Cardiomyopathy Associated with Trace-Element Deficiency Post Bariatric-Surgery

Introduction: It has been shown that non-compliance with vitamin and mineral supplement protocol,after Bariatric-Surgery, may lead to trace-element deficiency (such as Zn, Fe, Vitamin B and Selenium) and related complications, such as myocardial fibrosis, heart failure and arrhythmia; a phenomenon that resembles Keshan disease in China (congestive cardiomyopathy associated with endemic selenium deficiency).

Trace element`s deficiency, like Zn or Selenium (Se) were documented to participate in metabolic processes that reduce Oxidative stress. It has been proved that its deficiencies result in myocardial demage, fibrosis, CHF, arrhythmias and death.

Objectives: To raise awareness to the phenomenon and to emphasize preventive measures.

Case Report: A 30 year old female, one and a half months after delivery, was admitted to cardiology department because of dyspnea, and clinical evidence of heart failure. Her past history indicated Morbid obesity, Bariatric surgery fifteen and five years earlier. Iron deficiency Anemia; proteinuria and B12 and Zn deficiency. (The Selenium level could not be measured in our available laboratories). On examination there were signs of left and right heart failure as tachycardia, rapid pulse and heart sounds, S3, Jugular venous congestion, and reduced breath sounds at the base of the lungs, and severe sacral and legs` edema.

An Echocardiogram revealed severely reduced function (LVEF=30%).

The diagnosis was cardiomyopathy (peripartum on top of trace-element deficiency). The patient was treated with anti-failure therapy (including diuretics and vasodilators agents, combined with dietary supplements). A ten kilogram weight reduction was observed.

Combined cardiological and nutritional treatment, as well as follow-up were recommended.

Conclusions: Patients after Bariatric surgery should be treated by a combined cardiological and nutritional team, in order to prevent cardiac deterioration, CHF and death.