Diagnostic Dilemma

Dilated Cardiomyopathy

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.

What could be the cause of dilated cardiomyopathy_?
Expert Opinion :
More details added to the case:

Her serum ammonia was 202, blood gases and random blood sugar were normal. Any more possiibilities_?
Answer Discussion :
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