Cardiomyopathy Associated with Zinc Deficiency post Bariatric Surgery

Non-Compliance with vitamins and mineral supplement after bariatric surgery may lead to a true elements deficiency, such as Zinc, Iron, Vitamins B and Selenium. Zinc and Selenium deficiency are closely related to cardiac complications; and may manifest as myocardial fibrosis, cardiomyopathy, heart failure and arrhythmia. Simple treatment with Zinc supplement added to standard therapy, may lead to significant clinical and echocardiographic improvement.

Case study: We described a 30 years old female, six weeks post-delivery, who was admitted to cardiology department due to dyspnea and clinical evidence of heart failure. Her past medical history indicated sleeve gastrectomy, 5 years ago, due to morbid obesity, without other comorbidities.

Echocardiogram which was done routinely, prior to surgery was normal. The patient had neither previous cardiovascular disease, nor complains. Routinely blood level of Zinc was basically normal. On current admission there were physical signs of heart failure. An echocardiogram reveled non-dilated severely reduced systolic left ventricular function (LVEF=30%), with normal valvular function and no pericardial effusion. The initial diagnosis was cardiomyopathy, most probably peripartum. Anti-failure therapy regimen indicating diuretics, beta blocker and ACE inhibitor, was initiated, without significant improvement for 5 days.

Due to a significant low blood level of Zinc (35 mcg/dL, normal value 70-120 mcg/dL) oral Zinc supplement was added. After several days of treatment clinical improvement was noted. Consecutive echocardiograms indicated rapid improvement in systolic LV function.

Conclusion: Oral Zinc Supplement had a major contribution to the rapid improvement in heart failure. This case report indicates a link between Zinc deficiency and reversible cardiomyopathy. We recommend that patients after bariatric surgery should be routinely follow up by cardiologist and nutritional. Zinc and Selenium blood level, should be tested (and treated), in selected patients with unclear evidence of cardiac disease.