Dialated Cardiomyopathy Anaemia - post viral

[udeshmane]

hello,

My father who is 65 years old and lives outside US, non diabetic, non hypertensive, is  suffering from Post viral dialated cardiomyopathy.

Patient was healthy before May 1999. He had high fever & severe bronchitis leading to CCF & cardiomegaly. He was in hospital for 20 days and was treated by cardiologist.
Diagnosed as Dialated Cardiomyopathy Anaemia.

At that time his EF was 30 but after the treatment invlving medicines he recovered remarkably in a month. Xray showed normal size of heart. After three months, in the month of July 1999 patient went to other city for angiography by expert cardiologist. Angio report was normal, hence he suggested to stop the medicines after three months consulting local cardiologist. In July-1999 the EF return went up to 40.

FINAL IMPRESSION by doctor in May-1999:

DILATED LEFT VENTRICLE WITH GLOBAL LV HYPOKINESIA
MODERATE  LV  DYSFUNCTION
NORMAL VALVES, INTACT SEPTAE, NO THROMBUS,
Normal coronary arteries

This is past history. Patient took the medicines for about a year and stopped medicines after consulting his physician. All the reports are attached at the bottom after my questions.

Latest Problem:
---------------

Since 1st December 2000, patient had some digestive problems. It started with flatulence & restlessness. Gradually abdominal distension increased around 10th December 2000, urine output was reduced . Patient became restless, insomnic. There was no chest pain, no dyspnoea. When patient was admitted to hospital on 13th December 2000, he was in gross CCF, liver was palpable 4 fingers.
Urine output was very less.
Patient was given diuretic & other necessary medicines, ECHO was done and it was diagnosed as DIALATED CARDIOMYOPATHY. Echo showd that LA & LV are dilated with impaired LV function LVEF=29% and  LA:RA & RV are of normal size, normal valves, generalised hypokinesia was noted, no clot or vegetation, Normal pericardium. Doppler study showed Grade II Mitral regurgitation with Grade II tricuspid regurgitation with pulmonary hypertension (PAT =0.040 sec).

The cardiologist has advised very limited physical activity and the medicine treatment involving following..

Tab Cardivas bd      (carvedilol 3.125mg)
Tab Aldactone od      (spironolalctone 25mg)
Tab Lasix40mg od (frusemide 40 mg)
CAP Ramace bd (ramipril 1.25mg - ACE inhib)
Tab Nucarnit tid (levocarnitne 330mg)
Tab Lanoxin od (digoxin 0.25mg)
Cap UbiQ tid (Coenzyme Q10 30 mg)
Tab Zoloid hs (alprazolam 0.25mg)
Cap FULL 24 od (Ginkgo biloba extract 60mg & ginseng extract 42.5mg)
Cap Omez od (omeprazole 20mg)

My father does not live in this country, so the terms used for medicines could be different. The cardiologist is going to increase the dosage of Carvedilol slowly.

The patient has shown considerable improvement in last month, his heart x-ray has come out normal with lever related problems almost gone. Overall he is feeling a lot better in every aspect.

Please advise on following -

- Why did the Dialated Cardiomyopathy re-appear after 18 months?
  Is it because the medication was stopped too
  early last time or is it because he started his
  normal physical activities too early?
- Is the treatment that he is getting good?
  Do you suggest any changes to it?
- What type of precautions should he be taking?
  Any restrictions on his physical activity, fluid intake
  and food habits?
- What are the chances of this problem re-occuring?
- What's the prognosis? What should be his EF?

--------------------------
If you need details about various reports I have written them below:

Reports from May-1999:
----------------------

Treatment given at that time -

Tab cardone 100 mg od
Tab Lanoxin 0.25 mg 1/2 od
Tab Tobar 25 mg bd
Tab Amifru 1/2 od

Other report at that time (May-1999):

BSL - 99 mg/dl
Serum Creatinine1.1 mg/dl
Creat phospo kinease MB 34.0 IU/L (High)
Serum Sodium 134 mm ol/L (Low)
Serum Potassium 3.4 mm ol/L (Low)
Serum Chlorieds 108.0 mm ol/L
ESR 90 mm (one hour)
Hb 9.4 gm

Echo cardiography report from May-1999:

RVID 18 mm MVEPSS 20mm
IVS 09 mm MVDE 17mm
LVID-d 57mm MVEF Normal
LVPW 09mm AO 24mm
LVIDS 49mm LA 38mm
FS% 14% AORTIC ANNULUS
EF 30%

MITRAL VALVE    NORMAL
AORTIC VALVE NORMAL
TRICUSPID VALVE NORMAL
PULMONARY VALVE EF FLAT NO "A" WAVE
LEFT VENTRICLE DILATED NEAR RIGHT VENTRICLE DILATED
GLOBAL HYPOKINESIA
LEFT ATRIUM DILATED
RIGHT ATRIUM DILATED
PULMONARY ARTERY DILATED
AORTA NORMAL
PERICARDIUM NORMAL
IAS NORMAL
IVS NORMAL

ANGIOGRAPHY REPORT  from 28th July 1999:

LMCA is normal
Cricumflex is 2.5 mm smooth walled artery OM2 and PL are large
LAD is 2.5 mm sized smooth walled artery D2 is large
RCA is 2 mm sized smooth artery with smooth PD.

Reports after current problem in December-2000:
-----------------------------------------------

ECHO Report:

1. LA & LV are dilated with impaired LV function LVEF=29%
   LA:RA & RV are of normal size
2. Normal Valves
3. Intact septae. Generalised hypokinesia is noted
4. No clot or vegetation is noted
5. Normal pericardium
6. Doppler study shows Grade II Mitral regurgitation with Grade II tricuspid regurgitation
With pulmonary hypertension (PAT =0.040 sec)

A Valves observd values Normal (For Adult)
Mitral Valve
Anterior Leaflet
Appearance Thin
EF Slope 132 mm/sec 80-150 mm/sec
DE Amplitude 20mm 2-7 mm
E-PSS 22mm
"A" Wave Normal

Posterior Leaflet
Appearance Thin
Motion Normal

Others
MV area Normal
Cooption Maintained

2 . Tricuspid Valve
Appearance Thin
Cooption Maintained

3. Pulmonary Valve
Appearance Thin
EF Slope 12mm/sec 6-115 mm/sec
"A" wave 1 mm

4. Arotic Valve
Structure Thin
Cuspal separation 18mm 15-26 mm
Eccntricity Index 1mm
Closure Line Central

B Dimensions Observd (MM) Normal (for Adult)
1. Arotic root 29mm 20-37 mm
2. Left atrium 40mm 19-40mm
3. Left ventricle
D 63 mm 35-57 mm
S 22 mm 7-26mm
4. RV-D 22mm 7-26mm
5. IVST(D) 6mm 6-11mm
6 LVPWT(D) 6mm 6-11 mm

C Motion
1.IVS 2mm 3-8 mm
2.LVPW 3mm 5-14mm

D LV Volumes
1. EF% 29%
2.FS% 14%

E Wall Motion abnormality Generalised hypokinesia is noted

F Percardium Thin &Normal

BIOCHEMISTRY Report:

Test Result Normal

Blood Urea 40mg/dl
Serum Creatinine 1.42mg/dl high 0.9-1.4 mg/dl
Serum Proteins 7.1gm/dl
Serum Albumin 4.0 gm/dl
Serum Globulins 3.1gm/dl
A/G Ratio 1.29 :1

Urine report  - Normal

COMPLETE BLOOD COUNT

Haemoglobin 10.6 gm/dl Low
Erythrocytes 3.14mils/c.mm Low
Haematocrit 25.7% Low

Leucocytes 11,800 per c.mm High

Differential Count
Mature Neutrophils 73% High
Eosinophils 03%
Basophils 00%
Lymphocytes 20%
Monocytes 04%

Plateletcrit 0.330 % High

Periph. Smear Study Normocytic Hypochromia
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I appreciate the services that you are providing. And sincere thanks for it.

With regards.

[udeshmane]

Can other people who have similar problem share their information by posting/replying to this message.

Thanks.

[CCF CARDIO MD - DLB]

- Why did the Dialated Cardiomyopathy re-appear after 18 months?
Probably the dilated cardiomyopathy was never really "cured" but the medicines were just suppressing the symptoms. I do not think it is due to starting his physical activities too soon.
- Is the treatment that he is getting good?
The medical treatment he is getting is good, though doses will need to be increased slowly. I see no role for the non-prescription medications such as the CoEnzyme Q.
- What type of precautions should he be taking?
He should avoid salt and monitor his fluid intake and weight daily.
- What are the chances of this problem re-occuring?
Very likely to recur if all medications are stopped.
- What's the prognosis? What should be his EF?
The prognosis depends on his response to medications. If he respons well in terms of his symptoms, then the prognosis is reasonably good - if his symptoms do not improve on medications, then the prognosis is very poor. A normal EF is at least 55%, but this number is much less important to follow than his symptoms.