Can a viral infection cause dilated cardiomyopathy?

Question

Hi doctor,

For the past 10 months, my 32-year-old wife has been experiencing symptoms of bronchitis, including shortness of breath (SOB) and fatigue. Her feet and ankles began to swell, and for the past seven months, she has taken Furosemide as needed to manage the edema, which provided temporary relief.

Last month, she underwent several tests, including a chest X-ray, echocardiogram, and ECG. These results were mostly normal, except for sinus tachycardia (heart rate over 110 beats per minute) and mild fatty changes in the liver. Her doctor recommended the Hepatitis B vaccine (Engerix-B), and she has completed two doses, with the third dose due next month.

Two months ago, she traveled for three weeks. During this trip, she experienced acute breathlessness, stomach bloating, and swelling in her feet and ankles. She found it difficult to lie on her back. After seeing a gastroenterologist and pulmonologist, she underwent an abdominal ultrasound, which revealed ascites and bilateral pleural effusion. We then consulted a cardiologist, who recommended a repeat echocardiogram, ECG, and chest X-ray. The echocardiogram showed a severely reduced left ventricular ejection fraction (25 percent) and dilation of the left ventricle (LV) and left atrium (LA).

She is currently on medications, including Carvedilol, Sacubitril with Valsartan, Domperidone with Esomeprazole, Clonazepam, and nutritional supplements. A cardiac MRI was also performed, which confirmed the findings of the echocardiogram but did not yield any additional insights. Blood tests showed normal sodium (Na) and potassium (K) levels, an elevated NT-proBNP (504 pg/mL), and a slightly elevated bilirubin level (1.14 mg/dL).

We would like advice and opinions on the following:

What could be the cause of dilated cardiomyopathy in someone so young? Could it be due to a viral infection, even without a fever?
What treatment options are available?
Is this condition reversible, and is there a possibility for the dilation to return to normal?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Your wife has several health concerns, including dilated cardiomyopathy and PCOS (polycystic ovary syndrome). Dilated cardiomyopathy can have various causes, such as viral infections, pregnancy, familial and idiopathic factors, tachycardia, premature ventricular contractions (PVCs), and, in late stages, amyloidosis.

It seems that her current treatment is progressing well, as you mentioned. The Carvedilol dose can be increased if her heart failure condition allows, and Sacubitril with Valsartan can be gradually increased up to 200 mg if her blood pressure permits. Furosemide can be added, and Spironolactone should be started at 25 mg per day. All doses should be gradually up-titrated.

In some cases, dilated cardiomyopathy can be reversible, but after one year, the chances of reversibility are lower. If the condition does not improve, an implantable cardioverter-defibrillator (ICD) may be considered to prevent cardiac arrest, or a CRT-D (cardiac resynchronization therapy device) may be recommended to manage heart failure symptoms and prevent cardiac arrest.

For PCOS, she should consult a gynecologist for appropriate management.

Praying for your wife’s health and recovery.

Regards.