Case 32 — Seven Months After the Initial Diagnosis
Presenting Complaint
Recheck examination
Pertinent History
Mickey presented today for a recheck for his taurine responsive dilated cardiomyopathy. He was diagnosed with dilated cardiomyopathy seven months ago and has been responsive to taurine over the last 5 months.
Mickey receives 500 mg of taurine daily mixed in baby food and also is on a diet of Iams dry food and chicken breast.
The client reports that Mickey is doing well and currently has no problems except for loss of sight which has not resolved with taurine treatment.
Physical Examination
BARH. Wt = 4.4 kg. HR = 150. RR = 36. MM pink and CRT = 1.5 sec. Femoral pulses strong with no deficits. No murmur. Gallop rhythm. Eupneic.
Bronchovesicular sounds in all lung fields within normal limits. Anterior chamber, sclera, and conjunctiva are clear. PLRs present direct and indirect bilaterally. Ears are clean. Moderate gingivitis. Severe tartar. No masses palpated in abdomen. No lymphadenopathy.
Problems
Taurine responsive dilated cardiomyopathy
Clinical Diagnoses
Taurine responsive dilated cardiomyopathy
Comments
PE: A soft, intermittent extra heart sound is heard (present only at elevated heart rates).
Echocardiography: IVS(d) = 0.5 cm, IVS(s) = 0.6 cm, LVEDD = 1.5 cm, LVESD = 0.8 cm, SF = 42%, LVFWd = 0.5 cm, Ao:LA = 8.7:10.5 mm.
Assessment: Mickey responded extremely well to taurine therapy. The shortening fraction, end-systolic, and end-diastolic diameters are all within normal range. The vision is likely not to improve with therapy.
Plan: Continue taurine supplementation.
Discharge Summary
Mickey presented for a recheck for his taurine responsive dilated cardiomyopathy. Physical exam was unremarkable except for an extra heart sound, which is unlikely to be a gallop sound since Mickey’s cardiac function is now normal. This may be a systolic click. Echocardiography was within normal limits, which means Mickey’s heart disease is cured. Mickey will return for a re-check in one year.