Interesting Case Rounds Gabriel Piper March 3 rd , 2011

1. Interesting Case RoundsGabriel PiperMarch 3rd, 2011

2. 38 yo M Sent in from WIC with Chest Pain

4. 105,110/70, 20, 87% RA 95% 4 L JVP 5 cm, S3, Apex beat sustained and displaced laterally Crackles heard in bases bilaterally No leg edema, tenderness or erythema

5. Hgb 180 plts 199 WBC 12.2 Lytes Normal Cr 128 Glucose 6.7 TnT neg D-dimer 0.73

8. Differential Diagnosis….

10. Dilated Cardiomyopathy

11. Causes of DCM • Familial • Chronic excessive alcohol consumption • Other drugs • Heavy metals • Emetine • Anthracyclines (daunorubicin and doxorubicin) • Cocaine • Methamphetamine • Cobalt • Infections • Viral endocarditis/myocarditis (coxsackievirus, adenovirus, parvovirus, human immunodeficiency virus [HIV]) • Parasites • Protozoa • Chagas disease (most common cause in parts of South America) • High-output states • Anemia • Thyrotoxicosis • Pregnancy • Collagen vascular disease • Glycogen storage disease, type IV also known as Andersen disease • Thiamine deficiency and zinc deficiency • Hypophosphatemia • Amyloidosis • Neuromuscular disorders (Duchenne/Becker and Emery-Dreifuss muscular dystrophies) • Pheochromocytoma

12. Anabolic steroids as a possible cause of DCM?

13. Anabolic Steroids

16. Back to our case….