# Chagasic heart failure in a pregnant woman in a non-endemic area: case report and long-term follow-up

## TL;DR

A pregnant woman from Bolivia developed heart failure due to Chagas disease in a non-endemic area and was successfully treated with benznidazole and cardiological care.

## Contribution

This case highlights the importance of diagnosing Chagas disease in non-endemic regions through serology and appropriate treatment.

## Key findings

- Chagasic cardiomyopathy was diagnosed in a pregnant woman through positive serology and PCR.
- Benznidazole therapy and cardiological treatment led to improvement in the patient's condition.
- An implantable cardioverter defibrillator was placed five years later to prevent sudden cardiac death.

## Abstract

Chagas disease (CD) is caused by infection with the protozoan Trypanosoma cruzi, a parasite that nests in various tissues, causing irreversible cardiac damage in 30% of patients with chronic disease and neurological or digestive lesions in 10%. CD is now found in areas receiving migrant populations where no vector-borne transmission occurs. Chagasic cardiomyopathy (CC) is the most serious complication of the chronic phase of CD and the major cause of morbidity and mortality among patients with CD.

Bolivian woman at 38 weeks of gestation was admitted at the emergency room with the diagnosis of congestive heart failure. Cesarean section was performed and maternal hypotension and uterine atony occurred. Dilated myocardiopathy with severe left ventricle dysfunction was diagnosed. The patient referred positive serology for T. cruzi and polymerase chain reaction (PCR) was positive so benznidazole therapy was started. She was discharged due to progressive improvement with cardiological treatment and implantable cardioverter defibrillator was placed 5 years later for the prevention of sudden cardiac death.

The diagnosis of CC in non-endemic areas requires a high index of suspicion and it is based on serology. Antiparasitic drugs are almost 100% effective in infected newborn babies and highly effective in the treatment of patients in the acute stage of the disease. However, the efficacy of both drugs decreases the longer a person has been infected. Treatment of CC that causes chronic heart failure is similar to that in non-Chagasic etiology.