Delayed cardiac conduction disease in a young adult following childhood Chagas infection

Abstract

Presentation
A Bolivian man in his 30s presented to the ED with non-exertional chest pain and intermittent second-degree atrioventricular (2:1) block.

Diagnosis
Given a history of untreated childhood Trypanosoma cruzi infection and family history of Chagas heart disease, late cardiac manifestation was suspected. Structural and ischaemic causes were excluded.

Treatment
Antiparasitic therapy was initiated. Pacemaker implantation was considered but deferred following shared decision-making due to absence of symptoms.

Discussion
Chagas heart disease (CHD) may present decades after infection with conduction abnormalities. Recognition in the ED is essential to enable appropriate management and reduce the risk of progression to complete heart block and sudden cardiac death.