Medical history and current illness
36-year-old woman with a history of AHT. No DM or known hyperlipidaemia. Smoker of 20 cigarettes/day. No drinker. She denies consumption of other toxic substances. No known heart disease or bronchopathy. Preoperative ECG detected LBBB. Hepatic analytical alteration. Originally from the province of Cordoba in Argentina. IQ: caesarean section. Cholecystectomy in January 2011. No known drug allergies. On treatment only with oral contraceptives. Previously asymptomatic since 3 days before admission, she reported asthenia and progressive dyspnoea on exertion. Occasional epigastralgia.

Complementary tests
- Physical examination: conscious and oriented, well hydrated and perfused, good skin colour, no IY, no fever. BP 165/120. AC: rhythmic sounds without murmurs. AR: hypoventilation in both bases. Basal O2 sats: 98%. Abdomen: soft, pain on pressure in the epigastrium. EE.II: No oedema. Pedes little wide.
- ECG: RS. BRIHH.
- Chest X-ray: cardiomegaly. Right predominant insterstitial pattern. Right costophrenic sinus impingement.
- Angio-CT (performed in the emergency department): PTE was ruled out. Bilateral pleural effusion, more important on the right side. Right paratracheal lymphadenopathies of pathological size were observed.
- Laboratory tests: 1 hour ESR 14 mm. Red blood count and platelets normal. Leukocytes 11,003 with normal formula. Urate 7.9. Total cholesterol 192. HDL-C 43. LDL-C 132,2. Triglycerides 84. ProBNP 871.4. GGT 174. GPT 52. Ultrasensitive TnT (on admission) 12.1. Total bilirubin, creatinine, glomerular filtrate, glucose, urea, PT, chlorine, sodium, potassium, iron, GOT, FFAA, total CK, and TSH, within normal limits.
- Echocardiogram: with global hypokinesia and EF of 30%. Normal diastolic function. LV hypertrophy in the posterior face. Dilated LA (23 cm2). Thickened mitral valve with mild-moderate MR. Mild TR with PSAP of 54 mmHg.
- A referral was made to the Pneumology Department to assess right paratracheal adenopathy, performing mantoux (negative), recommending a CT scan within 2 months and subsequent assessment by the outpatient Pneumology Department.


Clinical evolution
Given the patient's origin, serology for Chagas disease (Trypanosoma cruzi) was performed and was positive. The diagnosis of Chagas disease was confirmed by IFA and ELISA, both positive. She was discharged with candesartan, bisoprolol and benznidazole 3 tablets together every 24 hours for follow-up in the Heart Failure and Infectious Diseases departments.

Diagnosis
- Chronic Chagas disease
- Severe grade systolic dysfunction
