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Chagas heart disease: Clinical manifestations and diagnosis

Authors
J Antonio Marin-Neto, MD, PhD, FACC
Benedito C Maciel, MD, FACC
Marcus V Simões, MD
Andre Schmidt, MD, PhD
Section Editors
William J McKenna, MD
Peter F Weller, MD, FACP
Deputy Editors
Susan B Yeon, MD, JD, FACC
Elinor L Baron, MD, DTMH

INTRODUCTION

Chagas disease (CD) is caused by Trypanosoma cruzi, a protozoan parasite that can cause acute myopericarditis as well as chronic fibrosing myocarditis. Chagas myocarditis is the most common cause of non-ischemic cardiomyopathy in Latin America [1].

The natural history of Chagas heart disease comprises an acute phase and a chronic phase. The chronic phase includes two forms of disease: an indeterminate (latent, preclinical) form and a determinate (clinical) form, which is subdivided into cardiac, digestive, and cardiodigestive forms. Most patients with acute disease have no or mild nonspecific symptoms and symptomatic myocarditis is rare. The indeterminate form is comprised of patients with evidence of T. cruzi infection without specific overt clinical evidence of cardiac or gastrointestinal disease. Approximately one-third to one-half of patients with indeterminate disease eventually develops chronic Chagas cardiomyopathy (CCC).

Among 499 initially healthy blood donors in Brazil noted to have T. cruzi seropositivity on initial screening, 24 percent went on to develop Chagas cardiomyopathy during mean 10.5 years of follow-up; of these, 26 percent of patients presented with ejection fraction <50 percent [2]. Among 488 matched individuals with T. cruzi seronegativity, 5 percent developed cardiomyopathy during mean 11 years of follow-up. It is important to emphasize that the high annual incidence of Chagas cardiomyopathy noted in this study should not be extrapolated to the universe of individuals with the indeterminate form of Chagas disease, since it was a retrospective cohort study and no assessment of cardiac function by ECG or chest radiographs had been performed at the time of the initial seropositivity screening. This implies that at least some of the individuals could already be cardiomyopathy patients at the outset of the study despite presenting at the blood bank without symptoms.

The clinical manifestations, diagnosis and evaluation of cardiac involvement in CD will be reviewed here. Other issues related to CD, including treatment of Chagas heart disease, prognosis of CCC and noncardiac manifestations are discussed separately. (See "Chagas heart disease: Treatment and prognosis" and "Chagas disease: Natural history and diagnosis" and "Chagas disease: Pathology and pathogenesis" and "Chagas gastrointestinal disease" and "Chagas disease: Antitrypanosomal drug therapy" and "Chagas disease: Management of acute disease, early chronic disease, and disease in immunosuppressed hosts".)

ACUTE PHASE

The acute phase of CD begins after an incubation period of one week to four months following exposure to T. Cruzi. (See "Chagas disease: Natural history and diagnosis", section on 'Acute phase'.)

                                   

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 13 00:00:00 GMT+00:00 2014.
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