From alcohol consumption to heart failure: Severe myocarditis with biventricular involvement, Case report

Background: Alcoholic cardiomyopathy (ACM) is a form of acquired dilated cardiomyopathy secondary to chronic ethanol consumption. Its association with acute inflammatory events can precipitate catastrophic heart failure. It is important to note that it is a diagnosis of exclusion.

Case presentation: A 39-year-old male with a 20-year history of chronic alcoholism presented with progressive dyspnea, palpitations, and edema following a bout of influenza. Atrial fibrillation with a rapid ventricular response and a proBNP level of 14,678 pg/mL were documented. Cardiac magnetic resonance imaging (CMR) revealed a severely dilated left ventricle with an ejection fraction (EF) of 15%, accompanied by myocardial edema (RAT 2.9) and late gadolinium enhancement, consistent with acute myocarditis progressing from a background of acute cardiomyopathy. In this case, other possible causes were first ruled out, and when none were found, this diagnosis was established.

Conclusion: This case highlights the vulnerability of myocardium with prior toxic damage to secondary inflammatory insults. Accurate diagnosis using cardiac magnetic resonance imaging (CMR) is essential to differentiate chronic structural damage from the recoverable acute process.