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Chagas Cardiomyopathy — EECC MCQ

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ModerateCardiomyopathyChagas CardiomyopathyEECC

A 25-year-old man from rural Brazil presents with progressive HF. He has megacolon and megaoesophagus. ECG shows RBBB, left anterior fascicular block, and frequent PVCs. Echocardiography reveals a dilated LV with apical aneurysm and LVEF 35%. Serological testing is positive for Trypanosoma cruzi antibodies. What is the diagnosis?

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Correct answer: D — Chagas cardiomyopathy

Chagas disease (caused by Trypanosoma cruzi, transmitted by triatomine bugs) is endemic in Latin America and is a major cause of cardiomyopathy worldwide. Cardiac involvement occurs in ~30% of infected individuals, typically decades after initial infection (chronic phase). Characteristic features include: RBBB with left anterior fascicular block, apical aneurysm, LV dysfunction, and complex ventricular arrhythmias. The combination of cardiac and GI involvement (megaoesophagus, megacolon) is pathognomonic. Treatment includes benznidazole (antiparasitic, limited efficacy in chronic phase), standard HF therapy, and ICD for arrhythmia prevention. Cardiac transplantation may be required.

Reference: ESC (2023): Guidelines on Cardiomyopathies; WHO Chagas Disease Guidelines