Case 2/2016 – 76-Year-Old Male with Hypertensive Heart Disease, Renal Tumor and Shock

Clinical aspects

The patient had multiple comorbidities, chest pain and dyspnea on exertion. During follow-up, cardiomyopathy installed with segmental impairment of left ventricular contractility and complex ventricular arrhythmia. Initially, he had arterial hypertension and sinus bradycardia, with no other significant changes. Later, the patient experienced clinical worsening and new comorbidities: hyperuricemia, smoking and obesity. The ECG showed a significant change over time, and RBBB appeared. The functional assessment of myocardial ischemia revealed no significant change during follow-up. The symptoms progressively worsened, and, at the age of 72 years, the patient was hospitalized due to sustained ventricular tachycardia with hemodynamic instability. He reported previous surgery to treat malignant urinary bladder neoplasm, and gastrectomy to treat peptic ulcer. In 2011, the patient received an ICD to prevent sudden death, the last assessment being in March 2012. In June 2012, he was hospitalized due to presumed septic shock and eventually died.

During follow-up, the patient developed progressive cardiomyopathy with segmental impairment of left ventricular contractility associated with complex ventricular arrhythmias, and no significant coronary artery disease.

[…]