Chagas Cardiomyopathy

INTRODUCTION: Chagas disease is an under-recognized cause of cardiomyopathy in the United States, and cardiac involvement may present decades after exposure with heart failure or ventricular arrhythmias. CASES: A 52-year-old man from El Salvador presented with progressive dyspnea and volume overload. Evaluation revealed severe biventricular dysfunction, elevated filling pressures, no obstructive coronary disease, and nonischemic late gadolinium enhancement. Trypanosoma cruzi serology was positive. He required inotropic support and was discharged on guideline-directed medical therapy with a wearable cardioverter defibrillator and follow-up. A 68-year-old man from El Salvador with ischemic cardiomyopathy and recurrent ventricular tachycardia despite implantable cardioverter-defibrillator placement and prior ablations presented with electrical storm. Heart transplantation evaluation revealed positive Chagas serologies. He underwent heart transplantation complicated by early graft dysfunction requiring temporary venoarterial extracorporeal membrane oxygenation, with subsequent recovery and preserved graft function. DISCUSSION/CONCLUSION: These cases demonstrate how a comprehensive social and environmental exposure history can identify Chagas infection in patients undergoing evaluation for cardiomyopathy or refractory arrhythmias and inform advanced therapy and post-transplant management.