SHM Converge Scientific Abstract ePoster Gallery-The Skinny on New Onset Heart Failure

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A 45-year-old woman with obesity and long-term phentermine use presented with two months of worsening dyspnea on exertion, orthopnea, and leg swelling. Exam showed tachycardia, elevated jugular venous pressure, an S3 gallop, wheezing, and bilateral edema. Initial testing revealed severe new dilated cardiomyopathy on transthoracic echocardiogram with an ejection fraction of 20%, grade II diastolic dysfunction, and elevated pulmonary artery pressure. Laboratory findings included markedly elevated BNP, mild troponin elevation, low TSH, elevated free T3, and positive thyrotropin receptor antibodies, suggesting Graves’ disease.<br /><br />Cardiac workup showed no significant coronary artery disease on left heart catheterization, while right heart catheterization demonstrated elevated right-sided and filling pressures, consistent with heart failure. Cardiology and endocrinology evaluated the patient and diagnosed new-onset heart failure with concurrent Graves’ disease. Phentermine was stopped, methimazole was started, and the patient received diuresis and guideline-directed heart failure therapy. Her symptoms improved, and repeat echocardiography two months later showed substantial recovery of cardiac function, with ejection fraction improving to 45–50% and normalization of left ventricular size.<br /><br />The case highlights a suspected association between long-term phentermine use and dilated cardiomyopathy, a relationship that is not well established in the literature. Phentermine is known to increase release of norepinephrine, dopamine, and serotonin and may reduce serotonin clearance, which has been linked to fibrogenesis and valvular changes. It has previously been associated with valvular disease, stress cardiomyopathy, coronary vasospasm, and arrhythmias, but reports connecting it directly to heart failure are scarce. The authors emphasize the importance of thorough medication review and broad differential diagnosis in new heart failure, as well as the usefulness of thyroid testing even in non-endocrine presentations.

Asset Subtitle

Tamari Papidze

Meta Tag

Author List Courtney E. Detwiler, Emily Sturkie, Emmy Yang, Jessica Fuller, Rimma Osipov, Tamari Papidze

Category Clinical Vignettes

Concept Heart Failure

Concept Dilated Cardiomyopathy

Concept Phentermine

Concept Cardiomyopathy

Concept Medication Reconciliation

Distinguished Non-Finalist

Presenter Organization UNC Hospitals

Presenting Author Tamari Papidze

Track Adult

Keywords

phentermine

dilated cardiomyopathy

heart failure

Graves disease

dyspnea on exertion

ejection fraction

thyrotoxicosis

BNP elevation

right heart catheterization

medication review

Heart Failure

Dilated Cardiomyopathy

Phentermine

Cardiomyopathy

Medication Reconciliation