The Role of Multimodality Cardiac Imaging in the Diagnosis and Management of Chronic Chagas Cardiomyopathy.

BACKGROUND

Chronic Chagas cardiomyopathy (CCC) is a late manifestation of Trypanosoma cruzi infection, now increasingly prevalent in nonendemic regions owing to migration. Diagnosis can be challenging, especially in patients with comorbid presentations.

CASE SUMMARY: A 50-year-old man originally from El Salvador presented with subacute dyspnea, fever, and weight loss. Work-up revealed severe biventricular dysfunction, apical aneurysm, and pulmonary consolidation. Multimodality cardiac imaging characterized structural abnormalities and excluded alternative causes of dilated cardiomyopathy. Serologic testing confirmed the diagnosis of Chagas cardiomyopathy, and blood cultures grew Francisella tularensis. The patient received targeted antibiotics for tularemia and guideline-directed medical therapy for heart failure.

DISCUSSION: CCC causes progressive myocardial fibrosis, conduction abnormalities, and malignant arrhythmias. Advanced cardiac imaging-especially magnetic resonance imaging-facilitates detection of apical aneurysms and fibrosis. Implantable cardioverter-defibrillator placement is indicated for secondary prevention in CCC and is considered for primary prevention in high-risk patients. Coexistent infections may obscure presentation.

TAKE-HOME MESSAGES: Suspect CCC in patients with new left ventricular dysfunction, especially in those with a travel history to endemic areas. Multimodality imaging helps characterize myocardial fibrosis/scar and exclude alternative etiologies. CCC carries high arrhythmic risk, and patients should be assessed for advanced therapies.