From the Guidelines
High dilation of the heart chambers, particularly the ventricles, can cause several noticeable symptoms, including shortness of breath, fatigue, and swelling in the legs, ankles, and feet due to fluid retention, as noted in the 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1. The symptoms of high dilation are primarily related to the heart's inability to pump blood efficiently, leading to blood backing up in the lungs and body tissues.
- Common symptoms include:
- Shortness of breath, especially during physical activity or when lying down
- Fatigue and weakness
- Swelling in the legs, ankles, and feet due to fluid retention
- Rapid or irregular heartbeat
- Persistent cough or wheezing
- Increased urination, particularly at night
- Abdominal swelling or bloating
- Decreased exercise tolerance In severe cases, patients may experience chest pain, confusion, or fainting, as mentioned in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1. It is essential to seek medical attention promptly if these symptoms occur, as high dilation can be a sign of serious underlying conditions like heart failure, valve disease, or cardiomyopathy, and treatment depends on the cause, but may include medications to improve heart function, reduce fluid retention, and control blood pressure, as discussed in the 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure 1.
From the Research
Symptoms of High Dilantin Levels
The symptoms of high dilantin levels, also known as phenytoin toxicity, can be severe and potentially life-threatening. Some of the common symptoms include:
- Nausea and vomiting 2, 3
- Central nervous system dysfunction, such as confusion, nystagmus, and ataxia 2, 4, 3, 5
- Depressed conscious state, coma, and seizures in more severe cases 2, 3
- Cardiac complications, such as arrhythmias and hypotension, although rare 2
- Unsteady gait, dizziness/vertigo, general weakness, and drowsiness 3
- Cerebellar ataxia, which can be present in patients with epilepsy and chronic exposure to phenytoin 5
Clinical and Radiological Characteristics
The clinical and radiological characteristics of phenytoin-related ataxia have been studied, and the results show that:
- Patients with epilepsy receiving treatment with phenytoin have a high prevalence of ataxia, with 40% of patients showing clinical evidence of ataxia 5
- The severity of ataxia can be determined clinically using the SARA score, and the pattern of cerebellar involvement can be assessed by neuroimaging, such as MRI volumetry and MR spectroscopy 5
- MRI scans have shown structural, volumetric, and functional deficits of the cerebellum in patients with phenytoin-related ataxia, with a predilection for vermian involvement 5
Treatment and Management
The treatment and management of phenytoin toxicity and related ataxia include:
- Temporary withdrawal of phenytoin and supportive care 2, 3
- Attention to vital functions, management of nausea and vomiting, and prevention of injuries due to confusion and ataxia 2
- No evidence that any method of gastrointestinal decontamination or enhanced elimination improves outcome, although activated charcoal may be considered if the patient presents early 2