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Cardiac manifestations of chronic Chagas disease
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Cardiac manifestations of chronic Chagas disease Divya V. Bhatia, MD, Ramesh M. Gowda, MD, Sanjayant Chamakura, MD, Sabrina L. Wilbur, MD From Beth-Israel Long-Island College Hospital, Brooklyn, New York. A 42-year-old primigravida woman was referred from the pregnancy clinic for cardiac evaluation because of ventricular premature depolarizations on routine ECG. Subsequent Holter monitoring recorded multiple salvos of nonsustained ventricular tachycardia. Upon further questioning, she revealed a past medical history significant for near-syncopal and syncopal episodes since age 8 years. In addition, her family history was notable for sudden death in three of six siblings. Her surviving brother received a pacemaker for bifascicular block. Her remaining sister had a cardiologic evaluation in Columbia for palpitations; however, the results were not available. The patient postponed further work-up until after delivery. Two
Address reprint requests and correspondence: Dr. Divya V. Bhatia, Beth-Israel Long-Island College Hospital, 339 Hicks Street, 5th Floor Cardiology, Brooklyn, New York 11201. E-mail address: [email protected] .
months after an uneventful delivery, she returned for further evaluation. An attempt at cardiac magnetic resonance imaging was unsuccessful because of high-grade ventricular ectopy. Subsequent cardiac catheterization revealed normal coronaries but mildly reduced left ventricular ejection fraction, a large apical aneurysm (multiple small arrows, Figure 1A) with a filling defect (arrowhead, Figure 1A), and a partially formed aneurysm (large single arrow, Figure1A). Transesophageal echocardiography later confirmed the filling defect was a thrombus. At electrophysiologic study, the patient had both spontaneous ventricular tachycardia and inducible ventricular tachycardia with hemodynamic compromise (Figure 1B). The two arrhythmias had similar axis and morphology. A serum sample was sent to the Centers for Disease Control, and the report came back noting a highly positive antibody titer for Chagas disease (1:256). The patient received an implantable cardioverter-defibrillator. At discharge, the patient was taking warfarin and mexiletine.
1547-5271/$ -see front matter © 2005 Heart Rhythm Society. All rights reserved.
doi:10.1016/j.hrthm.2005.03.010
Cardiac manifestations of chronic Chagas disease Divya V. Bhatia, MD, Ramesh M. Gowda, MD, Sanjayant Chamakura, MD, Sabrina L. Wilbur, MD From Beth-Israel Long-Island College Hospital, Brooklyn, New York. A 42-year-old primigravida woman was referred from the pregnancy clinic for cardiac evaluation because of ventricular premature depolarizations on routine ECG. Subsequent Holter monitoring recorded multiple salvos of nonsustained ventricular tachycardia. Upon further questioning, she revealed a past medical history significant for near-syncopal and syncopal episodes since age 8 years. In addition, her family history was notable for sudden death in three of six siblings. Her surviving brother received a pacemaker for bifascicular block. Her remaining sister had a cardiologic evaluation in Columbia for palpitations; however, the results were not available. The patient postponed further work-up until after delivery. Two
Address reprint requests and correspondence: Dr. Divya V. Bhatia, Beth-Israel Long-Island College Hospital, 339 Hicks Street, 5th Floor Cardiology, Brooklyn, New York 11201. E-mail address: [email protected] .
months after an uneventful delivery, she returned for further evaluation. An attempt at cardiac magnetic resonance imaging was unsuccessful because of high-grade ventricular ectopy. Subsequent cardiac catheterization revealed normal coronaries but mildly reduced left ventricular ejection fraction, a large apical aneurysm (multiple small arrows, Figure 1A) with a filling defect (arrowhead, Figure 1A), and a partially formed aneurysm (large single arrow, Figure1A). Transesophageal echocardiography later confirmed the filling defect was a thrombus. At electrophysiologic study, the patient had both spontaneous ventricular tachycardia and inducible ventricular tachycardia with hemodynamic compromise (Figure 1B). The two arrhythmias had similar axis and morphology. A serum sample was sent to the Centers for Disease Control, and the report came back noting a highly positive antibody titer for Chagas disease (1:256). The patient received an implantable cardioverter-defibrillator. At discharge, the patient was taking warfarin and mexiletine.
1547-5271/$ -see front matter © 2005 Heart Rhythm Society. All rights reserved.
doi:10.1016/j.hrthm.2005.03.010