:
---
Authors:
Mariana s. Brandão; Marisa Passos Silva; Nuno Dias Ferreira; Marco Oliveira; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">diagnosis of Kaposi’s sarcoma associated to human immunodeficiency virus 1 (HIV-1) infection was made (CD4 lymphocyte count <150/ul). He was additionally diagnosed with cytomegalovirus (CMV) infection with colitis and retinitis. Antiretroviral therapy and chemotherapy were prescribed following Infectious Diseases and Oncology consultations. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During initial investigation, a transthoracic echocardiogram (TTE) was performed (image A), revealing a mildly dilated left ventricle (LV) with severely depressed LV function (LV ejection fraction [LVEF] 21%), moderate functional mitral regurgitation and mild pericardial effusion. The patient denied any heart failure (HF) symptoms. Cardiac magnetic resonance (CMR) was also performed, and disclosed a mildly dilated (102 ml/m<sup>2</sup>), hypokinetic, severely dysfunctional LV (LVEF 12%). Severe right ventricular (RV) dysfunction (EF 22%) was also noted. T2-STIR images did not show myocardial edema or inflammation; transmural late gadolinium enhancement (LGE) was observed in basal and mid septal segments (septal striae). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Guideline-directed medical therapy for HF (angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist) was started. Genetic testing revealed a likely pathologic variant in the titin (TTN) gene. There was no family record of cardiovascular disease or sudden cardiac death. Referral for Genetic counseling was ensued. Siblings were phenotypically normal.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Follow-up TTE at 3-months (image B) showed significant improvement in LV volume and function (LVEF 55%). CMR was repeated at 6-months and confirmed recovery of LV (LVEF 68%) and RV (EF 62%) function. LGE pattern also changed: myocardial fibrosis was no longer evident. The patient remains asymptomatic, without adverse cardiovascular events.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This case of dilated cardiomyopathy (DCM) with recovered function poses a differential diagnosis challenge. Familial DCM, HIV-associated DCM, myocarditis or cardiotoxicity are among possible etiologies. We hypothesize, given the impressive and rapid recovery of biventricular function, that a phenomenon of myocarditis (possibly due to HIV-1 or CMV), in a susceptible patient with an underlying titin mutation, may be the most likely diagnosis in this young patient. Follow-up will be maintained in a dedicated cardiomyopathy consultation.</span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site