Chagas heart disease: pathophysiologic mechanisms, prognostic factors and risk stratification
Mem. Inst. Oswaldo Cruz
;
104(supl.1): 152-158, July 2009. ilus, tab
Artigo
em Inglês
| LILACS
| ID: lil-520875
ABSTRACT
Chagas heart disease (CHD) results from infection with the protozoan parasite Trypanosoma cruzi and is the leading cause of infectious myocarditis worldwide. It poses a substantial public health burden due to high morbidity and mortality. CHD is also the most serious and frequent manifestation of chronic Chagas disease and appears in 20-40% of infected individuals between 10-30 years after the original acute infection. In recent decades, numerous clinical and experimental investigations have shown that a low-grade but incessant parasitism, along with an accompanying immunological response [either parasite-driven (most likely) or autoimmune-mediated], plays an important role in producing myocardial damage in CHD. At the same time, primary neuronal damage and microvascular dysfunction have been described as ancillary pathogenic mechanisms. Conduction system disturbances, atrial and ventricular arrhythmias, congestive heart failure, systemic and pulmonary thromboembolism and sudden cardiac death are the most common clinical manifestations of chronic Chagas cardiomyopathy. Management of CHD aims to relieve symptoms, identify markers of unfavourable prognosis and treat those individuals at increased risk of disease progression or death. This article reviews the pathophysiology of myocardial damage, discusses the value of current risk stratification models and proposes an algorithm to guide mortality risk assessment and therapeutic decision-making in patients with CHD.
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Cardiomiopatia Chagásica
Tipo de estudo:
Estudo de etiologia
/
Estudo prognóstico
Limite:
Humanos
Idioma:
Inglês
Revista:
Mem. Inst. Oswaldo Cruz
Assunto da revista:
Medicina Tropical
/
Parasitologia
Ano de publicação:
2009
Tipo de documento:
Artigo
País de afiliação:
Brasil
Instituição/País de afiliação:
Anis Rassi Hospital/BR
/
Faculdade de Medicina de Ribeirão Preto/BR
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