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Case Reports
. 2025 Jun 25;30(16):104203.
doi: 10.1016/j.jaccas.2025.104203.

Multimodal Cardiac Imaging of a Sudden Cardiac Death Survivor From Central America

D Douglas Miller  1 , Gyanendra K Sharma  2 , Sam Natla  2 , Sean P Javaheri  2 , Vishal Arora  2
Affiliations
Case Reports

Multimodal Cardiac Imaging of a Sudden Cardiac Death Survivor From Central America

D Douglas Miller et al. JACC Case Rep. .

Abstract

Background: Sudden cardiac death (SCD) in a nonimmunosuppressed individual from El Salvador who had visited 2 Trypanosoma cruzi seropositive siblings raised clinical suspicion for Chagas disease.

Case summary: A 61-year-old male SCD survivor presented with electrocardiogram conduction abnormalities, cardiomegaly, myocardial necrosis with basal inferolateral aneurysm formation (echocardiography, left ventriculography), and sluggish contrast flow in the absence of coronary obstruction. Cardiac magnetic resonance defined the extent of myocardial fibrosis (delayed enhancement) from microvascular disease and guided endomyocardial biopsy. T. cruzi serology studies and circulating inflammatory markers supported late-stage Chagas cardiomyopathy.

Discussion: Patients in T. cruzi-endemic regions are at an increased risk of developing Chagas cardiomyopathy, predisposing to SCD. Multimodal imaging provided indications for antiparasitic therapy to reduce disease progression and for dual-chamber implantable cardioverter defibrillator for secondary prevention in high-risk patients (Rassi score = 13).

Take-home message: In SCD survivors with Chagas cardiomyopathy, multimodal cardiac imaging: 1) improves early management; 2) guides antiparasitic therapy; and 3) adds prognostic value.

Keywords: cardiac magnetic resonance; cardiomypathy; coronary angiography.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Coronary Angiogram (A) Normal left system. (B) Normal right coronary artery. (C) LV angiogram (arrow = inferolateral aneurysm).
Figure 2
Figure 2
Cardiac Magnetic Resonance (A, C, D) Late gadolinium enhancement (arrow). (B) T2-based short tau inversion recovery image with edema of the lateral wall.
Figure 3
Figure 3
T1 (Injury) and T2 (Edema) Myocardial Mapping Analysis T2 myocardial mapping demonstrating regional abnormalities in the lateral wall. T1 mapping shows diffuse abnormalities.
See this image and copyright information in PMC

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