CONGRESS ABSTRACT

A 49-years-old alcohol addicted man was admitted for worsening exertional dyspnoea. No cardiovascular risk factors were reported. On physical examination vesicular murmur was reduced on the right hemithorax. BP was 115/78 mmHg and oxygen saturation in room air was 91%, hence oxygen therapy was started. Blood exams showed elevation of the inflammatory markers. A CT scan showed a massive right pleural effusion. An EKG highlighted a normofrequent synus rhythm with a new left bundle branch block. A transthoracic echocardiography (ETT) revealed a dilated LV with severe systolic dysfunction (EF 15%) due to a diffuse hypokinesia, a large thrombus adherent to the middle segment of the antero-lateral wall and a severe RV dysfunction. In the Cardiac Intensive Care Unit he was started on an LMWH and diuretics. The day after, he developed a global aphasia and right hemiparesis: an ischemic stroke due to the occlusion of the right median cerebral artery was diagnosed through a CT angiography and an emergency mechanical thrombectomy was performed. After clinical stabilization, a coronary angiography showed no significant coronary artery stenosis and a cardiac magnetic resonance confirmed the diagnosis of dilated cardiomyopathy with severe impairment of the biventricular function, without evidence of late gadolinium enhancement (LGE). A right heart catheterization was consistent with a condition of post-capillary pulmonary hypertension with reduced cardiac index. During the hospitalization, the patient was kept on anticoagulant therapy, meanwhile switched to a VKA. Several echocardiographic controls documented the thrombus resolution, while the systolic function remained severely compromised. Genetic test for hereditary dilated cardiomyopathy turned out negative, therefore a diagnosis of alcoholic cardiomiopathy was made. The patient was discharged on dapaglifozin,  as  beta-blockers, ARBs and MRA were not tolerated due to hypotension. One month later the EF was 20%, hence the patient was scheduled for an ICD implantation. Alcoholic cardiomyopathy represents a common cause of dilated cardiomyopathy. Clinicians should be well aware of the possible life-threatening complications that can occur during the natural history of the disease, including acute heart failure, endoventricular thrombosis and embolization. Multimodality imaging is key for a correct diagnosis and a timely treatment.