Interesting Case Rounds Gabriel Piper March 3 rd , 2011
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Interesting Case Rounds
Gabriel PiperMarch 3rd, 2011
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38 yo MSent in from WIC with Chest Pain
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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
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Hgb 180plts 199WBC 12.2 Lytes NormalCr 128Glucose 6.7TnT negD-dimer 0.73
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Differential Diagnosis….
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Dilated Cardiomyopathy
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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
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Anabolic steroids as a possible cause of DCM?
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Anabolic Steroids
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Back to our case….
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