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Ventricular tachychardia in a latino-american patient
Session:
Sessão Speaker's Corner - Casos clínicos desafiantes… em Insuficiência Cardíaca
Speaker:
Mariana Carvalho
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Mariana Carvalho; Carolina Gonçalves; Margarida Cabral; Sara Fernandes; Rita Ribeiro Carvalho; Luís Graça Santos; João Morais
Abstract
<p>Backgroud: In Latin American patients, Chagas heart disease (CHD) is a frequent nonischemic substrate for left ventricular tachycardia while being uncommon in Europe and North America. Recently, due to higher immigration rates, Chagas disease is now seen in developed countries.</p> <p>Unexpected sudden cardiac death (SCD) is the most common cause of death in these patients, due to ventricular tachycardia (VT) that may degenerative in other malignant arrhythmias. It's still difficult to figure out which individuals are most likely suffer from SCD. In Chagas heart disease, the most prevalent electrocardiographic change that may precede malignant arrhythmias is right bundle-branch block (RBBB), and left anterior fascicular block (LAFB).</p> <p> </p> <p>Case presentation:</p> <p>A 43 year-old brazilian woman presented to the emergency department complaining of palpitations. She had a medical history of CHD having previously lost follow-up in Cardiology. A 12-lead electrocardiogram (ECG) showed a sustained ventricular tachycardia with hemodynamic instability so an electrical cardioversion was performed twice since the first was ineffective, resulting in a rapid conversion to sinus rhythm and return to hemodynamic stability. intravenous infusion of 150 mg of amiodarone was started. A new ECG was made showing synus rhythm and RBBB and LAFB. Transthoracic echocardiography revealed moderate left ventricular dysfunction (ejection fraction of 32% and longitudinal strain of -6%). The patient underwent cardiac catheterization that did not show any coronary abnormality. Cardiac MRI was later performed and showed severe left ventricular dysfunction with akinesia of the basal segments of anterolateral and inferolateral walls and mid segments of the inferolateral and inferior wall. Aneurisms were also noted in the apical aneurysm of glove finger type associated with an apical thrombus (18x13mm). Transmural late gadolinium enhancement was seen in basal segments of anterolateral and inferolateral walls, compatible with advanced chagas myocardiopathy.</p> <p>The case was discussed with the electrophysiology department, deciding later for the implantation of a cardioverter defibrillator with atrial pacing to facilitate beta-blocker treatment.</p> <p>The patient was discharged three days later without any complaints.</p> <p> </p> <p>Conclusion:</p> <p>This case illustrates a rare cause of ventricular tachycardia due to Chagas myocardiopathy, which should raise awareness of the emergence of this disease in developed countries in order to give the best possible treatment and outcome for the patient.</p>
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