Chagas heart disease: Treatment and prognosis
- J Antonio Marin-Neto, MD, PhD, FACC
J Antonio Marin-Neto, MD, PhD, FACC
- Full Professor of Medicine
- Head, Interventional Cardiology Unit, Department of Internal Medicine
- Medical School of Ribeirao Preto
- University of São Paulo, Brazil
- Marcus V Simões, MD
Marcus V Simões, MD
- Associate Professor of Medicine
- Cardiology Division, Department of Internal Medicine
- Medical School of Ribeirao Preto
- University of São Paulo, Brazil
- Andre Schmidt, MD, PhD
Andre Schmidt, MD, PhD
- Associate Professor of Medicine
- Head, Cardiology Division
- Medical School of Ribeirao Preto - University of São Paulo, Brazil
- Anis Rassi, Jr, MD, PhD, FACC, FAHA, FACP
Anis Rassi, Jr, MD, PhD, FACC, FAHA, FACP
- Scientific Director
- Anis Rassi Hospital
- Goiânia, Goiás, Brazil
- Section Editors
- William J McKenna, MD
William J McKenna, MD
- Section Editor — Myopericardial Disease
- Professor of Cardiology
- University College, London
- Peter F Weller, MD, MACP
Peter F Weller, MD, MACP
- Editor-in-Chief — Infectious Diseases
- Section Editor — Tropical Medicine
- William Bosworth Castle Professor of Medicine
- Harvard Medical School
- Professor of Immunology and Infectious Diseases
- Harvard T. H. Chan School of Public Health
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
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 .
The treatment and prognosis of Chagas heart disease will be reviewed here. Other issues related to CD, including clinical manifestations and diagnosis of Chagas heart disease and noncardiac manifestations, are discussed separately. (See "Chagas heart disease: Clinical manifestations and diagnosis" 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".)
Overview of phases — The natural history of Chagas disease (CD) has been divided into acute and chronic phases. Cardiac involvement and prognosis in the acute phase of T. cruzi is discussed separately. (See "Chagas heart disease: Clinical manifestations and diagnosis" and "Chagas disease: Natural history and diagnosis".)
In the chronic phase, two well-defined forms of disease are distinguished: indeterminate (latent, pre-clinical) and determinate (clinical), which is subdivided into cardiac, digestive, and cardiodigestive forms. The indeterminate form has been defined as a form of chronic T. cruzi infection in which anti-T. cruzi antibodies are present but no signs or symptoms of Chagas cardiomyopathy or gastrointestinal involvement are identified. Various criteria have been proposed to define the indeterminate form, as discussed separately. (See "Chagas heart disease: Clinical manifestations and diagnosis", section on 'Definition'.)
About one-third to one-half of patients with the indeterminate form develop chronic cardiomyopathy after a latent period ranging from 5 to 30 years. Chronic Chagas cardiomyopathy (CCC) is a cause of heart failure, cardiac arrhythmias and thromboembolism.
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- Overview of phases
- Prognosis of CCC
- - Rassi score for predicting mortality
- Prognostic value of ECG
- Acute and indeterminate disease
- Chronic disease
- - T. cruzi infection
- - Heart failure
- Medical therapy
- Other HF therapies
- - Bradyarrhythmias and heart block
- - Ventricular arrhythmia and SCA
- Our approach
- CCC-specific evidence
- - ICD therapy
- - Antiarrhythmic therapy
- - Ablation and surgery
- Recommendations of others
- - Thromboembolism
- Chagas cardioembolism risk score
- Antithrombotic prophylaxis
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- SUMMARY AND RECOMMENDATIONS