Chagas Heart Disease: Social Determinants and Delayed Diagnosis

Chagas cardiomyopathy (CCM) is an under-recognized cause of nonischemic cardiomyopathy (NICM) among immigrants from endemic regions or Latin America.

A 60-year-old Guatemalan man with heart failure with reduced ejection fraction presented with dyspnea and was ultimately found positive for Trypanosoma cruzi IgG. He underwent cardiac resynchronization therapy with defibrillator.

Timely recognition is crucial, as sudden cardiac death accounts for 60% of CCM-related mortality, which is higher than in non-CCM NICM. Early detection, prior to irreversible myocardial damage, also allows for curative antiparasitic therapy, a critical window that is almost always missed in the U.S.

Our patient presented with end-stage disease nearly 2 decades after the initial conduction system was documented. This oversight is a systemic failure, where CCM is often mistaken for "idiopathic" NICM given low clinician awareness and lack of routine targeted screening in the U.S., which in this case led to catastrophic and inequitable outcomes in an otherwise treatable infection.