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The presence of right-sided cardiac thrombi seems to increase the risk of death due to thromboembolic events. There is a discrepancy, however, between the prevalence of cardiac thrombus and clinical thromboembolic events. Besides, the individual characteristics associated with a high risk of mortality have not been established. We present here a case report of a patient with mansonic schistosomiasis and acquired immunodeficiency syndrome and chronic Chagas disease, who presents with a large thrombus in the right ventricle. The patient had uneventful evolution without any thromboembolic complications with resolution of right-ventricle thrombus.

Introduction: Despite significant left ventricular (LV) systolic dysfunction and cardiomegaly, pulmonary congestion does not seem to be a major finding in Chagas' cardiomyopathy (CC). This study sought to identify echocardiographic parameters associated with pulmonary congestion in CC and in dilated cardiomyopathy of other etiologies, such as non-CC (NCC), and to compare pulmonary venous hypertension between the two entities., Methods: A total of 130 consecutive patients with CC and NCC, with similar echocardiographic characteristics, were assessed using Doppler echocardiography and chest radiography. Pulmonary venous vessel abnormalities were graded using a previously described pulmonary congestion score, and this score was compared with Doppler echocardiographic parameters., Results: NCC patients were older than CC patients (62.4 ± 13.5 × 47.8 ± 11.2, p = 0.00), and there were more male subjects in the CC group (66.2% × 58.5%, p = 0.4). Pulmonary venous hypertension was present in 41 patients in the CC group (63.1%) and in 63 (96.9%) in the NCC group (p = 0.0), the mean lung congestion score being 3.2 ± 2.3 and 5.9 ± 2.6 (p = 0.0), respectively. On linear regression multivariate analysis, the E/e' ratio (β = 0.13; p = 0.0), LV diastolic diameter (β = 0.06; p = 0.06), left atrial diameter (β = 0.51; p = 0.08), and right ventricular (RV) end-diastolic diameter (β = 0.02; p = 0.48) were the variables that correlated with pulmonary congestion in both groups., Conclusions: Pulmonary congestion was less significant in patients with CC. The degree of LV of systolic and diastolic dysfunction and the RV diameter correlated with pulmonary congestion in both groups. The E/e' ratio was the hallmark of pulmonary congestion in both groups.

We describe the case of a 41-year-old man with congenital heart disease and infective endocarditis (IE), who presented multiple vegetations attached to the pulmonary, mitral, and aortic valves. Three valve replacements were performed, but the patient developed an abscess at the mitral-aortic intervalvular fibrosa and died due to sepsis. We briefly discuss the indications for surgery in IE, emphasizing its role in the treatment of uncontrolled infection.

Endomyocardial fibrosis (EMF) is a neglected tropical disease that affects millions of people worldwide. EMF is the most common cause of restrictive cardiomyopathy, caused by deposition of fibrous tissue on endocardial surfaces. EMF is a major cause of death in areas where it is endemic, but the pathogenesis of the disease is poorly understood. Schistosomiasis mansoni is a parasitic disease endemic in Brazil, where EMF has also been described. The association between EMF and schistosomiasis has been suggested in various publications, seeking a possible correlation between endocardial and periportal fibroses. This report describes a case of EMF associated with schistosomiasis.

Introduction: Chagas' disease can lead to severe and potentially lethal damage of cardiac function. Thus, the identification of cardiac abnormalities in patients presenting the indeterminate form (IF) can be important for risk stratification. This paper aimed to demonstrate whether IF chagasic patients who presented wall motion abnormalities showed functional and electric disturbances compared to patients with normal echocardiogram and Doppler studies., Methods: Thirty eight patients with the IF were studied, including 26 chagasic patients with normal electrocardiographic, radiological and echocardiographic exams and 12 chagasic patients showing segmental wall motion abnormalities in the echocardiographic exam. All the patients were submitted to complete echocardiogram and Doppler study, including tissue Doppler imaging (TDI) and Holter 24h monitoring., Results: Among the variables evaluated, significant differences among the two groups were verified in relation to: the ejection fraction (p ≤ 0.001); left ventricular systolic dimension (p = 0.029); isovolumic contraction time, measured by TDI in the basal segments of the left ventricle (p < 0.05); and the presence of isolated (p = 0.0005) and paired ventricular extrasystoles (p = 0.003), in the Holter monitoring., Conclusions: The indeterminate form of Chagas' disease can present cardiac wall motion abnormality, demonstrating functional and electric damage compared to chagasic patients with normal echocardiogram.

Introduction: Chagas disease remains a severe public health problem in Latin America, despite control over its transmission. This study evaluated the prevalence of Chagas disease in the Serra Azul district, in the central-western region of the State of Minas Gerais, through identifying electrocardiographic (EKG) abnormalities among serologically positive individuals., Methods: Specific serological tests for Chagas disease were carried out on 676 individuals (48% of the population). Clinical examinations and EKGs were performed on the serologically positive population. A control group was selected for comparison with the EKG data., Results: The study population lived mainly in rural areas, with low sociocultural level. Forty subjects were positive (prevalence of 2.1%). The individuals with Chagas disease were in an older age group (67 vs. 39 years; p < 0.001). EKG abnormalities were frequent among the individuals with Chagas disease (79%). Among the seropositive individuals, the EKGs showed greater prevalence of ventricular premature beats and conduction disorder of the right branch alone or in association with anterosuperior division blockage, in relation to the controls., Conclusions: The prevalence of Chagas disease in the Serra Azul district was 2.1%. The seropositive individuals were in an older group, thus suggesting that transmission had been brought under control. EKG abnormalities occurred frequently, and conduction disorders of the right branch predominated.

Infective endocarditis is a relatively rare disease in clinical practice, with significant morbidity and mortality despite the improvements on its diagnosis and treatment. It is often difficult to identify its complications and define strategies for them. Dissociation between the clinical evolution and the findings from complementary tests (especially echocardiographic tests) is common. Clinical decisions become even more difficult when there are atypical manifestations of the disease, such as right-side endocarditis. This report is about a rare case of right-side endocarditis in a patient with chronic renal disease, in which there was a contradiction between worsening of the echocardiographic findings and clinical improvement. This situation may lead to difficulties regarding the criteria for indicating surgery and the safety of conservative clinical treatment.