Arjun Patel, a 35-year-old software engineer, came to the cardiology clinic complaining of increasing fatigue, shortness of breath on mild exertion, and occasional swelling in his ankles over the past six months. He mentioned feeling unusually tired at work and getting breathless after climbing just a few stairs. Arjun had no significant past medical history but admitted to heavy alcohol consumption and occasional binge drinking over the last decade.
On physical examination, Arjun appeared pale and mildly breathless at rest. His heart rate was elevated with an irregular rhythm. A displaced and diffuse apex beat was noted, along with bilateral basal crackles on lung auscultation and pitting edema in both lower limbs. His blood pressure was low-normal, and jugular venous pressure was raised.
Routine investigations revealed an enlarged cardiac silhouette on chest X-ray, and ECG showed atrial fibrillation with a rapid ventricular rate. Echocardiography was the turning point — it demonstrated a significantly dilated left ventricle with poor contractility and an ejection fraction of 30%.
Arjun shared his lifestyle habits and a family history of sudden cardiac death. Chronic alcohol use had silently weakened his heart muscle over time, reducing its ability to pump blood efficiently.