Heart failure: A difficult case of diagnostic definition

We describe the case of a 58 year old man, who had recently undergone a coronary angioplasty with implantation of DES on the proximal circumflex branch and MO1 proximal for a NSTEMI, who had come to the emergency department complaining of severe pain in the back radiating in the precordial region. A few days later he developed a framework of acute heart failure with severe left ventricular dysfunction, accompanied by fever and blood cultures positive for Staphylococcus aureus. Instrumental examinations showed a massive coronary pseudoaneurysm originating from the circumflex branch ostium, which led to compressive action against anterior descending artery.