Cardiopatie dilatativă la un adolescent – prezentare de caz

Background. Heart failure is a rare but serious diagnosis in pediatric patients. While in newborns and infants con­ge­ni­tal heart disease is commonly the cause, in older chil­dren and in adolescents cardiomyopathies (primary or se­con­dary) take the lead. The diagnosis may be difficult to establish, as the symptoms are nonspecific (especially in young ages). Case presentation. A previously healthy 16-year-old girl had been experiencing heart failure symp­toms for the past 10 months, with gradual worsening of symp­tom severity. Upon evaluation, a diagnosis of class III Ross/NYHA heart failure due to dilated cardiomyopathy with severe left ventricular systolic dysfunction was es­ta­blished. Standard heart failure medication was initiated, al­le­via­ting congestion and partially controlling symptoms. There was no family or personal history of heart disease. The patient reported excellent exercise tolerance previously. No exposure to potentially toxic agents has been identified. The initial tests could not establish a definite cause, al­though a possible respiratory tract infection at the onset of symptoms and certain cardiac magnetic resonance ima­ging features could suggest previous eosinophilic myo­car­di­tis. Current literature to guide the diagnosis pro­cess and treatment options are discussed. Conclusions. Di­la­ted cardiomyopathy is rare but severe in children. Even the ty­pi­cal symptoms may be downplayed or ignored for long pe­riods, delaying the diagnosis; a high index of suspicion is therefore required when other more common disorders seem unlikely or have been ruled out. The possible underlying cau­ses vary with age and differ from the adult population. An etiological diagnosis is frequently difficult to achieve, but must nonetheless be sought out, as it may allow for tar­ge­ted therapy and improve prognosis. However, long-term out­come is usually grim.