A patient with arrhythmias and infective cardiac disease

Abstract

In western countries patients with a Trypanosoma cruzi infection and with Chagas cardiomyopathy are rare. We report the case of a patient with Chagas cardiomyopathy in Switzerland. Methods: The family history was consistent with a possible T. cruzi infection. The patient came from Central America. The patient had symptoms of arrhythmia and congestive heart failure. ECG detected a complex arrhythmia, with brady-/tachycardic episodes, Atrioventricular- and bundle- branch blocks, paroxysmal atrial fibrillation and complex supraventricular and ventricular premature beats. Echocardiography detected a dilated, hypokinetic left ventricle with moderately reduced left ventricular ejection fraction and severe diastolic dysfunction. NT-proBNP (N-terminal of the prohormone brain natriuretic peptide) was highly elevated. The patient had also symptoms of gastrointestinal Chagas disease. The diagnosis of T. cruzi infection was confirmed by IgG serological testing with an ELISA test and PCR assessment. Therapy: An implantable cardioverter defibrillator device was implanted and the patient was dismissed under medical treatment with amiodarone, perindopril, rivaroxaban, pantoprazole and benznidazole. In the follow-up, amiodarone was substituted with metoprolol retard and perindopril with candesartan. Congestive heart failure increased. The patient was treated with torasemide, low-dose spironolactone, metoprolol retard, valsartan/sacubitril, rivaroxaban and pantoprazole and signs and symptoms of heart failure were controlled. Conclusion: The chronic parasitic T. cruzi infection may be asymptomatic. However, after decades a highly arrhythmogenic cardiomyopathy occurs in up to 30% of patients. Gastrointestinal Chagas disease is less frequent. The majority of infections in Europe are found in persons who lived in Latin America. European cases of Chagas disease are rare and underrecognised. Suggestions: Persons who lived in Latin America may have been infected with T. cruzi. If there is a pertinent anamnesis, these persons should be checked for cardiac arrhythmias and dysfunction and also for gastrointestinal pathologies. Early assessment of these pathologies may allow treatment before the Chagas disease induces irreversible damage. There is no specific therapy for Chagas disease, but current empirical therapy allows a better prognosis.