Presentation
Lower limb swelling, vomiting, abdominal pain, and lethargy.
Patient Data
Left ventricle:
dilated cavity: end-diastolic left ventricular diameter: ~6.3 cm
no thrombus
normal left ventricular wall thickness.
impaired systolic function LVEF: ~14%,
global left ventricular wall hypokinesia
diastolic dysfunction (grade 2): pseudo normal relaxation pattern with elevated left ventricular end-diastolic pressures (LVEDP) average E/e': 25.1
Right ventricle:
dilated, basal diameter:~ 4.9cm with impaired systolic function
TAPSE: 1.49 cm
tissue Doppler imaging systolic velocity (TDI S'): 9.08cm/s
Interventricular septum: intact
Atria:
left atrium: dilated, area: 26.9 cm2, LAVI: 43.2 mL/m2
right atrium: dilated, area: 29.4 cm2
Aortic valve:
normal tricuspid
no aortic regurgitation
Mitral valve:
moderate mitral regurgitation
Tricuspid valve:
severe eccentric tricuspid regurgitation
Additional findings:
mildly elevated pulmonary pressures (estimated sPAP ~45 mmHg)
dilated IVC with < 50% inspirational collapse, dilated hepatic veins
mild pelvic ascites noted (not shown)
Case Discussion
Dilated cardiomyopathy (DCM) refers to left ventricular dilatation with systolic dysfunction, not sufficiently explained by abnormal loading conditions or coronary artery disease (CAD) 1. Mitral regurgitation in this case is secondary to the DCM.
DCM is caused by both genetic and nongenetic factors, including inflammatory and infectious causes, toxins, storage diseases, endocrinopathies, and tachyarrhythmias 1-3.
Multiple imaging modalities can be used to determine LV measures to diagnose DCM 1-3. Both M-mode and 2-dimensional echocardiography are frequently used to estimate the internal dimensions of the left ventricle in systole and diastole.
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