Q- A 65-year-old farmer presents to your clinic complaining of shortness of breath for 6 months. Last 2 weeks he noticed that he must get up several times during the night to be able to breathe. He proudly tells you that he had never visited a doctor before although he smokes and drinks every night. On physical examination, there is a displaced point of his maximum impulse, rales over both lungs, and an enlarged liver. Echo shows both right and left ventricular dilation and EF 30%. Laboratory tests are normal except for high bilirubin, AST 245, and ALT 180.
What is the initial cause of this patient presentation?
A-Smoking
B-Alcohol
C-Lyme disease
D-Chronic hypertension
E-High cholesterol
Answer:
This man’s symptoms are due to heart failure caused by long-term alcohol use. He has been drinking every night for years, and alcohol can slowly damage the heart muscle. Over time, the heart becomes weak and enlarged, which makes it unable to pump blood properly. That explains his shortness of breath, the need to sit up at night to breathe, the crackles heard in his lungs, and the enlarged liver caused by blood backing up. His echocardiogram shows both sides of the heart are dilated with a low ejection fraction of 30%, which means poor pumping ability. The elevated liver tests, including AST, ALT, and bilirubin, also support alcohol-related injury.
Smoking mainly affects the lungs and arteries, Lyme disease does not cause this chronic pattern, high blood pressure makes the heart thick rather than weak, and high cholesterol leads to blocked arteries, not this type of heart failure.
In summary, his condition is best explained by chronic alcohol use that weakened his heart muscle and led to dilated cardiomyopathy.
The correct answer is B
It could be chronique smoking wich lead to a BPCO and then to a right heart failur and cardiac cirrhosis .
The similar signs on both ventricles are unique to cardiomyopathy. In cor pulmonale, congestive heart failure would be different in which the right ventricle is dilated while the left ventricle is the same or even lower size.
Why can’t it be cor pulmonale?
This is true. Thank you Ajay
The points goes against Htn are:
No LV hypertrophy on Echo is the single most factor which goes against hypertension being the aetiology.!
It could be chronic hypertension but the history of drinking every night and the acute condition of left and right ventricular dilation lean towards cardiomyopathy. Thank you for your great question.
Why it can’t be chronic hypertension ?
Hypertensive heart disease leading to cardiomyopathy with CCF leading to Congestion of liver and Cirrhosis causing raised AST and ALT.