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Case report: diagnosis of chronic Chagas cardiomyopathy using a multimodality imaging approach

Shannon X Li1, Estefania Oliveros Soles2, Parikshit S Sharma1

  • 1Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612, USA.

European Heart Journal. Case Reports
|January 16, 2023
PubMed

Insights

Chagas heart disease, a growing public health issue in the USA, is often overlooked. Multimodality imaging is crucial for diagnosing and managing this condition, particularly in patients with ventricular tachycardia and heart failure symptoms.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Chagas heart disease affects approximately 300,000 people in the USA, representing a significant and under-recognized public health concern.
  • Dilated cardiomyopathy is a potential manifestation of Chagas disease, yet its etiological link remains under-diagnosed.
  • This case highlights the critical role of multimodality imaging in diagnosing and managing Chagas heart disease.

Observation:

  • A 54-year-old man with a history of travel from Mexico presented with chest pain and syncope, experiencing hemodynamically unstable ventricular tachycardia.
  • Coronary angiography showed no obstructive disease; however, echocardiogram revealed reduced left ventricular function and apical abnormalities.
  • Cardiac magnetic resonance imaging confirmed apical aneurysm, dyskinesis, and late gadolinium enhancement, alongside positive serologic testing for *Trypanosoma cruzi*.

Findings:

  • The patient was diagnosed with Chagas heart disease based on clinical presentation, imaging, and serology.
  • Successful ventricular tachycardia ablation and guideline-directed medical therapy, including anticoagulation and heart failure medications, were administered.
  • The patient experienced no further episodes of syncope or ventricular tachycardia post-treatment.

Implications:

  • Chagas heart disease is under-diagnosed in the USA despite the increasing prevalence of *Trypanosoma cruzi* infection.
  • Clinicians should consider Chagas heart disease in patients with heart failure symptoms and ventricular arrhythmias, especially with relevant travel history and characteristic imaging findings.
  • Multimodality imaging, including echocardiography and cardiac magnetic resonance, is essential for accurate diagnosis and effective management of Chagas heart disease.
Abstract

Keywords:
Case reportChagas heart diseaseDilated cardiomyopathyLeft ventricular apical thrombusVentricular tachycardia

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