A case of chest pain and heart failure

Case presentationDr Montano: A 60-year-old-man was admitted to ourEmergency Department (ED) for worsening dyspnea, andrecurrent episodes of oppressive chest pain that resolvedwithin a few minutes with rest. He had a history ofbenign prostatic hypertrophy (in therapy with Finasteride5 mg/day), mild chronic renal failure, a prior episode ofright lower limb thrombophlebitis (1992), pulmonary sar-coidosis diagnosed in 1991 and initially treated with6 months of steroid therapy without further follow-up in thepastfewyears.Hishistorywasnegativeforsmokingorothercardiovascular risk factors (Fig. 1).In ED, he appeared diaphoretic and dyspnoeic, wastachycardic and his blood pressure was 190/120 mmHg.The physical examination was otherwise substantiallynormal. An ECG showed sinus tachycardia (125 bpm), andisolated premature ventricular beats. The arterial blood gasshowed respiratory failure with a normal pCO