Caso 02 - para índice: homem, 50 anos, com passado de alcoolismo, internado para tratamento de insuficiência cardíaca descompensada

Abstract

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.