Interesting Case Rounds

Gabriel PiperMarch 3rd, 2011

38 yo MSent in from WIC with Chest Pain

105,110/70, 20, 87% RA 95% 4 L

JVP 5 cm, S3, Apex beat sustained and displaced laterally

Crackles heard in bases bilaterally

No leg edema, tenderness or erythema

Hgb 180plts 199WBC 12.2 Lytes NormalCr 128Glucose 6.7TnT negD-dimer 0.73

Differential Diagnosis….

Dilated Cardiomyopathy

Causes of DCM• Familial• Chronic excessive alcohol consumption• Other drugs

– Heavy metals– Emetine– Anthracyclines (daunorubicin and doxorubicin)– Cocaine– Methamphetamine– Cobalt

• Infections– Viral endocarditis/myocarditis (coxsackievirus, adenovirus, parvovirus, human immunodeficiency virus [HIV])– Parasites– Protozoa– Chagas disease (most common cause in parts of South America)

• High-output states– Anemia– Thyrotoxicosis– Pregnancy

• Collagen vascular disease• Glycogen storage disease, type IV also known as Andersen disease• Thiamine deficiency and zinc deficiency• Hypophosphatemia• Amyloidosis• Neuromuscular disorders (Duchenne/Becker and Emery-Dreifuss muscular dystrophies)• Pheochromocytoma

Anabolic steroids as a possible cause of DCM?

Anabolic Steroids

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