ISSN: 2578-4633
Authors: DLR Javier CB, Fernandez RP and Lapitan RL*
HIV-associated cardiomyopathy is a complication of HIV infection that affects the structure and function of the heart. Early detection and diagnosis is crucial and routine cardiac workup is recommended with people living with HIV. In this report, we have a 27-year-old, Male, who identifies as gay, with a history of AIDS and has been living with HIV since 5 years from admission with a recent undetectable viral load. He presented with undocumented fever, cough and dyspnea over 7 days nonresponsive to Azithromycin. Multimodality imaging stands in the forefront of diagnosis of HIV-associated Cardiomyopathy and cardiomyopathies in general. Transthoracic 2D echocardiography or Cardiac MRI is recommended on initial evaluation among patients suspected to have the disease in order to identify its specific phenotype. Echocardiography is further recommended in monitoring the progression of the disease and response to therapy. Patient’s initial echocardiogram fulfilled the criteria for DCM with an LVEDD of 59mm and a reduced ejection fraction of 40%. Due to scheduling issues, Cardiac MRI was done 77 days after guideline-directed medical therapy for heart failure with reduced ejection fraction ARNI, beta-blockers, SGLT-2 inhibitors, and diuretics as needed. Results showed significant improvement in ejection fraction to 60%, with resolution of previously seen hypokinesia, but persistence of the LV dilatation with an LV volume index of 121 mL/m2. More importantly, post-contrast imaging on the short axis show that there are linear mid-wall enhancement indicative of non-ischemic patterns of enhancement involving the basal to mid anterior septum, basal to mid inferior septum, basal to mid inferolateral, and basal lateral segments characteristic of a post-myocarditis cause of dilated cardiomyopathy.
Keywords: Cardiomyopathy; Heart; HIV; Echocardiography; Heart Failure; Antiretroviral Therapy
