Arterial microembolisation: an unusual presentation of dilated cardiomyopathy

Dilated cardiomyopathy is disease of the cardiac muscle causing abnormal enlargement of the heart ventricles and other associated problems. One major complication of this disease is the threat of blood clot development and consequent blockage of heart vessels (embolism). Embolisms can occur at any time, sometimes being the first symptom of the disease and sometimes occurring long after the disease has been diagnosed and producing no clinical symptoms. These clots tend to be rather large and affect other organs besides the heart. The case is reported of a 37-year-old woman with dilated cardiomyopathy who had arterial microembolization (very small clots) in the arteries of her toes as her initial symptom. The patient, who had no previous heart problems, complained of painful and discolored toes that had appeared one month before she came for examination. Examination of the heart found left ventricular enlargement and decreased left ventricular function, but no coronary artery disease or other heart disease. The vessels to the affected toes were found to be occluded by microemboli, but no vascular disease was found. The patient was treated with drug therapy for cardiomyopathy and the problems with her toes resolved and her heart functioning improved. The case was unusual in that the initial symptom was arterial microemboli in the periphery (arms and legs) rather than larger emboli in the trunk or brain and there were no symptoms of congestive heart failure. Cardiomyopathy should be considered when patients are suffering from peripheral microembolization. (Consumer Summary produced by Reliance Medical Information, Inc.)