Case 2/2018 – 73-Year-Old Male with Ischemic Cardiomyopathy, Cachexia and Shock

Clinical aspects

The patient here reported is a male elderly with ischemic cardiomyopathy, and significant weight loss in the previous 4 months, in addition to worsening of his general state of health and clinical instability in the 24 hours prior to admission. Some diagnostic possibilities could explain his significant weight loss.

Cardiac cachexia is a frequent complication in the advanced stages of congestive heart failure (CHF) and associates with shorter survival. The physiopathology of that disorder has been first described by Pitman and Cohen Later, new evidence showed that the cause is multifactorial, related mainly to anorexia, a change in the routine of food uptake, in absorption and in the metabolism of patients with heart failure. Up to 34% of the patients with CHF being followed up on an outpatient basis are estimated to develop cardiac cachexia in the medium to long run. The deleterious effects of that condition impair the cardiac and respiratory functions and decrease immunity, which leads to higher mortality. Our patient’s systemic complications that hindered the reversion of his final findings might have been aggravated by cardiac cachexia. Regarding treatment, the literature reports many simultaneous actions that fight the most critical points in cachexia, such as nutritional therapy and the use of appetite stimulants, correction of anemia and edema, use of anabolic steroids and immunomodulation. Parallel to drug therapy, physical activity is indicated to maintain skeletal musculature, respecting the limits imposed by the disease and requiring strict follow-up.

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