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Abstract: This patient, a 45-year-old Mr. Zhang, presented to the hospital with a 9-year history of chest tightness and shortness of breath after activity, and his symptoms had worsened in the past 3 days. He had a previous history of hypertension, smoked and drank alcohol on weekdays, and had an irregular work schedule. After examination, he was diagnosed with dilated cardiomyopathy. After completing the relevant examinations, he was given medication and instructed to adjust his poor lifestyle. After treatment, the symptoms were significantly relieved and all indicators improved.
Basic information】Male, 45 years old
Disease Type】Dilated cardiomyopathy, heart failure
Hospital】Harbin First Hospital
Date of consultation】May 2022
Treatment plan】Medication (recombinant human brain natriuretic peptide for injection, spironolactone tablets, sakubatril valsartan tablets, metoprolol succinate extended-release tablets, engramine tablets, furosemide injection)
[Treatment period] 10 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】Significant relief of symptoms and improvement of all indexes
I. Initial consultation
A middle-aged male came to the hospital with symptoms of chest tightness and shortness of breath after daily activities, which had been persisting for 9 years and had worsened in the past 3 days. The patient had a history of hypertension, and his blood pressure was well controlled after taking nifedipine extended-release tablets, but he often stayed up late at night and liked to smoke and drink. After the patient was admitted to the hospital, a cardiac ultrasound examination was performed and revealed that his left ventricular ejection fraction was significantly reduced to 31%. The left ventricle was 68 mm in size and the left atrium was 48 mm in size. The left heart was enlarged and the left ventricular wall motion was generally reduced. The electrocardiogram was performed, and the results showed sinus rhythm ST-T changes and amino-terminal pro brain natriuretic peptide of 834 pg/ml. together, the preliminary diagnosis of dilated cardiomyopathy with heart failure was made.
II. Treatment history
For the diagnosis of dilated cardiomyopathy, it is often necessary to further exclude heart failure caused by coronary heart disease. After consultation with the patient and his family, it was decided to perform further coronary angiography on the patient, which did not reveal significant coronary stenosis. In combination with the patient’s past medical history and cardiac ultrasound findings, a diagnosis of dilated cardiomyopathy was made.
Treatment of dilated cardiomyopathy often requires a combination of diuretic, vasodilator and other symptomatic supportive therapy. Therefore, this patient was treated with furosemide injection, but the sedative dose of furosemide injection should be adjusted at any time according to the patient’s actual sensitivity to diuretics, and the patient was given recombinant human brain natriuretic peptide for injection. To further prevent further enlargement of the heart form and improve the prognosis of heart failure, patients are advised to take oral spironolactone tablets, sakubatril valsartan tablets, metoprolol succinate extended-release tablets, and engramine tablets. In addition, patients should be encouraged to quit smoking and alcohol, pay attention to a low-salt and low-fat diet in daily life, and gradually carry out rehabilitation exercises to improve cardiopulmonary function.
Treatment effect
The patient was still young, and after a series of optimal treatment and medication, the patient’s symptoms improved significantly. After 10 days, the aminoterminal pro-brain natriuretic peptide was rechecked and showed 200 pg/ml, blood pressure dropped to 125/80 mmHg, heart rate was 68 beats/min, edema of the lower limbs disappeared, and the patient’s mental state also improved significantly compared with before. The patient’s mental status also improved significantly compared with before, and he could sleep flat at night without difficulty in sleeping or getting air, and the rest of the indexes improved and reached the discharge criteria.
IV. Notes
We are glad that after a series of treatment, the patient’s indexes have improved and he was discharged successfully.
1, after discharge, should come to the hospital every six months or so to review the electrocardiogram, cardiac ultrasound, liver and kidney function, lipid tests, blood glucose checks and other items to prevent recurrence of the disease.
2, regular monitoring of blood pressure and heart rate, as far as possible to control blood pressure below 130/80mmHg, heart rate below 70 beats / min, if the control fails to meet the standard, it is recommended that patients pay attention to communicate with the doctor as soon as possible to adjust the medication program.
3. if any uncomfortable symptoms occur during the course of taking medication at home, it is recommended to go to the outpatient clinic for follow-up in a timely manner to clarify whether it is caused by side effects of medication or aggravation of the disease.
4. Avoid overexertion and excessive exercise in daily life, strictly prohibit staying up late, ensure regular rest and rest, keep a happy mood, quit smoking and drinking, pay attention to a low-salt, low-fat diet, ensure a balanced daily intake of nutrients, and increase the intake of whole grains.
V. Personal insight
Dilated cardiomyopathy is a kind of cardiomyopathy with poor prognosis, the cause of this disease is not clear, some patients have a certain family heredity, cardiac ultrasound is an important test to confirm the diagnosis of this disease. In patients with dilated cardiomyopathy, the disease may be asymptomatic in the early stages, but gradually the patient may develop symptoms related to heart failure, such as dyspnea and decreased activity tolerance. In this case, the patient came to the clinic with symptoms such as chest tightness and shortness of breath after activity, which are typical of dilated cardiomyopathy.
For patients with dilated cardiomyopathy, attention should be paid to stopping the underlying etiology-mediated myocardial damage, as well as to preventing sudden death, controlling the ventricular rate, and treating for heart failure, so as to improve the patient’s future quality of life and prolong his or her survival, and must actively cooperate with the doctor for regular physical examination and review during the course of the disease.