Case 1/2017 – 26-Year-old Male with Rapidly Progressive Heart Failure

Clinical aspects

The patient was a 26-year-old male, reporting prophylaxis for rheumatic fever from the age of 12 years to 17 years, who, at the age of 24 years, developed dyspnea on heavy exertion, which improved with medication. However, after two years, dyspnea worsening and edema occurred (April 19, 2013).

The clinical and laboratory assessments before the referral revealed cardiopathy with ventricular dilatation. The echocardiogram evidenced left ventricular systolic and diastolic diameters of 60 mm and 44 mm, respectively, and ejection fraction of 51%. His serology for Chagas disease was negative, and his coronary angiography, normal. On physical examination, a third cardiac sound and a systolic murmur (++/6+) over the mitral area were heard. The ECG showed atrial flutter, atrioventricular block with probable ASDB, and heart rate of 40 bpm.

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