ABC | Volume 111, Nº2, August 2018

Anatomopathological Session Favarato & Aiello A 59-year-old woman with rheumatic mitral valve disease with severe dyspnea, shock and pulmonary condensation. Arq Bras Cardiol. 2018; 111(2):215-222 Figure 1 – ECG. Sinus tachycardia. Overloaded left atrium and indirect signs of overloaded right atrium (Peñaloza-Tranchesi signal) and overloaded right ventricle. Figure 2 – ECG. Nodal reentrant tachycardia, retrograde P wave (negative II, III and aVF) after QRS with short PR interval (< 70 ms) Figure 3 – ECG. Sinus rhythm; Both atria overloaded with giant P wave positive at V1 and overloaded right ventricle. Antibiotics were prescribed (ceftriaxone and clarithromycin), which later were changed for the piperacillin/tazobactam and vancomycin association, in addition to vasoactive amines, oxygen mask, and then orotracheal intubation for respiratory support. Laboratorial exams (17/Sep/2011) showed: red blood cells 4.2million/mm³, hemoglobin 12 g/dL, hematocrit 39%, VCM93 fL, RDW-CV 17.9%, leukocytes 13840/mm³ (90% neutrophils, 7% lymphocytes and 3% monocytes), platelets 161000/mm³, urea 63m/dL, creatinine 1.44 m/dL (FG = 40 mL/min/1.73 m²), magnesium1.3mEq/L, sodium137mEq/L, potassium3.9mEq/L, prothrombin time (INR) 1.7 and APTT rel 1.26. Thorax radiography (18/Sep/2011) revealed pulmonary congestion, opacification at the right base and increased cardiac area (presence of double contour and bulging unfolding of the mid aortic arch) (Figure 4). The coronary angiography (20/Sep/2011) did not reveal coronary obstructions; and there was severe calcification of the mitral valve. Laboratorial exams (20/Sep/2011) revealed hemoglobin 11 g/dL, hematocrit 36%, VCM92 fL, RDW-CV17.8%, leukocytes 13440/mm³ (90%neutrophils, 7% lymphocytes, 3%monocytes), platelets 142000/mm³, urea 74 mg/dL, creatinine 1.97 mg/dL (FG = 28 mL/min/1.73 m²), AST 34 U/L, ALT 34 U/L, calcium 4 mEq/L, magnesium 1.3 mEq/L, arterial lactate 155 m dL. Exams of 21/Sep/2011 showed hemoglobin 10.5 g/dL, hematocrit 37%, VCM 102 fL, RDW-CV 16.8%, leukocytes 216