Male, 57-year-old patient. Wide QRS Complex Tachycardia (WCT)
Brazil
Case presentation
JVC, male, 57-year-old patient. Mulatto, construction worker, protestant. He was born in Virgolândia, Minas Gerais, and currently lives in Santo André, São Paulo, Brazil.
Personal background: he denies suffering high blood pressure, diabetes, dyslipidemia, coronary heart disease, or Chagas disease. Former smoker (for 30 years he smoked a package a day). He stopped smoking ten years ago. He was an old-time alcohol drinker; he stopped drinking five years ago.
Family history: 2 healthy sons. His father died at the age of 72, due to heart problems (he cannot specify what). His mother died at 62 years of age, due to stomach cancer.
Main complaint: palpitations and chest pain.
History of current discomfort: he mentions that on March 5, 2010, while walking, he suddenly felt pre-syncope symptoms, rapid palpitations associated to precordial pain in anguish; dyspnea, vomiting, cold sweating, and headache. Precordial pain was described as very intense, oppressive, which lasted longer than 1 hour, irradiating toward the left shoulder and the back. He sought medical help, and after an ECG was conducted, an event was detected, being interpreted as VT. He was referred to chemical cardioversion (due to the lack of other resources) with endovenous amiodarone, which caused a quick reversion of the event.
He says that 3 weeks ago he suffered a similar, less intense event. On that occasion, an ECG, and later catheterization were performed. They did not reveal significant alterations.
He is not displaying symptoms presently.
Apresentaçao do caso
JVC, masculino, 57 anos, pardo, pedreiro, evangélico, natural de Virgolândia – Minas Gerais, e residente em Santo André – São Paulo – Brasil.
Antecedentes pessoais: nega hipertensão, diabetes, dislipdemia, coronariopatia ou doença de chagas.
Ex-tabagista (fumou por 30 anos, 1 maço/dia). Há dez anos livre do vício.
Ex-etilista inveterado, há cinco anos abstêmio.
Antecedentes familiares: 2 filhos sadios, pai falecido aos 72 anos por problemas cardíacos (não sabe especificar), mãe falecida aos 62 anos de câncer gástrico
Queixa Principal: “batedeira e dor no peito”
História da Moléstia Atual: refere que no dia 05/03/2010, durante caminhada, fora acometido de súbito de quadro de pre-síncope, palpitações rápidas associada a dor precordial em aperto, dispnéia, vômito, sudorese fria e cefaléia. A dor precordial a referia como de forte intensidade, opressiva, de duração maior que 1h, irradiada para ombro esquerdo e dorso. Procurou auxilio médico, onde após a realização de ECG detectou-se evento interpretado como TV, sendo submetido a cardioversão química (por falta de recurso) com amiodarona endovenosa a qual ocasionou rápida reversão do evento.
Refere evento semelhante, de menor intensidade, ocorrido há 3 semanas. Na ocasião, fora realizado ECG e posteriormente cateterismo, o qual não revelou alterações significativas.
No momento assintomático.
