43 year old active 6'-3", 237 lb male with regular yearly physicals. Totally asymptomatic (no lightheadedness or passing out). Regularly plays tennis, jogs 3 miles, or stairsteps for 40 minutes on an every other day basis.
1. Dilated Cardiomyopathy with left ventrical ejection fraction of 35-40% (evidently within the last two years since last EKG was normal).
2. Bradycardia with sleeping rate as low as the high-20s to mid-30s. Normal heart active heart rate of mid-50s to low-60s.
3. Left Bundle Branch Block, resting and throughout full treadmill stress test.
4. Coronary Catheterization reveals no coronary artery disease and no apparent scar tissue. Heart biopsy not taken.
1. 5mg Lisinopril and 325mg enteric coated aspirin daily.
2. Return for another echocardiogram in 1 month to determine if the condition is improving, stable, or deteriorating.
Patient is described by his peers as a heavy social drinker, daily drinker of large amounts of strong coffee, with a documented history of low potassium levels. What, if any, is the link between dilated cardiomyopathy and alcohol, caffeine, or potassium? Is abstinance from alcohol and caffeine and/or daily potassium supplements likely to show improvement at the 1-month retesting point? If so, how much (likely vs. potential)? If not, what about over the longer term?
You would definitely want to stop alcohol consumption altogether. There is no question that alcohol can lead to cardiomyopathy. Sometimes, though not always, the damage is reversible with abstinence. On the other hand, continued drinking almost always leads to deterioration of heart function. I would recommend cuttin back on the caffeine also, though this is not linked to cardiomyopathy. A low potassium can be seen in certain conditions that predispose to high blood pressure (which can lead to cardiomyopathy) - if this is the case, the condition needs to be treated specifically, not just with potassium supplementation.
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