A 52-year-old patient with recurrent trauma.
She has no history of hypertension, diabetes, or dyslipidemia.
There are no drug allergies, nor do they usually take drugs.
Current illness: Go to the consultation because for three months she has been very sad, with little desire to do things, asthenia, insomnia and frequent sighs.
He also reported feeling empty of the stomach, anorexia and weight loss of approximately 3 kg, not accompanied by changes in bowel rhythm or epigastric pain.
The patient relates it to work stress.
It is initially classified as an anxious depressive syndrome.
Antidepressant (fluoxetine) and anxiolytic treatment (bromazepam) were prescribed and general laboratory tests with thyroid hormones were requested.
Eleven days later she went back to the consultation due to worsening of her symptoms.
A new directed anamnesis was carried out, describing that for two weeks she had intense asthenia, dyspnea on moderate exertion, orthopnea of two pillows, decreased diuresis and swelling in lower limbs.
She also reports that, on several occasions, she has experienced episodes of episodes of hospitalisation, not accompanied by chest pain.
When asked about alcohol consumption, she says she drinks “normal”, although when performing an alcohol intake questionnaire it is estimated that its consumption is 295 g/week.
Physical examination showed blood pressure 130/86, normal nutritional status.
CA: rhythmic at 100 bpm without murmurs or extracts.
PA: biphasic crackles.
Abdomen: hepatomegaly to four costal toe ridges.
II: edema in both cavities with fovea to the knee.
The analytical highlights: AST: 52, ALT: 36, TG: 97.
Blood count and other biochemical tests were normal.
Only sinus tachycardia and frequent ventricular extrasystoles were observed on ECG performed in the clinic.
The clinical suspicion of heart failure is referred to the hospital for urgent chest X-ray.
The X-ray showed cardiomegaly and diffuse interstitial edema, suggestive of congestive heart failure.
With this diagnostic suspicion with diuretics, she is referred for review in two days and is referred to the cardiology consultation for study, stating that if at any time she presents treatment or attends the cardiology center.
Two days later, he returned to the clinic.
The patient comes to hospital due to seizures.
At the hospital, the following complementary tests were performed: ECG: AF with ventricular response at 150 bpm with nonspecific repolarization and extrasystole alterations.
Mild Doppler ultrasound: global pericardial effusion.
Light dilatation of the four cavities.
AI 52 mm VI with severe global hypokinesia.
Severe biventricular dysfunction.
LVEF: 26%.
Dilatation of the inferior vena cava and suprahepatic veins.
Moderate TI and MI (II/IV) systolic PAP 45 mmHg.
The primary diagnosis of Arrhythmia was confirmed in relation to medical care with alcohol abuse. Once the patient was hospitalized, intravenous digitalization was performed, diuretic treatment (furosemide), amiodarone, IEC was initiated.
