Massive right-sided cardiac thrombosis in Chagas' heart disease without left ventricular dysfunction.

A 63-year-old woman with the diagnosis of mega-oesophagus secondary to chronic Chagas' disease and no past cardiac history was referred for cardiac evaluation. The resting ECG showed right bundle-branch block, whereas a 2-D echocardiogram revealed marked right ventricular dilatation with hypokinesia, right atrial dilatation, normal pulmonary artery pressure, and normal left ventricular ejection fraction. A large, irregularly shaped mass, arising from the right atrium and protruding into the right ventricle through the tricuspid valve, with several different bizarre forms inside the right atrium during systole and/or diastole was seen on 2-D echocardiogram. Therefore, massive right-sided thrombosis can be detected in Chagas' disease patients with no overt right- and left-sided ventricular failure.

Endomyocardial fibrosis as a cause of Budd-Chiari syndrome and fatal pulmonary embolism.

A 24-year-old-man had right-sided heart failure of 3 months' duration. A Doppler echocardiogram revealed atrium and right ventricular enlargement, obliteration of the right ventricular apex, and a mass with an echolucent center measuring 20x21 mm in the right ventricular outlet. He died of pulmonary embolism. At autopsy, a huge organized thrombus obliterating the right ventricular apex passing through the tricuspid valve to the right atrium and then extending to the inferior vena cava up to the suprahepatic veins was seen. Histologically, an intense fibrotic thickening of the endomyocardium extending into the myocardium was observed. Cardiac thrombosis associated with endomyocardial fibrosis should be added to the list of causes of Budd-Chiari syndrome.

QT interval dispersion in patients with chronic heart failure secondary to Chagas' cardiomyopathy: correlation with clinical variables of prognostic significance.

BACKGROUND: QTc interval dispersion has rarely been studied in patients with chronic heart failure (CHF) secondary to Chagas' cardiomyopathy. One study has demonstrated an association between QT interval dispersion and sudden cardiac death. No data exist regarding the association of clinical variables and QT interval dispersion in patients with this condition. METHODS: Sixty three patients with CHF due to Chagas' cardiomyopathy, 34 Chagas' disease patients with no systolic dysfunction on echocardiography, and 36 individuals with no previous cardiac history, matched by sex and a 10-year age interval, were included in the investigation. The QTc interval dispersion was defined as the difference between maximum and minimum QTc. RESULTS: The mean QTc interval dispersion was 74+/-30.3 ms in surviving and 87+/-30.6 ms in nonsurviving patients (P=.13). Mean QTc dispersion was 95.20+/-28.46 ms in patients who died from pump failure, 73.33+/-29.61 ms in patients who died suddenly, and 74.46+/-30.27 in survivors (P=.07). Mean QTc dispersion value was higher in patients in the Class III or IV (P=.01).). Mean QTc interval dispersion was 67.2+/-22.7 ms in patients with and 85.5+/-33.5 ms in patients without premature ventricular contractions (P=.01), and 67.5+/-29.8 ms in patients with and 84.7+/-31.8 ms in patients without left ventricular apical aneurysm (P=.03). A correlation could be observed in QTc interval dispersion and left atrium dimension (r=.32; P=.009) Thus, QTc interval dispersion is associated to some prognostic indicators in patients with CHF secondary to Chagas' cardiomyopathy.

Angina-like chest pain and syncope as the clinical presentation of left ventricular endomyocardial fibrosis: a case report.

A 47-year-old woman complained of angina-like chest pain, near-syncope, and syncopal episodes of 17 years' duration. Physical examination was unremarkable. A 12-lead resting ECG showed symmetrically inverted T waves in the inferior and anterolateral leads. A graded treadmill exercise stress test precipitated angina-like chest pain accompanied by a near-syncopal episode associated with a systemic arterial pressure of 60/40 mm Hg. Echocardiography disclosed left ventricular apical obliteration. Left ventriculogram showed a typical "ace of heart'' shadow as well as filling defects and apical obliteration. Endomyocardial biopsy of the left ventricle diagnosed left ventricular endomyocardial fibrosis. Thus, angina-like chest pain and near-syncopal episodes should be added to the list of clinical manifestations of pure left ventricular endomyocardial fibrosis.