170 WHEN THE HEART GETS DRUNK

Abstract

Abstract A 53-old male with arterial hypertension, obesity (BMI 32) and gout presented to our Emergency department symptomatic for dyspnea, complaining about reduced functional capacity (NYHA III), gain of weight e increased abdominal circumference. In the days after we discovered a history of potus (2 liter of wine/day). At a first physical examination we confirmed clinical features of heart failure with pulmonary congestion and ascites. The EKG showed atrial fibrillation, 80 bpm. An echocardiogram showed severely reduced ejection fraction (EF 23%) with diffuse hypokinesia, increased left ventricular mass, deeply increased volumes, with only slightly increased thickness, a mild moderate diastolic dysfunction. Also, the right ventricular was hypokinetic and dilatated. During the hospitalization the patient underwent coronary angiography, which showed no coronary lesion, e cardiac RMN with no pathological features in both T1 and T2 weighted sequences. No increased uptake of contrast in LGE sequences was evidenced. We started diuretic therapy and optimized heart failure therapy with clinical improvement. The management of anticoagulant therapy was difficult because of hepatic dysmetabolic cirrhosis (Child-Pugh Score 8, class B) with contraindication for DOACs treatment. Moreover the patient performed a gastroscopy, which evidenced an ulcerative gastro-duodenitis and erosive gastritis confirming the temporary DOACs contraindication. The patient was discharged in hemodynamic stability, with wearable defibrillator and was taken in charge by a multidisciplinary team. After the normalization of hepatic function the anticoagulation was no longer forbidden so after three weeks we proceeded to successful electrical cardioversion. An echocardiogram was performed after 6 months with almost completely recovery of systolic function (EF 62%) and a slightly reduction of chamber dilatations. The patient denied alcohol consumption throughout the period. This case demonstrates that alcoholic cardiopathy if it's diagnosed at the beginning can be partially reversible. This case presents a challenging clinical setting due to the frequent comorbidities requiring a multidisciplinary approach. Achieving a significant patient compliance is also crucial for long term lifestyle changes.