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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 52-53

A Case Report of Reversible Dilated Cardiomyopathy


Department of Medicine, Sri Aurobindo Medical College, Indore, Madhya Pradesh, India

Date of Web Publication17-Jun-2014

Correspondence Address:
Abhishek Singhai
Department of Medicine, Sri Aurobindo Medical College, Sanwer Road, Indore - 453 555, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449x.134584

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  Abstract 

Dilated cardiomyopathy (DCM) is mostly an idiopathic disease with a progressive and irreversible course. It carries poor prognosis and outcome. Rarely, a reversible metabolic etiology that is amenable to specific therapy is identified. Alteration in thyroid status can lead to changes in systolic and diastolic function of left ventricle. Heart is sensitive to thyroid hormone changes, and cardiac disorders are commonly associated with both hyper and hypothyroidism. Diastolic dysfunction is the most common abnormality reported in hypothyroidism. In systolic function, prolonged systolic time interval or normal cardiac function has been reported by most workers. DCM is a rare presentation of hypothyroidism. Here, we report a case of 40-year-old female diagnosed with DCM due to hypothyroidism

Keywords: Diastolic dysfunction, dilated cardiomyopathy, hypothyroidism


How to cite this article:
Singhai A. A Case Report of Reversible Dilated Cardiomyopathy. Heart India 2014;2:52-3

How to cite this URL:
Singhai A. A Case Report of Reversible Dilated Cardiomyopathy. Heart India [serial online] 2014 [cited 2019 Jul 18];2:52-3. Available from: http://www.heartindia.net/text.asp?2014/2/2/52/134584


  Introduction Top


Dilated cardiomyopathy (DCM) is an idiopathic condition that results from impaired ventricular systolic function, leading to progressive cardiac remodeling and dilatation. [1] A reversible form of DCM can develop due to alcohol use, pregnancy, chronic uncontrolled tachycardia, hypothyroidism, hyperthyroidism, drug use, and other endocrine dysfunctions. [2],[3] We report a case of 40-year-old female patient with DCM with primary hypothyroidism.


  Case report Top


A 40-year-old female presented with history of progressive dyspnea for the past 1 year. She also had swelling of both lower limbs for the past 1 year. There was no history of fever, joint pains, chest pain, cough, loss of weight, or loss of appetite. She was admitted to hospital with these complaints. Her blood pressure was 110/70 mm Hg, pulse 88/min. Her apex beat was in sixth intercostal space in anterior axillary line. S1 and S2 were normal; left ventricular S3 was present. There was no murmur. There was no hepatomegaly. Her routine blood investigations including complete blood count, liver function test, and renal function test were normal. Her chest X-ray showed cardiomegaly [Figure 1], electrocardiography (ECG) showed low voltage, and 2D echocardiography showed DCM, moderate mitral regurgitation (MR), mild tricuspid regurgitation (TR), and ejection fraction (EF) of 15% [Figure 2]. There was no pericardial effusion. She was diagnosed as a case of DCM based on ECG, chest radiograph, and echocardiography. She was put on digoxin, angiotensin converting enzyme inhibitor (ACE I), and diuretics. Patient had mild relief after the aforementioned treatment.
Figure 1: Chest X-ray showing cardiomegaly

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Figure 2: Echo image showing dilated heart chambers

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She was further advised thyroid function tests (TFT). She had severe hypothyroidism with thyroid-stimulating hormone (TSH) >100 mU/l. She was started on tablet thyroxine 25 μg/day in addition to the therapy she was receiving for DCM, which was increased to 50 μg/day after 2 weeks. She started having symptomatic improvement. TFT repeated after 3 months still showed evidence of hypothyroidism and dose of thyroxine was increased to 100 μg/day. Repeat echo done after 6 months showed EF of 40%. Her digoxin and diuretics were omitted, and she was continued on ACE I. Subsequently, TFT and EF were normal on repeated testing. Now, she is off all drugs except thyroxine for the past 1 year, and she is well controlled on thyroxine 100 μg/day and is symptom free.


  Discussion Top


DCM, by definition, is decreased overall contractility of heart of idiopathic origin. It is irreversible and is slowly progressive. Hyperthyroidism, drugs, or other endocrine dysfunction are some of the causes of reversible DCM. [2],[3],[4]

It has been recognized for several decades that thyroid hormones exert direct cellular effects on almost all tissues of the body including heart. The available data suggest that effects of thyroid hormone on heart are primarily via a change in protein synthesis. Some abnormalities of cardiac function in patients with thyroid dysfunction directly reflect the effects of thyroid hormone on calcium-activated adenosine triphosphatase (ATP ase) and phospholamban, which are involved primarily in the regulation of systodiastolic calcium concentrations in cardiomyocytes. Sarcoplasmic reticulum calcium-activated ATP ase is responsible for the rate of calcium reuptake into the lumen of the sarcoplasmic reticulum during diastole that, in turn, is a major determinant of the velocity of myocardial relaxation after contraction. Bradycardia, systemic hypertension, with narrow pulse pressure and slightly increased mean arterial pressure, and some degree of exercise impairment are the most common findings in patients with overt hypothyroidism. [5]

Most consistent cardiac abnormality recognized in patients with overt hypothyroidism is impairment of left ventricular (LV) diastolic function, which is characterized by slowed myocardial relaxation and impaired early ventricular filling. [6] LV systolic function is only marginally subnormal.


  Conclusion Top


In conclusion, the present report and the previous ones should alert the clinician to consider hypothyroidism also as one of the possible causes of DCM.

 
  References Top

1.Kantharia BK, Richards HB, Battaghia J. Reversible dilated cardiomyopathy: An unusual case of thyrotoxicosis. Am Heart J 1995;129:1030-2.  Back to cited text no. 1
    
2.Khochtali I, Hamza N, Harzallah O, Hamdi S, Saad J, Golli M, et al. Reversible dilated cardiomyopathy caused by hypothyroidism. Int Arch Med 2011;4:20.  Back to cited text no. 2
    
3.Derish M, Eckert K, Chin C. Reversible cardiomyopathy in a child with Addison's disease. Int Care Med 1996;22:460-3.  Back to cited text no. 3
    
4.Danaher PJ, Cao MK, Anstead GM, Dolan MJ, DeWitt CC. Reversible dilated cardiomyopathy related to amphotericin B therapy. J Antimicrob Chemother 2004;53:115-7.  Back to cited text no. 4
    
5.McAllister RM, Delp MD, Loughlin MH. Thyroid status and exercise tolerance. Cardiovascular and metabolic consideration. Sport Med 1995;20:189-98.  Back to cited text no. 5
    
6.Ladenson PW, Sherman SI, Baughman KL, Ray PE, Feldman AM. Reversible alterations in myocardial gene expression in a young man with dilated cardiomyopathy and hypothyroidism. Proc Natl Acad Sci U S A 1992;89:5251-5.  Back to cited text no. 6
    


    Figures

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