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Male patient with 50 years of age from Atibaia (SP), obese, was admitted for decompensated heart failure.At 47 (April 2002), the patient was admitted with dyspnea on exertion and hypotension. He had had dyspnea on exertion for three years and progressed in the last three months before admission.Physical examination on that date revealed weight of 130 kg; height 1.72 m; BMI = 43.9 kg/m², tachypnea 36 breaths per minute, heart rate 80 bpm, blood pressure 100 x 90 mmHg. There were crackles in both lung bases; heart sounds were arrhythmic and systolic murmurs ++/6+ in the mitral area; the abdomen was distended, visceromegalies were not palpated and there was edema ++++/4+ in the lower limbs. The patient was an ex-drinker (six beers/day for 20 years) and had hip osteoarthritis. In October of that year, there was recurrence of atrial flutter or atrial tachycardia and oral anticoagulation was initiated for subsequent cardioversion. The patient was asymptomatic at that time.The patient presented with dyspnea on major exertion until he sought medical attention for dyspnea that had worsened on the previous day, on minimal exertion, without orthopnea, cough or fever.

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Background: It is still very controversial whether the characteristics of pain in the acute myocardial infarction could be related to the culprit coronary artery. There are no data about associations of pain with the ST-segment elevation myocardial infarction (STEMI) and left ventricular (LV) fibrotic segments.Methods: Data from 328 participants who had STEMI and were included in the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study were analyzed. The culprit artery was identified by coronary angiography and the injured myocardial segments by cardiac magnetic resonance. The statistical significance was established by P value < 0.05.Results: A total of 223 patients (68%) were selected. Association was not observed between chest pain and the culprit artery (P = 0.237), as well as between pain irradiation and the culprit artery (P = 0.473). No significant difference was observed in the pain localization in relation to the segments in the short axis basal, mid, apical, and long axis, except for the mid inferior segment. The data were not considered clinically relevant because this association was observed in only one of 17 segments after multiple comparisons. Conclusions:In patients with STEMI, no associations were observed between the location or irradiation of acute chest pain and/or adjacent areas and the culprit artery, or between pain and segmental myocardial fibrosis in the LV.