Thromboembolic Stroke in a Young Woman with Chagas Cardiomyopathy (P06.247)

Abstract

Objective: To report a case of acute ischemic stroke in a young woman originally from El Salvador, subsequently diagnosed with Chagas-associated cardiomyopathy. Background Chagas disease is an infectious disease caused by the tropical parasite Trypanosoma cruzi. The most frequent manifestation of the chronic form of Chagas disease is cardiomyopathy, associated with heart failure, arrhythmias, thromboembolism, and stroke. The incidence of chronic Chagas is estimated to be 8-14 million people world wide and is increasingly seen in the USA because of recent emigrations from endemic countries. Design/Methods: We describe the clinical course, investigations, and treatments of a 32 year old woman who presented with cardioembolic ischemic stroke secondary to Chagas cardiomyopathy. Results: A 32-year-old El Salvadorian woman presented with an acute episode of right-sided face/arm/leg tingling, weakness, confusion and inability to pronounce words. MRI/MRA demonstrated an acute left fronto-temporal infarct. Laboratory tests including hypercoagulable panel, toxicology, and lipids were unremarkable, but EKG and telemetry were notable for sinus bradycardia with sinus pause and junctional escape beats. TTE was concerning for a left ventricular thrombus. Cardiac MRI demonstrated fibrosis and a small mass within an akinetic apex, consistent with a cardiac thrombus. Further discussions with the patient elicited a history of symptomatic palpitations, difficulty swallowing solid foods and constipation, suggestive of chronic Chagas disease. The patient was started on a heparin bridge to warfarin and had an AICD placed. Chagas serologies sent to the CDC returned positive, and the patient was started on a course of Benznidazole to halt further progression of the disease. Conclusions: We report a case of a young El Salvadorian woman whose chronic Chagas disease was first diagnosed after presenting with a cardioembolic stroke. Given the increasing documentation of Chagas in the USA, Chagas-related cardiomyopathy should be considered in patients from endemic countries presenting with cardioembolic stroke. Disclosure: Dr. Busza has nothing to disclose. Dr. Cervantes-Arslanian has nothing to disclose. Dr. Kase has nothing to disclose.