Chronic Chagasic Cardiomyopathy (CCC) with severe biventricular involvement and intraventricular dromotropic disturbances

Dr. Raimundo Barbosa Barros
Brazil

Case presentation

29-year-old, female, Caucasian, from an endemic rural área for Chagas disease, a stick-up house, several family members infected, carrier of chronic chagasic cardiomyopathy with clinical signs of severe dilated cardiomyopathy functional class IV, even with full medication.
ECO: severe impairment of biventricular systolic function due to diffuse hypokinesia and LV ejection fraction = 22%. Severe ostial mitral regurgitation and tricuspid insufficiency; LV diastolic diameter = 4.7 LV/ height/cm/m, pulmonary artery systolic pressure = 44 mmHg. In regular use of carvedilol 25 mg twice daily, furosemide 40 mg twice daily, spironolactone 25 mg twice daily, enalapril maleate 20 mg twice daily, amiodarone 100 mg x day, acetylsalicylic acid 100 mg x day.

Questions

Which is the ECG / VCG diagnosis?
Which is the proper approach?

Apresentaçao do caso

Paciente de 29 anos, branca, procedente de área rural endêmica, casa de pau a pique, vários membros da família infectados, portadora de miocardiopatia chagásica crônica com quadro clínico de severa cardiopatia dilatada em classe funcional IV, mesmo com medicação plena.
ECO: severo comprometimento da função sistólica biventricular por hipocinesia difusa e fração de ejeção do VE = 22%. Insuficiência mitral e tricúspide ostial severas; diâmetro diastólico do VE = 4.7 Altura / cm / m, pressão sistólica da artéria pulmonar = 44 mmHg. Em uso regular de carvedilol 25 mg 2xdia, furosemida 40 mg 2xdia, espironolactona 25 mgxdia, maleato de enalapril 20 mg 2xdia, amiodarona 100 mg x dia, ácido acetilsalicílico 100 mg x dia.