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A 56-year-old man with co-prevalence of Leriche syndrome and dilated cardiomyopathy: case report and review

56-jähriger Mann mit gleichzeitigem Vorkommen eines Leriche Syndroms und einer dilatativen Kardiomyopathie

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Summary

We report about a 56-year-old man with dyspnoea and leg pain diagnosed with Leriche syndrome and chronic heart failure caused by dilated cardiomyopathy (DCM) with acute cardiac decompensation. Optimising of chronic heart failure therapy with diuretic and antihypertensive drugs leaded to recompensation. A defibrillator was implanted, and afterwards surgical therapy of Leriche syndrome was planned.

Leriche syndrome is an uncommon variant of atherosclerotic occlusive disease characterised by total occlusion in abdominal aorta and/or both iliac arteries. If aortic stenosis develops slowly, collateral vascular circulation can be found frequently. Typical symptoms are claudication, symptoms related to an arterial insufficiency of the lower extremities, erectile dysfunction and weight loss. Risk factors of Leriche syndrome are diabetes mellitus, hypertension, hyperlipaemia and smoking. Further it is often associated with chronic renal failure and coronary artery disease. Diagnosis is normally made by computed tomography (CT) or magnetic resonance imaging (MRI). Standard therapy is surgical revascularisation.

DCM is a common cause of a congestive heart failure, which could be induced by coronary artery disease, hypertension, toxic, metabolic, inflammatory and infectious agents, and inherited gene defects.

Zusammenfassung

Wir berichten über den Fall eines 56-jährigen Patienten, der sich wegen Dyspnoe und Beinschmerzen in der Notaufnahme vorstellte. Verursacht wurden die Beschwerden durch ein Leriche Syndrom und eine dekompensierte Herzinsuffizienz auf dem Boden einer dilatativen Kardiomyopathie. Durch eine Optimierung der Herzinsuffizienztherapie mit unter anderem dem Einsatz von diuretisch und antihypertensiv wirksamen Medikamenten konnte eine Rekompensation erreicht werden.

Ein Leriche Syndrom stellt eine seltene Variante der atherosklerotischen Verschlusskrankheit dar, charakterisiert durch einen kompletten Verschluss der abdominellen Aorta und/oder beider Aa. iliacae. Wenn sich die Aortenstenose über einen langen Zeitraum entwickelt, kann meist eine Kollateralenbildung beobachtet werden. Typische Symptome eines Leriche Syndroms sind Claudicatio-Schmerzen und andere Symptome verursacht durch die Unterversorgung der unteren Extremitäten, erektile Dysfunktion und Gewichtsverlust. Risikofaktoren eines Leriche Syndroms sind Diabetes mellitus, Arterielle Hypertonie, Hyperlipidämie und Rauchen. Weiterhin sind häufig Assoziationen des Syndroms zu einer chronischen Niereninsuffizienz und einer koronaren Herzkrankheit zu bemerken. Die Diagnose wird in den meisten Fällen mittels Computer-Tomographie oder Magnet-Resonanz-Tomographie gestellt. Standardtherapie ist die gefäßchirurgische Revaskularisierung.

Eine dilatative Kardiomyopathie ist ein häufiger Grund einer chronischen Herzinsuffizienz, welche sowohl durch eine koronare Herzkrankheit und eine Arterielle Hypertonie als auch durch toxische, metabolische, entzündliche und infektiöse Agens und durch vererbte Gendefekte ausgelöst werden kann.

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Authors and Affiliations

  1. Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Karsten Keller MD, Meike Coldewey MD,  Thomas Munzel MD &  Philipp Wild MD, MSc

  2. Centrum for Thrombosis and Haemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany

    Karsten Keller MD, Meike Coldewey MD,  Thomas Munzel MD &  Philipp Wild MD, MSc

  3. Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz, Katholisches Klinikum Mainz (KKM), Mainz, Germany

    Johannes Beule MD &  Wolfgang Dippold MD

  4. Department of Radiology and Nuclear Medicine, Katholisches Klinikum Mainz (KKM), Mainz, Germany

    Jörn Oliver Balzer MD

Authors
  1. Karsten Keller MD
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  2. Johannes Beule MD
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  3. Jörn Oliver Balzer MD
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  4. Meike Coldewey MD
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  5. Thomas Munzel MD
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  6. Wolfgang Dippold MD
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Correspondence to Karsten Keller MD.

Additional information

The patient of this case report was hospitalised in the Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM) (Head: Prof. Dr. med. W. Dippold), and the Department of Medicine II, University Medical Center Mainz (Johannes Gutenberg-University Mainz) (Head: Univ.-Prof. Dr. med. T. Munzel).

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Keller, K., Beule, J., Oliver Balzer, J. et al. A 56-year-old man with co-prevalence of Leriche syndrome and dilated cardiomyopathy: case report and review. Wien Klin Wochenschr 126, 163–168 (2014). https://doi.org/10.1007/s00508-013-0476-2

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