Heart failure caused by restrictive cardiomyopathy. Role of integrated

diagnostics for the etiologic diagnosis

Dott. Cosimo CommissoU.O.C. Cardiologia – UTICPoliclinico Casilino , Rome - Italy

Disclosure

I have no actual or potential conflict of interest in relation to this

presentation

Clinic case

Woman, 43 years oldDiabetes mellitus Repeated hospitalizations for congestive

heart failure, on one occasion complicated by cardiac arrest

Previous diagnosis of myopathy with EMGCame to our attention for recurrent heart

failure complicated by state anasarcatico

Diagnosis of myopathy with EMG

Blood testsThrombocytopeniaHyperbilirubinemia (previous diagnosis of Gilbert's

syndrome )Proteinuria

ELECTROCARDIOGRAMBAV I°- Low voltage QRS

MONITORING ECG-graph repeated episodes of NSVT

BAV I°- Low voltage QRS

ECHOCARDIOGRAM

CARDIAC MRI with contrast medium

MORE CLINICAL INVESTIGATIONS

LABORATORY TESTSØ CK-MB negative

Ø Immunofixation SERUM and URINE Negative

LET'S PUT ALL TOGETHER...● Restrictive Syndrome

• Restrictive Syndrome • AV conduction disturbance• Signs of myopathy with EMG

ENDOMYOCARDIAL BIOPSY

AND NOW?