A 15-year-old male with progressive muscular dystrophy of the Becker type and severe heart failure

Abstract

The patient is a 15-year-old male admitted to the hospital due to abdominal pain, vomiting, dark urine, and edema.The patient had a history of good health until the age of 10 years when progressive muscular weakness, mainly in the lower limbs, began. He sought medical assistance and was diagnosed of progressive muscular dystrophy of the Becker type. His mother, a 34-year-old woman, is considered an asymptomatic carrier of the gene for progressive muscular dystrophy, and his 4-year-old brother has signs of progressive muscular dystrophy of the Duchenne type.The patient also had bronchial asthma. He reported fatigue on exertion six months earlier and daily crises of tachycardic palpitations 4 months earlier with cold sweating and perioral paleness of approximately 15 minutes of duration. He denied syncope. Two months earlier, dyspnea became worse, being triggered on minimum exertion, and edema appeared. To the patient was prescribed 40mg of furosemide and 0.25mg of digoxin daily. One month earlier, the patient required hospitalization to control heart failure, and he was discharged with symptom improvement and the same medicamentous prescription. Chest X-ray at that time showed cardiomegaly (+++/4+), and the patient was then referred to InCor for medical treatment.On physical examination (1/24/97), the patient was in a wheelchair, thin, eupneic, with a regular pulse of 92bpm, and blood pressure of 100/70mmHg. The precordium was mildly bulgy and the lung examination was normal. The ictus cordis was palpable on the 7 th intercostal space, no thrill was audible, the first cardiac sound was split on the tricuspid region, the 4 th