CASE OF DILATED CARDIOMYOPATHY WIYH SHOCK

CASE OF DILATED CARDIOMYOPATHY ADMITTED WITH SHOCK AND ACUTE LVF

1. CASE 1

2. 16Y/ female, Newly Diagnosed with DCMP Presented with c/o – Dyspnea on exertion 3 days prior to admission Progressed to at rest over next 2 days Clinical presentation

3. Onset duration and progress:- Patient was apparently alright 3 days ago when she started developing dyspnea on exertion which was NYHA Class II initially…. The dyspnea progressed over next 24 hours to Class III and then to class IV… Patient also gave history of Per rectal bleeding during defecation along with pain in abdomen since last many days.

4. Referred from a Private hospital at Morgaon… Patient or the relatives didn’t give any history of ….. No c/o cough /cold/fever No c/o chest pain /palpitation/sweating/ bluish discoloration of skin No c/o pedal edema/decreased urine output No significant history suggestive of rheumatic heart disease or congenital heart disease

5. On examination: Pt was conscious and oriented Afebrile Vitals P :140/ min regular, equal on both sides Bp:90/60 mm Hg Spo2: 96% on 2 lit O2 on nasal prongs Neck veins distended Pallor + + Icterus + Koilonychia + No cyanosis/clubbing /edema /lymphadenopathy

6. Systemic examination CVS: S3 gallop heard CNS: conscious and oriented RS: b/l basal crepitations + PA :soft ,hepatosplenomegaly +

7. ELECTROCARDIOGRAM Sinus tachycardia Occasional vpc’s LV strain

8. INVESTIGATIONS Outside 2D ECHO: Dilated cardiomyopathy with EF =20% Moderate MR /TR USG (A+P) B/L pleural effusion Bilateral small kidneys

9. CBC AND SERUM ELECTROLYTES PERIPHERAL BLOOD SMEAR Hb (11-13)gm% 4.7 7.1 TLC(4-10 )*10 3 13.8 31.26 Plt(1.5-4.5) 10 5 419 438 MCV (75-100)FL 49 53 MCH(27-33)pg. 11 14 Na(135-145)mEq/L 139 133.5 K(3.5-4.5)mEq/L 4.5 2.61 Urea(7-20)mg/dl 34.3 42.9 Creat(0.59-1.04) 0.65 0.81 BT(0.1-1.2)mg/dL 0.76 4.17 BD(0-0.2)mg/dL 0.26 1.14

10. MANAGEMENT On admission patient was in shock with bp of 90/60 mmHg and being Managed in MICU Patient was started on Inj dobutamine and inj Lasix drip Also peripheral blood smear s/o iron deficiency anemia Started on inj. Iron sucrose Tab ivabradine for tachycardia In due course of admission patients blood pressure remained persistent about 90/60 mm Hg , again dropped to 80/60 mmHg Blood pressure not improving on Dobutamine /Lasix infusion Shifted to noradrenaline and Lasix infusions

11. Patient in cardiac arrest CPR started with simultaneous intubation done After two cycles of CPR Monitor showed ventricular fibrillation DC shock with 150 j given Repeat ECG s/o sinus tachycardia with tall t wave Advised: Inj Calcium gluconate 10cc with inj D25+ 10 u insulin Inj MgSO4 2gm stat Started on inj amiodarone infusion

12. Patient again went into cardiac arrest Received CPR Despite all efforts of resuscitation Patient succumbed

13. CAUSE OF DEATH 1a. Cardiogenic shock 1b. Acute left ventricular failure 1c. Dilated cardiomyopathy 2. Iron deficiency anemia

14. Thank you!