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DOI: 10.5935/abc.20170058 The patient is a 56-year-old male, born and living in São Paulo, hospitalized due to heart failure decompensation and submitted to heart transplantation. His symptoms started at the age of 51 years, with dyspnea on moderate exertion, which evolved in 3 months to dyspnea on minimum exertion and orthopnea, and wheeze. The patient required hospitalization for clinical compensation. After discharge, he was referred for treatment at InCor. His discharge prescription included daily furosemide 40 mg, captopril 100 mg, spironolactone 25 mg, and aminophylline 200 mg. The patient smoked (40 pack-years) and had systemic arterial hypertension. His parents had died due to stroke. On his first medical visit, one month after that hospitalization, his complaints remained similar to those at the time of hospitalization. His physical examination (Jul 23, 2008) revealed: weight, 73.6 kg; height, 1.58 m; body mass index, 29.5 kg/m2; pulse rate, 76 bpm; right upper limb and right lower limb blood pressures, 148/96 mm Hg and 150/100 mmHg, respectively. His lung auscultation showed no crepitant rales, and his heart auscultation revealed low cardiac sounds with no murmur. His abdominal exam was normal. There was neither lower limb edema, nor signs of increased jugular venous pressure, and his pulses were palpable and symmetrical. The X ray revealed marked cardiomegaly. The ECG (Jul 18, 2008) showed: sinus rhythm; heart rate, 67 bpm; PR, 163 ms; QRS duration, 96 ms; QTc, 455 ms; overload of left chambers and secondary changes of ventricular repolarization (Figure1). His laboratory tests were as follows: hemoglobin, 14.4 g/dL; hematocrit, 44%; red blood cells, 5,000,000/mm3; leukocytes, 11,400/m3; uric acid, 9 mg/dL; glucose, 105 mg/dL; creatinine, 1.05 mg/dL; total cholesterol, 266 mg/dL; HDL-C, 35 mg/dL; LDL-C, 153 mg/dL; triglycerides, 412 mg/dL; potassium, 4.6 mEq/L; sodium, 139 mEq/L; and normal urinalysis.

arquivos brasileiros de cardiologia

Case 2/2017 - 56-Year-Old Male with Refractory Heart Failure, Systemic Arterial Hypertension and Aortic Valve Stenosis That Led to Heart Transplantation