Dilated Cardiomyopathy in a Young Man with Illicit Cocaine Use: A Case Report

Introduction: Dilated cardiomyopathy (DCM) is a progressive disease of the cardiac myocytes, characterized by enlargement in the ventricle and contractile dysfunction in the presence of normal ventricular wall thickness. Alcohol, Cocaine consumption, and Sarcoidosis are associated with development of DCM. Case report: 31 year old male patient, unemployed for 3 years, was admitted to the emergency department with a chief complaint of dyspnea. His condition worsened over the last three days. His vital signs were as follows: TA 115/75 mmHg, pulse rate 100 bpm, and respiratory rate 27 bpm, temperature 36.5°C. Previously suspected of having sarcoidosis, the patient had a history of alcohol and cocaine abuse. Alcohol and cocaine abuse lasts 7 years. Necrosis and perforation were remarkable in the nasal septum due to cocaine abuse. ST segment elevation of 2 mm in V2-4 leads without any reciprocal changes was noted in the electrocardiogram taken on presentation. Besides, there was 2 mm ST-segment depression in lead V6. Chest X-ray revealed cardiomegaly, marked pleurisy on the right, bilateral hilar congestion, and increased reticular density. Echocardiogram disclosed significantly dilated heart chambers, accompanied by mitral and tricuspid valve regurgitation. Left ventricular ejection fraction was measured at 25%. Imaging and pulmonary findings suggested that the development of DCM might be multifactorial, due to sarcoidosis and cocaine abuse. Conclusion: Heart failure secondary to DCM should be included in the differential diagnosis of patients with dyspnea, especially in those with prominent risk factors such as substance abuse.