Case Report

Worsening of Heart Failure in Becker Muscular Dystrophy After Nonsteroidal Anti-inflammatory Drugs

Authors: Claudia Stöllberger, MD, Josef Finsterer, MD

Abstract

A 40-year-old male with Becker muscular dystrophy and cardiac involvement was stable in New York Heart Association class II for 7 years. He then had arthralgia caused by bilateral gonarthrosis. He received diclofenac 100 mg/d and 500 mg/d mephenamine acid. Six weeks later, he was hospitalized because of heart failure (New York Heart Association class IV). Echocardiography revealed biatrial and biventricular dilation, a left ventricular end-diastolic diameter of 82 mm, an ejection fraction of 26%, a severe tricuspid regurgitation, and an elevated pulmonary artery pressure of 60 mm Hg. Nonsteroidal anti-inflammatory drugs were discontinued, and physiotherapy and equipment with a corset were initiated. He improved after treatment with parenteral diuretics, returning to class II. Nonsteroidal anti-inflammatory drugs should be given with caution in Becker muscular dystrophy with cardiac involvement.


Key Points


* Nonsteroidal anti-inflammatory drugs may lead to worsening of heart failure, fluid retention, and an increase in blood pressure.


* Nonsteroidal anti-inflammatory drugs attenuate the effects of diuretics, β-blockers, angiotensin-converting enzyme inhibitors, and angiotensin-2 blockers.


* Nonsteroidal anti-inflammatory drugs should be given with caution to patients with cardiac involvement of Becker muscular dystrophy.

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