Multimodal Cardiac Imaging of a Sudden Cardiac Death Survivor From Central America

Background

Sudden cardiac death (SCD) in a nonimmunosuppressed individual from El Salvador who had visited 2 Trypanosoma cruzi seropositive siblings raised clinical suspicion for Chagas disease.

Case Summary

A 61-year-old male SCD survivor presented with electrocardiogram conduction abnormalities, cardiomegaly, myocardial necrosis with basal inferolateral aneurysm formation (echocardiography, left ventriculography), and sluggish contrast flow in the absence of coronary obstruction. Cardiac magnetic resonance defined the extent of myocardial fibrosis (delayed enhancement) from microvascular disease and guided endomyocardial biopsy. T. cruzi serology studies and circulating inflammatory markers supported late-stage Chagas cardiomyopathy.

Discussion

Patients in T. cruzi-endemic regions are at an increased risk of developing Chagas cardiomyopathy, predisposing to SCD. Multimodal imaging provided indications for antiparasitic therapy to reduce disease progression and for dual-chamber implantable cardioverter defibrillator for secondary prevention in high-risk patients (Rassi score = 13).

Take-Home Message

In SCD survivors with Chagas cardiomyopathy, multimodal cardiac imaging: 1) improves early management; 2) guides antiparasitic therapy; and 3) adds prognostic value.