A 27-year-old Caucasian male professional rugby player was admitted to his local district general hospital with signs and symptoms of decompensated heart failure.
He admitted to regularly taking cocaine and performance enhancing steroids. He had no other significant past medical history.
- His ECG showed atrial fibrillation (AF), (Figure 1).
- A transthoracic echocardiogram revealed bi-atrial dilatation and a dilated left ventricle (LV) with moderate to severe LV systolic dysfunction.
- He was acutely managed with intravenous diuretics and initiated on evidence-based heart failure medications including beta-blockers and angiotensin converting enzyme (ACE) inhibitors.
- Once stabilised he was discharged on bisoprolol 2.5 mg, ramipril 5 mg and rivaroxaban, a non-vitamin K antagonist.
In view of his drug history a diagnosis of drug-induced dilated cardiomyopathy (DCM) was made.
Figure 1: Admission ECG showing atrial fibrillation
Test your knowledge
Read also the corresponding case report:
"Game changer? A sporting indication to implant a left atrial appendage closure device in a rugby player with atrial fibrillation: A case report" by Andre Briosa e Gala, Andrew Cox, Michael Pope and Timothy R Betts
European Heart Journal - Case Reports, doi:10.1093/ehjcr/ytz242
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