Hi doctor, For the past 10 months, my wife (age 32 years) started developing symptoms of bronchitis (complaints of SOB and fatigue). Her feet and ankles started to swell and used to take Lasix (to treat edema) on SOS basis for the past seven months, which gave her temporary relief. Next month she underwent checkups (did chest X-ray, echo and ECG) and everything was normal with exception of sinus tachycardia (HR was 110+). and slight fatty changes in liver. The doctor also advised taking Hep-B vaccine (Engerix-B), for which she has taken two doses already and the next one is due in a month. Two months back, she traveled for a period of three weeks. There she suffered from acute breathlessness, stomach bloating, feet and ankle swelling, bloating of the stomach. She could barely lie down on her back. After visiting a gastroenterologist and a pulmonologist, she was advised to undergo USG-abdomen. The USG revealed ascites, bilateral pelural effusion. We saw a cardiologist and was advised to do echo, ECG and chest X-ray. The echo resulted in very poor LV EF (25 %) and dilated LV, LA. She is under medication (Cardivas 6.25, Vymada 100, Nexpro RD 40, Rivotril 0.25, Bevon]. She was also advised to undergo cardiac MRI. The MRI results were pretty much the same as echo (did not result in anything conclusive). Blood tests were also conducted (Na, K are normal, NT-PRO BNP is high 504 pg/ml, bilirubin is a little high 1.14). I want to get an opinion and advise on the below. The cause of dilated cardiomyopathy in such a young person. Is it viral infection? She did not have a fever. What is the treatment? Is the condition reversible? Will the dilation get back to normal?
Hi. Your wife has multiple issues including dilated cardiomyopathy and PCOS (attachment removed to protect patient identity). There are multiple causes of dilated cardiomyopathy including viral infections, pregnancy, familial and idiopathic, tachycardia, PVCs, amyloidosis in late stages, etc. Treatment is going well which you told. Carvedilol dose can be increased if heart failure condition allows, Vymada can also be increased upto 200 mg if BP allows, Lasix can be added and Spironolactone should also be started at 25 mg per day. Doses should slowly be uptitrated. Yes sometimes condition is reversible, but after one year chances of reversibility are rare. Then a device called ICD is implanted in the heart to prevent cardiac arrest or CRTd for heart failure symptoms and to prevent cardiac arrest. For PCOS, consult a gynecologist. Praying for your wife's health.