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Título

Rheumatic Etiology of Heart Failure with rapid Progression: A Case-Based Update

Resumo

INTRODUCTION: Dilated Cardiomyopathy (DCM) is characterized by the dilation of the ventricles alongside a decrease in the heart's contraction performance. Patients with this condition experience impaired systolic function and may develop Heart Failure (HF). The diagnosis is given by an ejection fraction (EF) < 40% in the Echocardiogram (ECHO). In this report, we present a case of DCM with rapid progression and unidentified etiology.
CASE DESCRIPTION: A 43-year-old man with previously diagnosed hypertension, without a history of acute myocardial infarction, was diagnosed 2 months ago with HF, presented with paroxysmal nocturnal dyspnea, evolving to dyspnea NYHA class 3 and orthopnea in 2 months, progressing to NYHA class 4 a couple days before hospital presentation. The patient had pharyngitis treated with penicillin 2 years ago. The patient presented with Quincke’s sign and Corrigan’s pulse. Medications in use: losartan 50 mg; bisoprolol 5 mg; furosemide 40 mg; spironolactone 50 mg; rivaroxaban 20 mg. Initial assessment included an electrocardiogram revealing atrial fibrillation and an ECHO revealing a significant grade of DCM, aortic regurgitation with a rheumatic lesion and mitral regurgitation. The EF was 33%. The patient was admitted to the intensive care unit, awaiting a catheterization, which revealed the need for aortic valve replacement.
DISCUSSION: The estimate of DCM prevalence is 1:2700. Various disorders can lead to DCM, including ischemic causes, infectious diseases, inflammatory conditions and genetic factors. Ischemic cardiomyopathy is the main cause of HF and DCM globally, while Chagas disease is primary in South America. In this case, there were no DCM diagnoses in the patient's first-degree relatives. Ischemic and infectious causes have been ruled out, and the main hypothesis is a Rheumatic lesion, observed on the aortic valve. We were able to provide this diagnosis with the assistance of the ECHO, in addition to the patient's recent pharyngitis. Considering a rheumatic etiology for this case is challenging due to the low prevalence of rheumatic fever in adult males. What's concerning is the patient's rapid progression, with significant dilation within a short timeframe.
CONCLUSION: Although it's not a typical etiology of DCM in adult men, it's important to be aware of the possibility of this etiology to elucidate the current case. The diagnosis could have been made months earlier, leading to a better prognosis.

Palavras Chave

Cardiomiopatia Dilatada; Heart Failure; Cardiopatia Reumática

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