FERNANDO FAGLIONI RIBAS
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- Case 6 / 2016-Heart Failure in a 23-Year-Old Male with a History of Illicit Drug Use(2016) RIBAS, Fernando Faglioni; GUTIERREZ, Paulo SampaioMale patient, 23 years-old, sought medical treatment for malaise, nausea, vomiting, and retrosternal burning pain for three days (09/25/2013). Two weeks before seeking medical attention, the patient was diagnosed with a heart disease after an evaluation done one month before his complaint of malaise, for a research of dyspnea during physical effort with progressive worsening. He stated to have been a cocaine user in the past, but had been clean for seven years. Transthoracic two-dimensional echocardiogram (09/11/2013) showed: left atrium diameter 58 mm; left ventricle diameters (diast./syst.) 81 mm/72 mm, LVEF = 24%; accentuated diffuse ventricular hypokinesis; restrictive filling pattern; moderate to severe mitral insufficiency. The patient was prescribed: enalapril 1 omg, furosemide 40 mg, spironolactone 25 mg, and carvedilol 6.25 mg daily. Lab exams (09/19/2013) revealed: urea 48 mg/dL, creatinine 1.82 mg/dL, sodium 140 mEq/L, potassium 4.8 mEq/L. During the physical exam (09/25/2013), the patient presented regular overall condition, acyanotic, afebrile, and hydrated; heart rate was 92 bpm; blood pressure was 80x60 mmHg, arterial saturation 98%; pulmonary auscultation was normal; heart auscultation showed the presence of third sound and regurgitant systolic murmur +++/6+ in mitral area; abdominal exam was normal, and there was no edema in the lower limbs. Electrocardiogram showed overload of the left chamber. Lab exams (09/25/2013) revealed: CKMB 1.61 ng/mL, troponin I 0.447 ng/mL, urea 60 mg/dL, creatinine 2 mg/dL, C-reactive protein 2.65 mg/L, sodium 139 mEq/L, potassium 4.3 mEq/L, PT (INR) 1.3, PTT (rel) 0.87, hemoglobin 16.8g/dL, hematocrit 49%, leukocytes 9100/mm(3) (61% neutrophils, 1% eosinophils, 1% basophils, 30% lymphocytes, and 7% monocytes), platelets 286000/mm(3).