Giant Megacolon in Chagasic Cardiomyopathy: A Challenging Combination

This case concerns a 62-year-old man diagnosed with chagasic cardiomyopathy, presenting with a dilated and arrhythmogenic form, showing significant ventricular dysfunction, and currently undergoing cardiac resynchronization therapy with a previously implanted implantable cardioverter defibrillator. In the outpatient setting prior to admission, the patient’s medical records indicate recurrent ventricular arrhythmias and multiple appropriate shocks from the device over recent years.

Upon admission to the emergency department, the patient complained of severe asthenia, abdominal pain, postprandial vomiting, and choking persisting for a week. His current medication regimen included losartan 100 mg/day, carvedilol 50 mg/day, spironolactone 25 mg/day, empagliflozin 25 mg/day, furosemide 80 mg/day, acetylsalicylic acid 100 mg/day, and atorvastatin 40 mg/day. During the physical examination upon admission, a significant drop in general condition, cachexia, blood pressure of 84×57 mmHg, and heart rate of 93 bpm were observed. In addition to hypotension, cold extremities and prolonged capillary refill time were noted. There were no peripheral edema, jugular distension or pulmonary congestion. In addition, there was significant abdominal distension and pain on palpation. Based on the patient’s clinical history and physical examination findings, a diagnosis of acute obstructive abdomen and decompensated heart failure (HF) with an L-profile was determined.

[…]