We discussed a 23 year old with T1DM who presented with progressive DOE over 1 month. He had chest pain 2-3 months prior and etiology was never determined. He reported his symptoms were preceded by URI but he was no longer complaining of URI symptoms at presentation. His family history was significant for diabetes. He was a former smoker, heavy drinker, smoked marijuana and no IVDU. Was sexually active and reported condom use consistently. Vitals were stable on admission and exam revealed reduced tactile fremitus at bases as well as trace pitting edema in his legs. His A1c on admission was 7.1% and CXR showed cardiomegaly. A formal ECHO showed an enlarged LV, EF of <20%, mild MR and TR and no other abnormalities. After an extensive work up his NICM was thought to be due to alcohol use vs viral myocarditis and he was discharged on medications for heart failure. Follow up revealed that he had significant family history of cardiomyopathy and sudden death.


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