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Aortic valve vegetations
11%
1/9
Asymmetric septal hypertrophy with ventricular outflow tract obstruction
Dilated ventricles with diffuse hypokinesia
0%
0/9
Idiopathic pulmonary arterial hypertension
78%
7/9
Mitral stenosis
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This patient presents with symptoms of heart failure (shortness of breath, lower extremity edema) following a recent upper respiratory tract infection, suggesting the development of post-viral dilated cardiomyopathy.Dilated cardiomyopathy results from myocardial damage caused by a variety of toxic, metabolic, or infectious insults. Viral or idiopathic myocarditis can follow Coxsackie B infection. Other implicated viruses include adenovirus, CMV, echovirus, hepatitis C, influenza, parvovirus B19, and EBV. The diagnosis is supported by echocardiogram, which shows dilated ventricles with diffuse hypokinesis resulting in a low ejection fraction. The cardiomyopathy in viral myocarditis can result from direct viral damage or from the immune response to persistent viral infection.King et al. review the diagnosis and evaluation of patients with heart failure. A displaced cardiac apex, an S3 gallop, and venous congestion or interstitial edema are useful findings. Echocardiography is the gold standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Incorrect Answers:Answer 1: Aortic valve vegetations may be observed in patients with infective endocarditis. This condition may present with a fever, cardiac murmur, and history of immunosuppression or IV drug use.Answer 2: Asymmetric septal hypertrophy with ventricular outflow tract obstruction would suggest a diagnosis of hypertrophic obstructive cardiomyopathy. This condition presents with exertional syncope or even sudden cardiac death often precipitated by exercise or dehydration.Answer 4: Idiopathic pulmonary arterial hypertension often presents in younger women and may cause symptoms similar to those of this patient such as dyspnea, chest pain, lower extremity edema, and reduced exercise tolerance. Right-sided heart failure may be seen.Answer 5: Mitral stenosis is almost exclusively caused by rheumatic heart disease. A diastolic rumbling murmur that radiates to the apex would be heard on exam.Bullet Summary:Dilated cardiomyopathy may occur as a sequela of viral infection and on echocardiogram would demonstrate dilated ventricles with diffuse hypokinesis.
4.9
(14)
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