STUDENT COPY

Case Title: Chronic Heart Failure secondary to dilated cardiomyopathy

A 45-year old chronic alcoholic male developed easy fatiguability, shortness of breath for
several months. A few days before consult, he complained of 2-pillow orthopnea and dyspnea at
rest.
Pertinent physical examination showed BP= 110/80, PR=100/min, RR= 30/min.
Heart: PMI at 5th ICS, lateraled to mid-clavicular line, S3, soft S1, holosystolic murmur at apex
radiating to axilla
Lungs: fine crackles both lung bases

2-D echocardiogram: enlarged left ventricle with decreased systolic function, mild mitral
regurgitation, ejection fraction < 30%

Initially, he was given furosemide with slight relief. Later, Enalapril 5 mg OD, carvediol
6.25 mg and spirinolactone were added. However, he developed dry cough and shortness of
breath persisted.