ABSTRACT
Left-ventricular ejection fraction (LVEF) and abnormalities of regional wall motion (WMA) were studied by means of radionuclide ventriculography in 41 patients prospectively diagnosed as having chronic Chagas' disease. Thirteen patients were asymptomatic (ASY), 16 were arrhythmic (ARR), and 12 had congestive heart failure (CHF). Mean LVEF was normal in ASY (0.64 +/- 0.06) but markedly depressed in CHF (0.28 +/- 0.08). Regional WMAs were minimal in ASY and their severity increased in ARR. Most CHFs (75%) had diffuse hypokinesia of the left ventricle. The region most frequently affected was the infero-apical (63%). Seven patients had a distinct apical aneurysm. Correlation between radionuclide and contrast ventriculography data was good in 17 patients. For LVEF, r = 0.90. For WMA there was agreement between the two techniques in 77% of 65 segments compared. Best agreement occurred with infero-apical lesions (88%), and worst with septal (69%). Selective coronary arteriography showed normal arteries in all patients. Therefore, chronic Chagas' heart disease joins ischemic heart disease as a cause of regional WMA.
Subject(s)
Chagas Cardiomyopathy/diagnostic imaging , Heart Ventricles/diagnostic imaging , Adult , Arrhythmias, Cardiac/diagnostic imaging , Chagas Cardiomyopathy/physiopathology , Female , Heart Aneurysm/diagnostic imaging , Heart Failure/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Movement , Prospective Studies , Radionuclide Imaging , Stroke VolumeABSTRACT
The EKG response to exercise and the working capacity in a group of 70 patients with positive serology for Chagas' disease has been determined by stress testing on a bicycle-ergometer, in order to establish the usefulness of such a test in the early diagnosis of Chagas' cardiomyopathy. The exercise EKG provides information which cannot be obtained by other diagnostic procedures, since the stress test can induce or increase ventricular arrhythmia, and is particularly indicated in patients with Chagas' infection and the incipient forms of Chagas' cardiomyopathy. Measuring the working capacity is useful in order to establish the degree of functional impairment of each individual patient. After the application of oral digoxin, no significant increase of ventricular extrasystoles following exercise has been observed and the working capacity has improved in the majority of the studied cases with Chagas' cardiomyopathy.
Subject(s)
Cardiomyopathies/diagnosis , Chagas Disease/diagnosis , Administration, Oral , Adult , Aged , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Cardiomyopathies/physiopathology , Chagas Disease/physiopathology , Digoxin/administration & dosage , Exercise Test , Female , Humans , Male , Middle AgedABSTRACT
The natural history of Chagas' disease and its manifestations when the heart is involved are detailed clinically and pathologically. Three phases are recognized: the acute phase, lasting from 1-3 months, the latent phase, which may last from 10-20 years, and the chronic phase, which has the most serious manifestations. This phase is subdivided into three clinical stages. An analysis of the varied cardiac manifestations on 235 patients is included.
