The case of this week is a patient with dyspnea on exertion , hepatosplenomegaly.The displaced point of maxiumal impulse indicates that the size of heart has changed.The Echocardiogram reveals dilated bilateral ventricular and low-LVEF.
Considering the symptoms and echo result,we can confirm that the patient gets congestive heart failure(CHF).
According to these,the first flash in our mind is 'Dilated Cardiomyopathy (DCM)',and the second flash is 'Alcoholic Cardiomyopathy (ACM)' because of he long-term alcohol consumption.
The most likely correct diagnosis is ACM.Because DCM's definition shows that all of the etiology reasons must be excluded.But in this case,according to the liver function tests,we can get one massage: alcoholic cirrhosis,in other word,chronic alcoholism.
So ,how to differntiate them? The clinical manifestaions of the two disease are very similar.The endomyocardial biopsy (EMB) has not enough specificity.However, ACM paients' heart function could recover partly after alchohol withdral in 6~8 weeks.
So the following principles of treatment can be used:
1.Compellent alcohol withdrawl
2.Standard CHF treatment
3.Liver protection treatment
4.Symptomatic treatment(Balance the electrolyte)
本病例由岚哥岚逸筠篁解析。
