ABC | Volume 113, Nº4, October 2019

Anatomopathological Correlation Martins et al. Cardiac failure after non-ST-elevation myocardial infarction Arq Bras Cardiol. 2019; 113(4):775-782 Figure 1 – Right coronary in right anterior oblique view. A) Left coronary in right oblique view (B) Figure 2 – Low-voltage electrocardiogram of the QRS complex in the frontal plane and ST-segment depression from V 2 to V 5 . pressure of 65 mmHg. He evolved with a refractory shock, with mechanical ventilation difficulties and died at 12:05 (March 31st, 2017). Clinical Aspects This is a 55-year-old male patient known to have insulin dependent DM and CKD who in February 2017 had a nocturnal episode of dyspnea. Due to the episode, he sought medical care in the emergency room, where changes in markers of myocardial necrosis were identified - increased CKMB and troponin, as well as ST-segment depression fromV 2 to V 6 on the ECG. A coronary angiography was performed at the time showing only a 30% lesion in the right coronary artery. After discharge, the patient developed orthopnea and lower limb edema requiring further hospitalization seven days after discharge. On admission to our service, he presented signs of pulmonary and systemic congestion, the ECG maintained previous parameters, a chest X-ray showed cardiomegaly and massive bilateral pleural effusion, and laboratory tests showed a worsening of renal function and anemia. The transthoracic echocardiogram showed 22% LVEF, through the Simpson method, with diffuse hypokinesia and no segment changes. After this initial evaluation, the following hypothesis was raised for this patient - type 2 AMI and myocarditis. In order to enable a better investigation of the patient´s conditions, propaedeutic complementation was performed. The serologies for Chagas disease and cytomegalovirus were negative. A cardiac resonance showed increased systolic dysfunction in both ventricles with 11% LVEF, with slight left ventricular dilation, increased 776