Complete Resolution of Electrocardiographic Changes Induced by Acute Chagas Myocarditis

We present a case of a female adolescent with severe acute Chagas myocarditis, acquired by oral transmission in an endemic area in the Brazilian western Amazon, who had electrocardiographic changes normalized after empirical treatment with the antiparasitic drug benznidazole combined with conventional treatment for severe heart failure.

Keywords:
Chagas Disease/epidemiology; Trypanosoma Cruzi; Chagas Cardiomyopathy; Electrocardiography/methods; Heart Failure/drug therapy; Antiparasitic Agents

Authorship

Joseane Elza Tonussi Mendes Rossette do Valle

Secretaria de Estado de Saúde do Acre, Rio Branco, AC - BrazilSecretaria de Estado de Saúde do AcreBrazilRio Branco, AC, BrazilSecretaria de Estado de Saúde do Acre, Rio Branco, AC - Brazil

http://orcid.org/0000-0003-1434-0113

Luiz Carlos de Abreu

Faculdade de Medicina do ABC (FMABC), Santo André, SP - BrazilFaculdade de Medicina do ABCBrazilSanto André, SP, BrazilFaculdade de Medicina do ABC (FMABC), Santo André, SP - Brazil

http://orcid.org/0000-0002-7618-2109

Raimundo Barbosa Barros

Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE - BrazilHospital de Messejana Dr. Carlos Alberto Studart GomesBrazilFortaleza, CE, BrazilHospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE - Brazil

http://orcid.org/0000-0002-5113-3116

Rodrigo Daminello Raimundo

Faculdade de Medicina do ABC (FMABC), Santo André, SP - BrazilFaculdade de Medicina do ABCBrazilSanto André, SP, BrazilFaculdade de Medicina do ABC (FMABC), Santo André, SP - Brazil

http://orcid.org/0000-0002-3043-0728

Andrés Ricardo Pérez Riera Mailing Adress: Andrés Ricardo Pérez Riera R. Nicolau Barreto, 258. Postal Code: 04583-000, Vila Cordeiro, São Paulo, SP - Brazil. E-mail: riera@uol.com.br, arperezriera@gmail.com

Faculdade de Medicina do ABC (FMABC), Santo André, SP - BrazilFaculdade de Medicina do ABCBrazilSanto André, SP, BrazilFaculdade de Medicina do ABC (FMABC), Santo André, SP - Brazil

http://orcid.org/0000-0003-4948-538X

Isabel Sorpreso

Universidade de São Paulo, São Paulo, SP - BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilUniversidade de São Paulo, São Paulo, SP - Brazil

http://orcid.org/0000-0002-5475-5957

Mailing Adress: Andrés Ricardo Pérez Riera R. Nicolau Barreto, 258. Postal Code: 04583-000, Vila Cordeiro, São Paulo, SP - Brazil. E-mail: riera@uol.com.br, arperezriera@gmail.com

Author contributions

Conception and design of the research: Valle JETMR, Pérez-Riera AR. Acquisition of data: Valle JETMR. Analysis and interpretation of the data: Pérez-Riera AR. Writing of the manuscript: Valle JETMR, Barros RB, Pérez-Riera AR. Critical revision of the manuscript for intellectual content: Valle JETMR, Abreu LC, Barros RB, Raimundo RD.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

SCIMAGO INSTITUTIONS RANKINGS

Secretaria de Estado de Saúde do Acre, Rio Branco, AC - BrazilSecretaria de Estado de Saúde do AcreBrazilRio Branco, AC, BrazilSecretaria de Estado de Saúde do Acre, Rio Branco, AC - Brazil

Faculdade de Medicina do ABC (FMABC), Santo André, SP - BrazilFaculdade de Medicina do ABCBrazilSanto André, SP, BrazilFaculdade de Medicina do ABC (FMABC), Santo André, SP - Brazil

Universidade de São Paulo, São Paulo, SP - BrazilUniversidade de São PauloBrazilSão Paulo, SP, BrazilUniversidade de São Paulo, São Paulo, SP - Brazil

Figures

Figures (2)

Thumbnail

Figure 1
ECG-1: Sinus rhythm, heart rate of 90 bpm, P-wave axis + 55º, P-wave duration > 110 ms, P-wave voltage ≥ 2.5 mm in lead II, peaked, broad, bimodal, and plus-minus P-waves in lead V1, prolonged and bimodal P-wave in leads V₄-V₅, low QRS amplitude in lead V₁ contrasting with high QRS voltage in lead V₂: indirect signs of right atrial enlargement (“Sodi-sign”), normal PR interval, extreme left axis deviation (QRS axis - 60º), rS pattern in the inferior leads, qRs in I, and qR in aVL: left anterior fascicular block. Precordial QRS transition displaced to the left, deep S-waves in leads V₅-V₆, rS pattern from V₁ to V₅ demonstrating severe right ventricular overload. Conclusion: Biatrial enlargement; biventricular overload with predominant right ventricular overload; left anterior fascicular block.

Thumbnail

Figure 2
ECG-2: Electrocardiographic tracing after empirical treatment with BZ associated with conventional treatment for heart failure. Sinus rhythm, heart rate of 60 bpm, normal P-wave, normal PR interval, normal QRS axis (+60º), precordial transition area in lead V₂ (normal), visible U-wave from leads V₃ to V₅. Conclusion: normal tracing.

Figure 1 ECG-1: Sinus rhythm, heart rate of 90 bpm, P-wave axis + 55º, P-wave duration > 110 ms, P-wave voltage ≥ 2.5 mm in lead II, peaked, broad, bimodal, and plus-minus P-waves in lead V1, prolonged and bimodal P-wave in leads V₄-V₅, low QRS amplitude in lead V₁ contrasting with high QRS voltage in lead V₂: indirect signs of right atrial enlargement (“Sodi-sign”), normal PR interval, extreme left axis deviation (QRS axis - 60º), rS pattern in the inferior leads, qRs in I, and qR in aVL: left anterior fascicular block. Precordial QRS transition displaced to the left, deep S-waves in leads V₅-V₆, rS pattern from V₁ to V₅ demonstrating severe right ventricular overload. Conclusion: Biatrial enlargement; biventricular overload with predominant right ventricular overload; left anterior fascicular block.

Figure 2 ECG-2: Electrocardiographic tracing after empirical treatment with BZ associated with conventional treatment for heart failure. Sinus rhythm, heart rate of 60 bpm, normal P-wave, normal PR interval, normal QRS axis (+60º), precordial transition area in lead V₂ (normal), visible U-wave from leads V₃ to V₅. Conclusion: normal tracing.

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Complete Resolution of Electrocardiographic Changes Induced by Acute Chagas Myocarditis

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[1] Mailing Adress: Andrés Ricardo Pérez Riera R. Nicolau Barreto, 258. Postal Code: 04583-000, Vila Cordeiro, São Paulo, SP - Brazil. E-mail: riera@uol.com.br, arperezriera@gmail.com