A 45-year-old man has a left ventricular ejection fraction of 25% (N>55%) with diffuse hypokinesis. He has a sedentary life-style. He eats red meat up to 6 times weekly and drinks 4 alcoholic beverages daily. He is 185 cm (6 ft 1 in) tall and weighs 86 kg (190 lb); BMI is 25 kg/m^2. His blood pressure is 90/60 mm Hg. Coronary arteriography shows no evidence of atherosclerosis. To prevent further heart damage, which of the following is the most appropriate recommendation?
1.Aerobic exercise program
2.Avoidance of alcohol
3.Ingestion of more vegetables and decrease in red meat intake
4.Isometric/weight-training exercise program
5.Weight loss
Correct answer
Avoidance of alcohol
This patient has heart failure, hypotension, and no signs of atherosclerosis in the setting of alcohol abuse, sedentary lifestyle, and poor dieting. The most likely diagnosis is dilated cardiomyopathy secondary to alcohol abuse. Dilated cardiomyopathy is the most common cardiomyopathy and etiologies include alcohol abuse, thiamine deficiency, coxsackie viral infection, cocaine abuse, doxorubicin toxicity, and idiopathic. Ultimately, patients suffer from systolic dysfunction with eventual cardiac arrest. The most appropriate recommendation for this patient is to remove the source of his cardiomyopathy—alcohol (choice B).
Diet (choice C), exercise (choice A & D), and weight loss (choice E) will definitely have cardio-protective effects; however, removing the etiology of the patient’s heart failure needs to have highest priority in the management of this patient.