Reversible transition from a hypertrophic to a dilated cardiomyopathy. (9th December 2015)

• Record Type: Journal Article
• Authors: Spillmann, Frank; Kühl, Uwe; Van Linthout, Sophie; Dominguez, Fernando; Escher, Felicitas; Schultheiss, Heinz‐Peter; Pieske, Burkert; Tschöpe, Carsten
• Is Part Of: ESC heart failure. Volume 3:Number 2(2016)
• Page Start: 138
• Page End: 142
• Publication Date: 2015-12-09
• Subjects: Dilated cardiomyopathy -- Hypertrophic cardiomyopathy -- Transition of cardiomyopathy; Heart failure -- Periodicals; 616.129005
• DOI: 10.1002/ehf2.12072
• Languages: English
• ISSNs: 2055-5822

Abstract

Abstract: We report the case of a 17‐year‐old female patient with known hypertrophic cardiomyopathy and a Wolff‐Parkinson‐White syndrome. She came to our department for further evaluation of a new diagnosed dilated cardiomyopathy characterized by an enlargement of the left ventricle and a fall in ejection fraction. Clinically, she complained about atypical chest pain, arrhythmic episodes with presyncopal events, and dyspnea (NYHA III) during the last 6 months. Non‐invasive and invasive examinations including magnetic resonance imaging, electrophysiological examinations, and angiography did not lead to a conclusive diagnosis. Therefore, endomyocardial biopsies (EMBs) were taken to investigate whether a specific myocardial disease caused the impairment of the left ventricular function. EMB analysis resulted in the diagnosis of a virus‐negative, active myocarditis. Based on this diagnosis, an immunosuppressive treatment with prednisolone and azathioprine was started, which led to an improvement of cardiac function and symptoms within 3 months after initiating therapy. In conclusion, we show that external stress triggered by myocarditis can induce a reversible transition from a hypertrophic cardiomyopathy to a dilated cardiomyopathy phenotype. This case strongly underlines the need for a thorough and invasive examination of heart failure of unknown causes, including EMB investigations as recommend by the actual ESC position statement.