A Bad Heart From a Stomach Ache.

SESSION TYPE: Cardiovascular Student/Resident Case Report Posters IPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: This case describes a patient who was initially diagnosed with a cardiomyopathy of unknown etiology. Subsequent testing several years later revealed an underlying celiac disease as the primary etiology.CASE PRESENTATION: A 37 year old male who emigrated to the United States from Albania in 2000 with past medical history significant for mild elevation in liver function studies as well as non-ischemic cardiomyopathy diagnosed in 2006 presented to our internal medicine clinic in 2009 to establish care. At that time, the patient had complaints of abdominal distension, weight loss, as well as prior elevated liver function tests of unknown etiology. Initial laboratory studies showed an alkaline phosphatase of 142, ALT of 100, and AST of 75. Abdominal ultrasound and outside CT scan results were unremarkable for any pathology. A hepatitis panel as well as alpha-1-antitrypsin level were normal. The patient was subsequently referred to the gastroenterology department, who performed a colonoscopy with biopsies. Biopsy results showed likely celiac disease, which was confirmed with positive tissue transglutaminase studies. The patient was started on a gluten-free diet. His transaminase levels were noted to decrease. In addition, the patient's cardiac function began to improve as well, without changes in medication. Initial cardiac MRI results from 2009 when the patient first established care showed global left ventricular hypokinesis with a left ventricular ejection fraction of 33%. Subsequent echocardiograms after the initiation of a gluten-free diet showed improvement of function, with the latest left ventricular ejection fraction of 45% in August 2010. The patient was subsequently diagnosed with cardiomyopathy secondary to celiac disease. As the patient modified his diet, his cardiac function began to improve while his tissue transglutaminase antibodies declined.DISCUSSION: This case is interesting in the fact that a patient's diet change after moving to the United States from Albania caused an exacerbation of an underlying celiac disease, which attributed to the patient developing a non-ischemic cardiomyopathy. Studies have shown a loose relationship between autoimmune conditions, such as celiac disease and non-ischemic cardiomyopathy. Our case provides additional evidence to this relationship.CONCLUSIONS: Although rare, Celiac Diseaes is a known cause of cardiomyopathy. The vast majority of patients improve significantly solely with the implementation of a gluten-free diet and, therefore, physicians should be aware of this disease relationship.1) Goel, et al.. Cardiomyopathy Associated with Celiac Disease. Mayo Clinic Proceedings. 2005;80:674-6.2) Curione, et al.. Carnitine deficiency in patients with coeliac disease and idiopathic dilated cardiomyopathy. Nutrition, Metabolism & Cardiovascular Diseases. 2005;15:279-83.DISCLOSURE: The following authors have nothing to disclose: David Snipelisky, Keels JornNo Product/Research Disclosure InformationMayo Clinic, Jacksonville, FL.