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Case report of a heart failure caused by dilated cardiomyopathy

Kristiana Gocheva, Dimitrina Yordanova, Zhenia Hinkova, Vesela Zlateva


Introduction: Dilated cardiomyopathy (DCM) is a progressive disease of the heart muscle that is characterized by ventricular chamber enlargement and contractile dysfunction. This condition is the third most common cause of heart failure and the most frequent reason for heart transplantation.

Materials and methods: This is a clinical case of a 61 year old male diagnosed with DCM a few years ago with manifestations of heart failure. The patient is admitted with symptoms of easy fatigue, pro­gressive dyspnea, cough and paroxysmal nocturnal dyspnea-orthopnea. He used to be a professional athlete. Present symptoms came up after a virus infection with fever up to 40°C.

Results: On the physical examination he was with regular rhythm, frequent extrasystoles, tachycar­dia, S3 gallop. Echocardiogram showed dilated heart cavities, reduced ejection fraction of 34%. Ther­apy with diuretics, anticoagulants, beta-blockers, angiotensin II receptor blockers was started. Fif­teen days after dehospitalization the symptoms persisted. He was discussed for cardiac resynchro­nization therapy (CRT), but the QRS complex wasn`t widened enough. He met the criteria for ther­apy with a new drug class - angiotensin receptor neprilysin inhibitor. It combines the angiotensin II receptor blocker Valsartan and the neprilysin inhibitor prodrug Sacubitril in a 1:1 ratio. Sacubi­tril is converted by esterase, which inhibits neprilysin, the enzyme responsible for the degradation of the natriuretic peptides and many other vasoactive peptides. This combination addresses two of the pathophysiological mechanisms of heart failure: activation of the renin-angiotensin-aldosterone sys­tem and decreased sensitivity to natriuretic peptides. Since then his general condition improved and the symptoms of the heart failure decreased.

Conclusions: DCM is very common and irreversible disease. The clinical case is also an example of the good effect of this new class of drugs on patients with heart failure.


dilated cardiomyopathy; heart failure; ARNI; virus infection; new therapy



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