A 47-year-old woman with a history of hypertension treated with losartan and hormone replacement therapy.
She presented with a 3-month history of progressive deterioration of her functional capacity, which led to dyspnea on minimal exertion and was hospitalized.
On admission, the patient had signs of poor peripheral perfusion, dyspnea and evident loss of muscle mass.
The segmental examination showed the presence of engorged jugular veins, regular rhythm at 3 times per R3 and mild murmur of mitral regurgitation, crypts in both lung bases, lower costal liver 2 cm.
The admission exams showed: hemoglobin 12.8 g/dL, albumin 3.0 g/dL, creatinine 1.8 g/Dl, SGOT: 24 U/L. A peripheral vascular catheter di900 cm was installed.
Treatment was initiated with nitroglycerin and intravenous diuretics with regular response, so dobutamine was added at low doses.
Echocardiography showed a dilated left ventricle (diastolic diameter [DD J : 76; systolic diameter [DS J : 71 mm) with thinned walls, left ventricular ejection fraction (LVEF) of 17%.
Mitral regurgitation and severe tricuspid regurgitation with systolic pulmonary artery pressure of 60 mmHg were also described.
Coronary angiography showed no coronary artery lesions.
1.
The patient improved and was discharged with conventional medical therapy with converting enzyme inhibitors, betablockers, progressive nausea and diuretics.
During the five months she presented at least 3 hospitalizations for heart failure without a clear body mass index (15.9), appearing last month a history of liquid depositions without pathological elements, intermittent and significant weight loss (39.7 kg).
In view of the above, a circular fold was diagnosed with celiac disease requesting antiendomysial antibodies (indirect immunofluorescence). The result was positive in dilution 1/2.5 and serum IgA 543 mg/dl.
The biopsy was compatible with celiac disease.
A gluten-free diet was started with which the patient rapidly improved her functional capacity (FC) reaching FC I after one month, also presenting a progressive weight gain.
A control echocardiogram showed normal left ventricle size (DD: 48; SD: 29 mm) with normal systolic function (LVEF 64%) and absence of mitral and tricuspid regurgitation.
