Severe and rapidly progressive heart failure in a young adult patient with chronic Chagas cardiomyopathy: diagnostic and therapeutic challenge

Abstract

Chagas disease is responsible for 12 thousand deaths annually in the Americas, mainly due to Chronic Chagas Cardiomyopathy (CCC) that occurs in 20 to 30% of those infected people, after 60 years old, 30 to 40 years after the first infection, leading to biventricular heart failure (HF), arrhythmias, blocks and embolisms. The diagnosis is based on epidemiology, clinical condition, electrocardiographic changes and imaging tests associated with serology. The present study reports the case of a patient with atypical evolution for her age due to rapid progression to advanced and refractory HF, associated with high morbidity and mortality, a typically late manifestation of CCC. Clinical case: 37 years old female patient admitted to the Intensive Care Unit of a tertiary hospital in a city of São Paulo State for decompensated congestive heart failure, associated with pleural effusion. The echocardiogram and serology for Trypanosoma Cruzi confirmed the diagnosis of CCC and risk of mortality estimated in 84%. Treatment started with beta-blocker, spironolactone, diuretic, enalapril and patient was discharged from hospital. After 20 months, she was readmitted with cardiogenic shock, cardio-renal syndrome and atrial fibrillation treated with diuretics, inotropic and amiodarone, and progressing to death after three days. It was not possible to refer for resynchronization therapy or heart transplantation, due to psychiatric comorbidity, poor medication adherence and unavailability at the service. The precocious presentation of advanced and refractory HF, in this case, revels the importance of adherence to medication treatment, reduction of readmissions and the quick referral to a transplant center and ventricular support, in an attempt to reduce the morbidity and mortality of these patients.