Dilated Cardiomyopathy Due to Alimentary Iron Deficiency

Abstract

Dilated cardiomyopathy (DCM) is a severe condition, characterised by left ventricular dilation and systolic dysfunction, necessitating heart transplantation when all other treatment options fail. This case report describes a 2-year-old girl initially presenting with oedema, listlessness, and severe iron deficiency anaemia. She was diagnosed with DCM. Extensive diagnostic workup ruled out other causes, leading to the suspicion of DCM due to alimentary iron deficiency. This was confirmed by the parents' report that the girl was fed almost exclusively with low-fat cow's milk. Prompt treatment, including packed red cell transfusion, iron supplementation, and heart failure medications (diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists), resulted in significant improvement in cardiac function within days. This report demonstrates the potential risks of alimentary iron deficiency, the most common cause of microcytic hypochromic anaemia in young children, which might even result in the development of life-threatening cardiac dysfunction in extreme cases.

Keywords: anaemia; cardiomyopathy; iron; nutrition; paediatric cardiology.

Figure 1

Electrocardiogram showing sinus rhythm, time intervals in the normal range, prominent Q-waves in III, aVF, and V6.

Figure 2

Chest X-ray on admission: cardiac silhouette is clearly enlarged (HTQ 0.64).

Figure 3

Echocardiography on admission: left ventricle is significantly enlarged (LV enddiastolic diameter of 4.68 (Z-score +4.7) and reduced systolic function (EF 48.6%).