Precordial chest pain in patients with chronic Chagas disease

•Precordial chest pain affects 15% to 37% of patients with chronic Chagas disease.•In the absence of megaesophagus, it reflects chronic Chagas heart disease.•Precordial chest pain is atypical, but can masquerade acute coronary syndrome.•Precordial chest pain not always has a benign clinical course.•Betablockers, calcium channel blockers and nitrates can be used in this condition.

Precordial chest pain affects about 15% to 33% of patients with chronic Chagas disease. In the absence of megaesophagus, it should be ascribed to chronic Chagas heart disease. Precordial chest pain is atypical because it can usually neither be associated to physical exercise nor be alleviated by nitroglycerin. However, in certain circumstances, precordial chest pain can masquerade as acute coronary syndrome. Although obstructive coronary artery disease can occasionally be found, microvascular angina seems to be the mechanism behind such phenomenon. Precordial chest pain not always has a benign clinical course; sometimes, it can herald a dismal prognosis. On the basis of cases previously reported, it seems that nitrates, betablockers and/or calcium channel blockers can be of value in the treatment of this condition.