Caso 5/2010: homem de 41 anos de idade portador de hipertrofia miocárdica com evolução para insuficiência cardíaca congestiva

Abstract

Treatment with amiodarone was withdrawn and atenolol was prescribed.The patient started to present worsening of exertional dyspnea. The worsening was associated with the use of atenolol, which was discontinued, and the patient restarted amiodarone, 200 mg/day.The patient was submitted to ergometric test (February 21, 2003). At basal condition, the HR was 124 bpm and BP was 134/98 mmHg; after 2 minutes and 45 seconds of exertion, these parameters were 192 bpm and 158/94 mmHg. He started to present atrial fibrillation and nonsustained ventricular tachycardia during exertion. The symptoms abated; the exertional dyspnea persisted, as well as occasional episodes of palpitations, throughout two years. Subsequently, the dyspnea presented rapid increase, which started to occur even with the patient at rest. After one month, the patient had not improved and sought medical attention.At physical examination (June 3, 2004), the patient presented HR of 98 bpm, 24 breaths per minute, BP of 140/110 mmHg, increased jugular venous pressure, rales in the left hemithorax. Heart assessment disclosed arrhythmic beats, muffled heart sounds and systolic murmur +++/4+ in the aortic area. The liver was palpable at 2 cm from the right costal margin and the patient presented ++/4+ lower-limb edema.The chest X-ray showed an enlarged cardiac area with a round shape. The morphological analysis disclosed an increased P wave, QS in leads I, aVL and Q wave in lead V6. Right atrial overload, electrically inactive lateral area and ventricular repolarization alterations were diagnosed.Laboratory assessment (December 19, 2001) disclosed: hemoglobin -15.5 g/dl; hematocrit -46%; total cholesterol -242 mg/dl; triglycerides -241 mg/dl; fasting glycemia -107 mg/dl and creatinine -1.3 mg/dl. e112