Diagnostic Dilemma - Pediatric Oncall
Dilated Cardiomyopathy
Author: Pediatric Oncall
A 5 month old girl born of non consanguineous marriage presented with cough and cold since 1½ months of age and breathlessness with suck-rest-suck cycle since 2½ months of age with gradual increase in symptoms. There is no fever or cyanosis. On examination, heart rate was 140, min with good volume pulses, normal blood pressure. There was cardiomegaly with a systolic murmur at apex. Other systems were normal. Echocardiography showed dilated left atrium and ventricle with severe mitral regurgitation and fractional shortening of 15 percent and ejection fraction of 30 percent suggestive of dilated cardiomyopathy. Her CPK was 52 IU, L with CPK-MB, CPK ratio of 2. Her CBC, liver function tests, calcium was normal.
Answers of this discussion
Author :- richa sharma on 06 June 2012.
Answer :- congenital thiamine deficency

Author :- koutha rama on 07 June 2012.
Answer :- Primar carnitine deficiency

Author :- Ramboncash on 08 June 2012.
Answer :- 1} Post viral myocarditis 2} Hypocalcemic {ca,P, ALP}.

Author :- sarah Ashour on 09 June 2012.
Answer :- post viral myocarditis

Author :- margot anderson on 09 June 2012.
Answer :- Would expect thiamine deficiency to present more acutely, but of course a dose of IM B1 would be an inexpensive and non-toxic thing to try. Most likely this infant has post-viral myocarditis or a congenital cardiomyopathy. Would think the former would have the better prognosis. I think I would try afterload reduction {ACE inhibitor} and furosemide. Challenging case!

Author :- mani srinivasan on 09 June 2012.
Answer :- idiopathic

Author :- Nagla Elhag on 10 June 2012.
Answer :- Genetics

Author :- boda ramesh on 10 June 2012.
Answer :- viral myocarditis

Author :- vyomesh vyas on 10 June 2012.
Answer :- fibro-elastosis

Author :- rafik lamiy on 10 June 2012.
Answer :- viral myocarditis

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