Complicated acute myocardial infarction

Caucasian, 64 years-old, high school teacher, natural and resident in Santo André, São Paulo – Brazil. Centripetal obesity, type 2 diabetes mellitus (from 5 years ago), type IV dislipidemic (from 10 years ago), hypertension (20 years ago) and smoker of 20 cigarettes/day during the last 30 years. In regular use of anlodipine 5mg + chlortalidone 12,5mg + enalapril maleate 10mg x2 + AAS 100mg + genfibrozile 600mg x1. The patient complains of oppressive chest pain (with six hours of duration) radiating to the internal portion of left arm until the left elbow. Additionally irradiated to the lower jaw. Concomitantly complain of dyspnea at rest, cold profuse diaphoresis, nausea and vomit. In January 2000 he has had myocardial infarction.

Familiar antecedents: his mother is obese and diabetic and his father high blood pressure. He has two brothers with hypertension and obesity.
Physical examination blood pressure 15/10 HR = 110bpm B3 with gallop cadence, B4 present. Holosystolic++/+++ murmur in apex irradiated to left axila. Rales bilateral one third lower bases. Liver palpable without pain on right costal border.

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Apresentaçao do caso

Homem branco, 64 anos, professor, natural e residente de Santo André, São Paulo – Brazil. Obeso centrípeto, diabético tipo 2 (5 anos), dislipidêmico tipo IV (10 anos), hipertenso (20 anos) e fumante (20 cigarros/dia desde 30 anos atrás). Em uso regular de anlodipina 5mg + chlortalidona 12,5mg + enalapril 10mg x2 + AAS 100mg + genfibrozila 600mg x1.

Refere dor, tipo opressiva retroesternal, de seis horas de duração, Irradiada a borda interna do braço esquerdo até cotovelo e a mandíbula. Concomitantemente queixa-se de dispnéia de repouso, diaforese fria, náusea e vômito. Em janeiro de 2000 teve infarto de miocardio. Antecedente familiares, mãe obesa e diabetica, pai hipertenso, dois irmãos hipertensos e obesos. Exame físico: PA 150/100 frequência cardíaca = 110bpm. Terceira bula com cadência de galope e presença de quarta bula. Sopro sistólico ++/+++ na ponta, irradiada para a axila esquerda. Estertores crepitantes no terço inferior de ambas as bases. Figado palpável na borda costal direita