Dilated Cardiomyopathy Presenting with Epigastric Pain, Mild Dyspnea and Rapidly Progressing Multi-Organ Failure

Abstract

Introduction: Dilated cardiomyopathy (DCM) is characterized by ventricular dilation and impaired systolic function, defined by a left ventricular ejection fraction (LVEF) below 40%. While it typically presents with heart failure symptoms, atypical or gastrointestinal manifestations could delay diagnosis and treatment. Case Presentation: A 17-year-old previously healthy male presented with a five-day history of epigastric pain, vomiting, mild exertional dyspnea, and palpitations. On admission, he had hypotension (BP 60/20 mmHg), tachycardia (HR 130 bpm), and tachypnea (RR 30/min). Echocardiography revealed global hypokinesia with an LVEF of 25%, consistent with DCM. Laboratory test results showed leukocytosis, renal impairment, conjugated hyperbilirubinemia, coagulopathy, and transudative pleural effusions, indicating multi-organ dysfunction. Infectious, metabolic, and toxic causes were excluded. The patient required triple inotropic support, nine sessions of hemodialysis, and thoracentesis. Conclusions: With multidisciplinary management, he stabilized clinically and biochemically. At the four-week follow-up, echocardiography showed improved LVEF (45%) with complete symptomatic recovery.