What is the cause of his sudden cardiac illness?
34-year-old previously healthy male, who has recently immigrated from South America (Brazil), presented with a 2 months history of exertional shortness of breath. He denies any chest pain, palpitations, dizziness, or syncope. His only other medical problem was megacolon, which was treated 2 years ago. On examination, there are bilateral basilar crepitations heard and a 1+ pedal edema and mild elevation of jugular venous distention. CBC revealed hemoglobin of 13.9. EKG showed nonspecific repolarization changes and intraventricular conduction abnormalities. Chest x-ray revealed cardiomegaly and pulmonary congestion. Echocardiogram revealed an ejection fraction of 40%. Based on these findings, which of the following is the most likely cause of his problem?
A. Diphtheric myocarditis
B. Premature coronary artery disease
C. Trypanosoma cruzi
D. Giant cell myocarditis.
E. Rickettsial myocarditis.