Posters
Presenting Author Academic/Professional Position
Resident
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Academic Level (Author 5)
Faculty
Discipline/Specialty (Author 5)
Internal Medicine
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Cardiomyopathies (CM) are defined as myocardial disorders in the absence of coronary artery disease, hypertension, valvular or congenital heart conditions. Dilated CM is characterized by dilation and impaired contraction of one or both ventricles. The prevalence of this condition is underestimated because of variable disease expression and challenging diagnosis. We present the case of an undocumented and immunocompetent patient who debuted with acute heart failure after being exposed to significant environmental stressors.
Case Presentation: A 44-year-old Hispanic gentleman with a history of untreated hypertension presented to the ED with severely persistent left-sided chest pain at rest associated with frontoparietal headache. The patient came to the US from Venezuela after a 2-month on-foot travel. On admission, vital signs included a blood pressure of 221/149 mmHg. Blood work showed normal troponin levels. EKG showed sinus rhythm with a normal axis, left ventricular hypertrophy (LVH) signs, and inverted T waves noted in precordial leads. Chest X-ray showed mild cardiomegaly without pulmonary vascular congestion. His echocardiography revealed LVEF 20-24%, moderate to severe concentric LVH, anterolateral and apical akinesis, and moderate global hypokinesis. Left heart catheterization (LHC) showed dilated non-ischemic cardiomyopathy. The viral panel came positive for Coxsackie B virus antibodies. The patient had plans to move to Georgia after discharge and was started on guideline-directed medical therapy (GDMT). He was advised to follow cardiology and repeat an echocardiogram in 40 days to assess candidacy for ICD implantation.
Discussion: Dilated Cardiomyopathy definition is expanding to patients with systolic dysfunction without necessarily left ventricular or biventricular dilation, for which high suspicion is needed to make a diagnosis in the early stage of the disease. The initial workup includes a comprehensive clinical history, 12-lead EKG, and echocardiography. However, an etiology-driven diagnosis involves specific imaging modalities, genetic testing, and endomyocardial biopsies, which are not always available in limited-resource settings. In our patient, the etiology of dilated CM can be attributed to an acquired infection, in this case, Enterovirus, and environmental factors that act as stressors and disease modifiers. However, predisposing genetic factors cannot be ruled out, and further genetic testing is needed. One of the principal barriers in our patient’s case was the language barrier and being under-custody, leading to decreased health-seeking behavior and access to care.
Conclusion: A comprehensive diagnosis of dilated cardiomyopathy requires specific diagnostic tests and frequent follow-ups that, in some instances, due to social disparities, mostly in minorities, are generally not achieved.
Recommended Citation
Malaga-Espinoza, Barbara; Dockery-Joseph, Donnel; Daza, Jessica; Lopez, Oscar; and Suarez Parraga, Andres, "Acute Heart Failure Secondary to Coxsackie Dilated Cardiomyopathy in an Immunocompetent Adult: A Case Report from a Social Disparities Perspective" (2025). Research Symposium. 30.
https://scholarworks.utrgv.edu/somrs/2025/posters/30
Included in
Cardiology Commons, Cardiovascular Diseases Commons, Internal Medicine Commons, Virus Diseases Commons
Acute Heart Failure Secondary to Coxsackie Dilated Cardiomyopathy in an Immunocompetent Adult: A Case Report from a Social Disparities Perspective
Introduction: Cardiomyopathies (CM) are defined as myocardial disorders in the absence of coronary artery disease, hypertension, valvular or congenital heart conditions. Dilated CM is characterized by dilation and impaired contraction of one or both ventricles. The prevalence of this condition is underestimated because of variable disease expression and challenging diagnosis. We present the case of an undocumented and immunocompetent patient who debuted with acute heart failure after being exposed to significant environmental stressors.
Case Presentation: A 44-year-old Hispanic gentleman with a history of untreated hypertension presented to the ED with severely persistent left-sided chest pain at rest associated with frontoparietal headache. The patient came to the US from Venezuela after a 2-month on-foot travel. On admission, vital signs included a blood pressure of 221/149 mmHg. Blood work showed normal troponin levels. EKG showed sinus rhythm with a normal axis, left ventricular hypertrophy (LVH) signs, and inverted T waves noted in precordial leads. Chest X-ray showed mild cardiomegaly without pulmonary vascular congestion. His echocardiography revealed LVEF 20-24%, moderate to severe concentric LVH, anterolateral and apical akinesis, and moderate global hypokinesis. Left heart catheterization (LHC) showed dilated non-ischemic cardiomyopathy. The viral panel came positive for Coxsackie B virus antibodies. The patient had plans to move to Georgia after discharge and was started on guideline-directed medical therapy (GDMT). He was advised to follow cardiology and repeat an echocardiogram in 40 days to assess candidacy for ICD implantation.
Discussion: Dilated Cardiomyopathy definition is expanding to patients with systolic dysfunction without necessarily left ventricular or biventricular dilation, for which high suspicion is needed to make a diagnosis in the early stage of the disease. The initial workup includes a comprehensive clinical history, 12-lead EKG, and echocardiography. However, an etiology-driven diagnosis involves specific imaging modalities, genetic testing, and endomyocardial biopsies, which are not always available in limited-resource settings. In our patient, the etiology of dilated CM can be attributed to an acquired infection, in this case, Enterovirus, and environmental factors that act as stressors and disease modifiers. However, predisposing genetic factors cannot be ruled out, and further genetic testing is needed. One of the principal barriers in our patient’s case was the language barrier and being under-custody, leading to decreased health-seeking behavior and access to care.
Conclusion: A comprehensive diagnosis of dilated cardiomyopathy requires specific diagnostic tests and frequent follow-ups that, in some instances, due to social disparities, mostly in minorities, are generally not achieved.
