Cardiomyopathy in Children and Adolescents. Case Report

Dilated cardiomyopathy (DCM) is a common cause of heart failure (HF) and is the most common diagnosis in patients who undergo cardiac transplantation. DCM is characterized by dilatation and systolic dysfunction of one or both ventricles. Diagnosing the rare patient with cardiomyopathy in a child in the acute care setting is essential, but frequently such patients present with symptoms more commonly associated with other illness or disease. Case - The patient - 17-year-old B.G. - came to the emergency department with a complaint of epigastric area, vomiting, which was associated with eating pizza. It should be noted that 2 days before, the patient was hospitalized with the same complaint. Routine tests were performed. It was considered as food intoxication and discharged. In our clinic he had - HR-178'; T/A-107/70 mmHg; RR-27'; T-36.7 C; SatO2-96% weight-55kg.; Troponin I-9 ng/l.; ALT-65 U/L; AST-86 U/L. Tachycardia was the reason of referral to cardiologist. An echocardiogram demonstrated a severely dilated left ventricle, severely depressed left ventricular function, mitral and aortic regurgitation, he was noted to have a shortening fraction EF-16%. Patient was diagnosed with dilated cardiomyopathy and referred to specialized cardiological department. Unfortunately, he died before implantation of cardiac pacemaker (after 2 months). Early and accurate diagnosis of a child with heart failure can be a difficult task. There are no definitive tests for myocarditis or cardiomyopathy. The clinician must be alert for the possibility of heart failure in any patient, and should start with a thorough physical examination, paying special attention to presenting vital signs. The patient's heart rate may be a clue of underlying cardiac disease. Tachycardia is commonly seen and usually relates to fever, fear, or a pulmonary problem. However, tachycardia may also be seen in a failing heart with arrhythmias or decrease in ventricular contractility, causing poor cardiac output. Bradycardia is more rarely seen in the acutely ill patient and merits further evaluation for cardiac dysfunction. Patients with heart failure may present with a normal cardiovascular examination, but a careful survey can reveal important markers of cardiac disease. Abdominal pain can be a presenting symptom in patients with heart failure. Conclusion. Ultimately, diagnosing heart failure in the pediatric population begins with maintaining a high index of suspicion. Vital signs should be reviewed and potential diagnoses broadly considered. Additionally, physical exam should be thorough and directed. Only after the diagnosis is considered can additional testing help corroborate your diagnosis and lead the appropriate treatment. It is often difficult to make the diagnosis of heart failure if failure is not consciously considered as a possibility. Armed with knowledge and clinical suspicion, the astute physician will make this diagnosis hard to miss.