The failing heart: a bad case of the 'flu'

Abstract

A 24-year-old Nepali man presented to hospital with a short history of feeling unwell with a flu-like illness. He subsequently went into acute renal failure requiring several sessions of renal replacement therapy by haemofiltration. The underlying aetiology of his renal failure was unclear. His renal function recovered following haemofiltration and he was discharged home with a plan for outpatient follow-up and investigations. He re-presented to hospital 6 days later with severe fluid overload. Echocardiogram was suggestive of impaired left ventricular systolic function; subsequent cardiac MRI confirmed this and was indicative of a dilated cardiomyopathy. A diagnosis of dilated cardiomyopathy with cardiorenal syndrome was made, most likely secondary to viral myocarditis in view of his initial presentation. He was diuresed and treated with prognostic medications for heart failure. His symptoms resolved and on subsequent outpatient review he was feeling well.

Figure 1

Repeat echo (as initial echo non-diagnostic due to poor views) showed dilated left ventricle (LV) with severely impaired LV systolic function. It is worth noting that there was poor endocardium definition and suboptimal image quality due to body habitus and fluid overload status.

Figure 2

Outpatient follow-up echo (after resolution of symptoms) showed considerable improvement in left ventricle (LV) systolic function with a non-dilated LV, consistent with the findings on cardiac MRI.

Figure 3

(A; diastolic view) Cardiac MRI acquired on index presentation reveal a dilated left ventricle (LV) with severely impaired LV systolic function with minimal change in end-systolic versus end-diastolic LV volume. (B; systolic view) Cardiac MRI acquired on index presentation reveal a dilated LV with severely impaired LV systolic function with minimal changes in end-systolic versus end-diastolic LV volume.

Figure 4

(A; diastolic view) Images from second cardiac MRI (during follow-up) show left ventricular two-chamber view with end diastole and end systole, respectively, with the improved left ventricular systolic function. (B; systolic view) Images from second cardiac MRI (during follow-up) show left ventricular two-chamber view with end diastole and end systole, respectively, with the improved left ventricular systolic function.