SCMR 22nd Annual Scientific Sessions
Description of Clinical Presentation: A 54-year-old man, originally from Mexico, presented to the emergency department after experiencing chest pain and recurrent syncopal episodes. On arrival, he was found to be in hemodynamically unstable wide complext tachycardia requiring urgent cardioversion with restoration of sinus rhythm.
Diagnostic Techniques and Their Most Important Findings:
He underwent urgent coronary angiography which revealed no obstructive disease. A transthoracic echo revealed moderately reduced left ventricular systolic function (ejection fraction 35-40%) with apical akinesis and an aneurysm of the apical septum. Cardiac MRI (CMR) confirmed a prominent apical aneurysm with dyskinesis of the apical septum. There was transmural myocardial late gadolinium enhancement of the entire left ventricular apex, extending into the mid anterolateral wall, indicating extensive fibrosis. Additionally, a small apical thrombus was visualized. Given the CMR findings and normal coronaries, further history was obtained. The patient reported emigrating from Mexico to the United States 20 years ago, but recalled living in a small mud hut in Mexico that was swarming with “chinches,” small nocturnal bugs that routinely bit the sleeping inhabitants. The history and clinical findings raised a strong suspicion for Chagas heart disease. Specific serologic testing was positive for Trypanosoma cruzii IgG antibody. Repeat testing at the Centers for Disease Control and Prevention(CDC) testing was also positive, confirming the diagnosis of Chagas cardiomyopathy.
Learning Points from this Case: This case highlights the critical role of an interdisciplinary approach to the successful diagnosis and treatment of Chagas heart disease.