A 20-year-old man with no known morbid history.
The patient had a 3-day history of odynophagia, dry cough, precordial and dorsal pain associated with dyspnea at rest.
Located in a primary care center where a chest X-ray was requested, highlighting great cardiomegaly and signs of pulmonary congestion.
Physical examination and chest X-ray three years ago showed no abnormalities.
1.
The patient was referred to a tertiary care center on the fourth day of evolution.
He was hemodynamically stable.
Electrocardiogram (ECG) showed intermittent atrial tachycardia, initially treated with amiodarone.
1.
He was admitted to our service with tachycardic (84/56 mmHg), tachycardic (116 beats per minute, irregular), respiratory distress, respiratory rate of 18 per minute and 92% perfused with environmental oxygen.
The pharynx was somewhat red, jugular and engorged.
No pulmonary congestion and cardiac examination showed third heart sound and gallop rhythm.
Extremities without edema.
Laboratory tests revealed mild leukocytosis, low CRP, cardiac enzymes and normal troponin levels.
The echocardiogram performed in our unit showed severely dilated left ventricle (LV) (74 mm) with severe global diastolic dysfunction [ejection fraction (EF): 20%], diffuse hypokinesia, type III IV dysfunction.
The LA was 49 mm, with right ventricular systolic dysfunction, mild dilation of the right cavities and moderate pulmonary hypertension.
1.
Cardiac magnetic resonance imaging concluded cardiomyopathy with no signs of fibrosis or necrosis and severe systolic dysfunction.
The patient remained tachycardic, low blood pressure, under treatment with angiotensin converting enzyme (ACE) inhibitor and low-dose beta-blocker.
Within the requested study: normal thyroid function; HBV (-), HCV (-), HIV (-), cytomegalovirus (-), IgM Mycoplasma pneumoniae (+) was treated for 5 days.
Endomyocardial biopsy confirmed nonspecific changes consistent with cardiomyopathy, with no evidence of active inflammatory disease.
The ECG Holter showed incessant atrial tachycardia over 90% of the time.
The diagnosis of tachycardiomyopathy was proposed.
Treatment with amiodarone, bisoprolol and digitalis was not effective in the management of tachyarrhythmia.
It was decided to map and ablation of incessant atrial tachycardia using the EnSite NavxTM system.
Focal ablation was identified and performed in association with the superior vena cava and right superior pulmonary vein, converting to sinus rhythm with 85 beats per minute.
She was discharged 21 days after admission.
In subsequent controls it was maintained in functional capacity I, sinus rhythm, with heart rate around 70 beats per minute, regular and normotensive.
At 3 months after ablation, the echocardiogram showed marked reduction in cardiac chambers with improvement in LV systolic function and minimal mitral regurgitation.
At 6 months the patient is in functional capacity I and the echocardiogram is normal limit with normal chest X-ray.
