“Coração fora do peito” is a popular Portuguese expression that literally means “heart outside the chest”, but in this case it does not refer to a figure of speech. An 86-year-old male patient presented to his family physician due to pacemaker (PM) exteriorization with one week of evolution, without pain or fever.The patient has a history of long-standing arterial hypertension with target organ damage, dyslipidemia, stage G4 A2 chronic kidney disease, hypertensive heart disease with mild congestive heart failure, and has had a dual-chamber permanent pacemaker since 2020 due to symptomatic bradycardia. Physical examination revealed dehiscence of the PM pocket with partial exteriorization and peripheral necrosis, without signs of systemic infection. He was referred to the hospital emergency department, where laboratory tests and blood cultures were negative. The patient was admitted to the cardiology ward for monitoring and pacemaker replacement, starting antibiotic therapy with ciprofloxacin.The use of pacemakers has increased significantly in recent decades, reflecting an aging population and greater survival of patients with cardiac disease. Erosion or exteriorization of the generator is a rare complication, with reported rates of 1–7%, depending on individual risk factors, multiple reinterventions, and center experience. This case illustrates a relatively uncommon clinical presentation and emphasizes the need for early surveillance, identification of predisposing factors, and multidisciplinary intervention.This case highlights the importance of monitoring implanted devices, recognizing early signs of exteriorization, and planning timely surgical intervention. The experience suggests that future practices could include systematic assessment of subcutaneous tissue, preventive strategies for generator positioning, and individualized follow-up protocols for elderly patients or those with complex comorbidities.The literature shows that although this complication is rare, it can have a significant impact on the patient, conditioning a potencial life-threatening situation, requiring a multidisciplinary approach. Prevention of erosion involves proper implant planning and continuous monitoring, with early interventions to minimize risks.This case underlines the clinical relevance of pacemaker exteriorization, reinforcing the need for preventive strategies, careful surveillance, and coordinated management. It provides practical lessons applicable to similar contexts, contributing to improved patient safety and care.