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A-41 Years Old Male with Alcoholic Cardiomyopathy at Tabanan General Hospital, Bali-Indonesia: a Case Report

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A-41 Years Old Male with Alcoholic Cardiomyopathy at Tabanan General Hospital, Bali-Indonesia: a Case Report CASE REPORT Intisari Sains Medis 2019, Volume 10, Number 2: 516-520 P-ISSN: 2503-3638, E-ISSN: 2089-9084 A-41 years old male with alcoholic cardiomyopathy at Tabanan General Hospital, Bali-Indonesia: a case report Gede Wikananda1*, Eka Ariawan2, Ary Priadnyana3 ABSTRACT Background: Alcoholic cardiomyopathy is a form of toxic examination, bibasilar crepitation on both lungs was found. Cardiac cardiomyopathy which develops as a result of long-standing examination showed systolic murmur of mitral regurgitation (MR) chronic ingestion of alcohol. Its clinical findings share similar and tricuspid regurgitation (TR). On supporting investigation, a features to other forms of dilated cardiomyopathy. Diagnosis can chest x-ray showed cardiomegaly (cardiothoracic ratio; 57%). ECG be made based on the history of long term alcohol abuse, clinical examination showed sinus tachycardia and left atrial (LA) and left findings, and supporting diagnostic studies. This case report aims ventricular (LV) enlargement. Trans-thoracal echocardiographic to overview alcoholic cardiomyopathy; from establishing the initial (TTE) examination revealed; RWMA: global hypokinetic-akinetic, diagnosis to the treatment given for the condition. multi-chamber dilated and severe LV systolic dysfunction (EF 29%) Case Description: A 41 years old male came to the emergency and diastolic function (Grade IV (E/A Ratio>4)). Valve examination department unit with shortness of breath since last few days. showed moderate-severe MR and moderate TR (TVG 40 mmHg). Shortness of breath was said to be getting worse over time and Conclusion: Alcohol cardiomyopathy is one of the most common progressed to breathlessness at rest. Other complaints were causes of heart failure in young age and carries a poor prognosis palpitations, fatigue, and long-standing cough. The patient was if not treated properly. Treatment of alcoholic cardiomyopathy found to have a history of drinking alcohol in large quantities mainly includes total alcohol abstinence along with drugs used to since 27 years ago. The blood pressure was 110/70 mm Hg, pulse treat systolic heart failure to reverse the condition and correct any rate 105 beats/min, and respiratory rate was 20 breaths/min. nutritional deficiencies. Slight edemas on both legs were also found. From auscultation Keywords: alcoholic, cardiomyopathy, Tabanan general hospital Cite This Article: Wikananda, G., Ariawan, E., Priadnyana, A. 2019. A-41 years old male with alcoholic cardiomyopathy at Tabanan General Hospital, Bali-Indonesia: a case report. Intisari Sains Medis 10 (2): 516-520. DOI: 10.15562/ism.v10i2.437 1General Practitioner at INTRODUCTION alcoholic beverages consumption.2 Cardiovascular Department BRSU Alcoholic cardiomyopathy is a form of Tabanan Hospital, Bali, Indonesia Alcohol is one of the most frequently consumed 2Cardiologist at BRSU Tabanan cardiac abnormality caused by excessive alcohol beverages in various societies and cultures in the consumption. As its name suggests; it mainly affects Hospital, Bali, Indonesia world. The burden caused by alcohol abuse creates 3Senior clerkship at Sanglah myocardial structure and function with associated General Hospital, Bali, Indonesia losses in health, economic, and social fields. From cardiac dysfunction. The clinical picture could be a health perspective, the complications of excessive indistinguishable from another form of dilated or alcohol use are both mentally & physically. They familial cardiomyopathies, which is characterized are ranging from physichatric, gastrointestinal, by biventricular dilatation and impaired heart *Corresponding to: neurological, and cardiological disturbance. function without any other predisposing etiology. Gede Wikananda; General In western countries, up to 10% of the adult Practitioner at Cardiovascular It is suspected that one-third of all cases of non- population suffers from an alcoholism-related ischemic dilated cardiomyopathy caused by long- Department BRSU Tabanan disease. It is among the most common diagnosis Hospital, Bali, Indonesia; standing, excessive alcohol use.1 [email protected] requiring hospitalization in North America. The Diagnosis of alcoholic cardiomyopathy is made highest prevalence is detected in the third to fifth 1 based on structured anamnesis related to chronic decade of life. According to RISKESDAS 2018; long-standing alcohol abuse. The patient may national alcohol consumption in Indonesia is 3%, also complain about cardiac symptoms of heart with predominance by traditional drinks, followed Received: 2019-03-13 failure, including; fatigue, shortness of breath, and by beer and winery product. Bali is the second palpitation, or even asymptomatic at an early stage.1 Accepted: 2019-07-28 province with the most excessive proportion of Published: 2019-08-01 Physical examination could show signs of health 516 Published by DiscoverSys | Intisari Sains Medis 2019; 10(2): 516-520Open |access: doi: 10.15562/ism.v10i2.437 http://isainsmedis.id/ CASE REPORT failure if found on advanced stages, such as fatigue, dilated, severe left ventricular (LV) systolic signs of congestion and associated cardiac murmur. dysfunction (EF 29%) and diastolic function (Grade Supporting investigations of cardiac biomarker, IV (E/A Ratio>4)). Valve examination showed laboratories study, electrocardiogram (ECG) and MR moderate-severe and TR moderate (TVG main echocardiography are needed to establish 40 mmHg). Diagnosis of congestive heart failure the diagnosis. Early recognition and management (CHF) secondary to alcoholic cardiomyopathy was based on underlying etiology are important, made. The patient was admitted and given normal considering the disease is reversible at an early stage saline solution 500 ml, oxygen therapy with a nasal and has a fatal consequence if not appropriately cannula, furosemide bolus 2 ampule continued treated.1,3 Based on those above, this study aims to with 40 mg (1-1-0), lisinopril 1 x 2, 5 mg, bisoprolol determine further the effort of early diagnosis as 1 x 2,5 mg and letonal 1 x 25 mg as pharmacologic well as prompt management regarding alcoholic treatment. cardiomyopathy as a rare case in Tabanan General Hospital, Bali, Indonesia. DISCUSSION CASE PRESENTATION Excessive alcohol consumption induces several pathologic changes in the myocardial structure. It A 41 years old male was found with clinical features shares indistinguishable feature from other forms of alcoholic cardiomyopathy. He came to the of dilated or familial cardiomyopathy. The exact emergency department unit with the chief complaint pathogenesis is still unclear, but it is believed to shortness of breath since last few days. Shortness of be related to direct toxic result of ethanol or its breath was said to emerge on moderate exertion metabolites, which results in altered metabolism of earlier but getting worse over time and progressed fatty acid, disruption of cardiac calcium hemostasis, to breathlessness at rest. Other complaints were loss of contractile protein, decreased myocardial palpitations, fatigue, and long-standing cough. The protein synthesis and impaired mitochondrial patient denied chest pain and fever. The patient also function. Histologically, it features myofibrillar denied the history of the same complaint. History necrosis and fibrosis. Various studies have also of cardiac disease and other chronic diseases was shown that alcohol exerts adverse inotropic effects denied by the patient. The patient did not smoke on the myocardium. Ethanol may also cause and denied a family history of heart disease. Patient oxidative stress through the generation of free work as office workers and have a sedentary lifestyle. radicals. It also increases circulating catecholamine. The patient was found to have a history of drinking This condition is believed to play a role in generating alcohol in large quantities from his young age. He myocardial damage, which can be proven by the drinks around six bottles of beer daily and several increase of troponin release.1,4 cups of Arak Bali occasionally since 27 years ago. Genetics factor is also assumed to contribute Vital sign examination shows; blood pressure in developing alcohol cardiomyopathy. Studies was 110/70 mm Hg, pulse was 105 beats/min, showed that not all individuals with chronic alcohol and respiratory rate was 26 breaths/min. Physical abuse develop the same conditions. Individuals examination revealed an ill-looking man in with the angiotensin-converting enzyme (ACE) shortness of breath and fatigue. Slight edema on DD genotype tend to have an increased risk of both legs was found. From chest auscultation developing alcoholic cardiomyopathy.1,3,5 Total examination, bibasilar crepitation on both lungs alcohol abstinence combined with drugs used in was found. On cardiac examination, a systolic systolic heart failure and corrected any nutritional murmur of mitral regurgitation (MR) and tricuspid deficiencies is the mainstay of the treatment.2 regurgitation (TR) was found. This patient clinical finding matched with On supporting examination; complete blood alcoholic cardiomyopathy. From anamnesis, the count (CBC) showed leukocytosis (14.7x103/μL) patient complained shortness of breath, which gets with other laboratory values within normal limits. worse over time. These complain is accompanied Posterior-anterior chest x-ray showed cardiomegaly by long-standing cough and palpitation. Physical (cardiothoracic ratio; 57%). ECG examination examination revealed bibasilar crepitation on the showed sinus tachycardia
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