A 38 year old male was admitted to hospital with a two month history of fatigue

A 38 year old male was admitted to hospital with a two month history of fatigue and a two week history of increasing edema. Congestive heart failure was diagnosed and a cardiac catheterization revealed normal coronary arteries but marked cardiac enlargement with four chamber dilation and mural thrombosis of the left ventricle. The cardiac index was 1.4. Further history revealed that he had been drinking a case of beer a day for many years and that he smoked one pack of cigarettes per day.His condition acutely deteriorated two weeks later with development of Enterobacter cloacae septicemia. He was transferred from a community hospital to a university hospital for management of sepsis and for possible cardiac transplantation. Despite antibiotic therapy and aggressive supportive measures he expired the next day.