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Heart Failure at Age 46?

Posted on by Susan Montgomery, DVM, MPH
Dotson E-80
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Susan Montgomery, DVM, MPH, is the Epidemiology Team Lead in the Parasitic Diseases Branch of CDC’s Division of Parasitic Diseases and Malaria, Center for Global Health.
Susan Montgomery, DVM, MPH, is the Epidemiology Team Lead in the Parasitic Diseases Branch of CDC’s Division of Parasitic Diseases and Malaria, Center for Global Health.

People often ask me what I enjoy most about the work I do. For me, it is the individuals we help to make healthier, those whose quality of care are directly impacted by the guidance we can give physicians.

Recently, a physician in southern California contacted CDC about her patient, Jose. When Jose was just 46 years old, he was admitted to the hospital with chest pain and shortness of breath. He and his wife were worried he had a heart attack. After running tests, his cardiologists discovered something even more complicated: he was suffering from advanced heart failure.

Because of his age and otherwise good health, Jose’s doctors planned to put his name on the national waiting list to receive a lifesaving heart transplant. But then one of the doctors on his team remembered hearing about Chagas disease in medical school. She knew the disease could cause heart failure and even death. His medical team consulted with their infectious disease colleagues at the local hospital and university, but none had ever treated a patient with the infection, so the physician contacted CDC.

I was the one on call that day to answer urgent inquiries through CDC’s parasitic diseases’ physician hotline. After talking with the doctor and learning more about Jose’s patient history and clinical status, I advised the treating physician that his heart failure could indeed be caused by Chagas disease.

I recommended testing for Jose. His doctors immediately went into action, first contacting the state health department and then shipping blood samples to CDC for confirmatory testing. Within days, the results were back: the test confirmed infection with Trypanosoma cruzi (T. cruzi), the deadly parasite that causes Chagas disease.

We discussed the results and options, including whether Jose should receive one of the two medicines used to treat infection with T. cruzi. Although they are effective to treat early Chagas disease, Jose’s heart disease was already advanced. Being on the transplant list further complicated the decision. Jose needed the transplant to save his life but the medicines used to help after an organ transplant can allow the parasite to quickly multiply and spread, causing serious illness and even death. I talked Jose’s doctor through his questions about what to watch for if Jose did get a heart transplant, including the lab testing that should be done to monitor him for infection and what to do if the infection did start to spread.

This series of events is not unique. While parasitic diseases do occur in the United States, they are not common. CDC is often a critical resource for U.S. healthcare providers and state and local public health professionals who may have questions about these conditions. For some diseases, CDC is the only source for specific testing and treatment drugs not available elsewhere. The hundreds of inquiries we receive each year may be about any one of the dozens of parasites CDC studies and works to prevent and control—but often the questions are about Chagas disease.

Chagas disease affects about 6–7 million people globally, and we estimate that there are about 300,000 people in the U.S. living with Chagas disease. Most do not know they are infected.

Some, who have a heart condition like Jose, may not find out until they develop symptoms and their healthcare provider thinks to test them for Chagas disease. Others are identified as a result of routine testing done when they donate blood. Because Chagas disease can be transmitted from infected blood donors, all blood donations in the United States are tested to keep the T. cruzi parasite out of the blood supply. This has been done since 2007. Blood from donors who are found to have the infection is discarded and a letter is sent to the donor indicating that he or she is positive and should seek medical evaluation for the disease. For many, this may be the first time the individual or his or her healthcare provider has heard about Chagas disease. This is why CDC and others are helping to increase awareness of Chagas disease, particularly among physicians specializing in infectious diseases and among transplant centers.

Jose was lucky to get a new heart right before the holidays, and his clinical team and my colleagues at CDC closely monitored the situation over the New Year. Two months after the transplant surgery, testing at CDC quickly detected the earliest signs that his infection was worsening, and we approved and shipped the drugs (which are not yet commercially available in the U.S.) to his doctors for Jose’s treatment. Soon after, his infection was under control, allowing his new heart to continue to function normally. I hope he continues to have many healthy years!

Jose is one example of the many patients we help when Chagas disease expertise and treatment drugs are needed. It’s a small part of what we do at CDC, but knowing that our work helped save the life of a family’s loved one is a critically important and rewarding part of our work. This is what I enjoy most about my job.

Learn more about Chagas disease

Posted on by Susan Montgomery, DVM, MPHTags , , , ,

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