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2.
Br Heart J ; 53(3): 298-309, 1985 Mar.
Article in English | MEDLINE | ID: mdl-3155954

ABSTRACT

To study left ventricular diastolic function in Chagas's disease, simultaneous echocardiograms, phonocardiograms, and apexcardiograms were recorded in 20 asymptomatic patients with positive Chagas's serology and no signs of heart disease (group 1), 12 with Chagas's heart disease and symptoms of ventricular arrhythmia but no heart failure (group 2), 20 normal subjects (group 3), and 12 patients with left ventricular hypertrophy (group 4). The recordings were digitised to determine left ventricular isovolumic relaxation time and the rate and duration of left ventricular cavity dimension increase and wall thinning. In groups 1 and 2 (a) aortic valve closure (A2) and mitral valve opening were significantly delayed relative to minimum dimension and were associated with prolonged isovolumic relaxation, (b) left ventricular cavity size was abnormally increased during isovolumic relaxation and abnormally reduced during isovolumic contraction, and (c) peak rate of posterior wall thinning and dimension increase were significantly reduced and duration of posterior wall thinning was significantly prolonged; both of these abnormalities occurred at the onset of diastolic filling. These abnormalities were more pronounced in group 2 and were accompanied by an increase in the height of the apexcardiogram "a" wave, an indication of pronounced atrial systole secondary to end diastolic filling impairment due to reduced left ventricular distensibility. Group 4, which had an established pattern of diastolic abnormalities, showed changes similar to those in group 2; however, the delay in aortic valve closure (A2) and in mitral valve opening and the degree of dimension change were greater in the latter group. Thus early isovolumic relaxation and left ventricular abnormalities were pronounced in the patients with Chagas's heart disease and may precede systolic compromise, which may become apparent in later stages of the disease. The digitised method is valuable in the early detection of myocardial damage.


Subject(s)
Chagas Cardiomyopathy/physiopathology , Echocardiography/methods , Heart/physiopathology , Adult , Analog-Digital Conversion , Arrhythmias, Cardiac/physiopathology , Cardiomegaly/physiopathology , Computers , Diastole , Electrocardiography , Female , Heart Ventricles/physiopathology , Hemodynamics , Humans , Kinetocardiography , Male , Middle Aged
3.
J Nucl Med ; 24(7): 563-7, 1983 Jul.
Article in English | MEDLINE | ID: mdl-6864308

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 Volume
4.
Circulation ; 67(6): 1219-26, 1983 Jun.
Article in English | MEDLINE | ID: mdl-6851016

ABSTRACT

Ten patients (six women and four men) with endomyocardial disease, four with and six without hypereosinophilia, were studied by two-dimensional echocardiography (2-D echo). Eight had biventricular congestive heart failure and two had atypical chest pain with ischemic electrocardiographic changes. The patients were 15-50 years old (mean 40 years) and duration of illness was 2-9 years (mean 4.4 years). Nine had cardiac catheterization and three pathologic examination. Characteristic 2-D echo findings included apical obliteration of one or both ventricles by echogenic material suggestive of fibrosis or thrombosis; bright, specular echoes at the cavity surface of the apical obliteration suggesting patchy calcification; preserved left apical systolic inward motion, which differed significantly from the dyskinetic motion of thrombotic apical obliteration of ischemic or Chagasic origin (p less than 0.001); involvement of the papillary muscles and posterior atrioventricular valve; preserved ventricular contractile function in most patients; and the combination of normal-to-small ventricles with large atria. None of 14 subjects with secondary hypereosinophilia followed for 15.4 months developed similar 2-D echo findings. We conclude that both forms of endomyocardial disease had a 2-D echo pattern useful for noninvasive recognition and differentiation from patients who have valvular heart disease, constrictive pericarditis and cardiomyopathies of other origins.


Subject(s)
Echocardiography , Endomyocardial Fibrosis/diagnosis , Eosinophilia/etiology , Adolescent , Adult , Cardiac Catheterization , Diagnosis, Differential , Endomyocardial Fibrosis/complications , Female , Heart Valve Diseases/diagnosis , Humans , Male , Middle Aged , Pericarditis, Constrictive/diagnosis , Time Factors
5.
Postgrad Med J ; 59(689): 162-9, 1983 Mar.
Article in English | MEDLINE | ID: mdl-6844201

ABSTRACT

Twenty-three cases of endomyocardial disease (ED) are presented, studied in Venezuela, a tropical country in northern South America. The diagnosis was confirmed in 18 cases by means of pathological studies, and in 5 cases by angiocardiography which showed the characteristic obliterative ventricular lesions. Eosinophilia was present in 35% of the patients. The most frequent clinical feature was heart failure associated with mitral regurgitation. Systemic embolism was the first clinical feature in 5 cases. In 2 cases, ED was associated with autoimmune haemolytic anaemia or vasculitis. Necropsy revealed a predominance of the left-sided (9/16 cases) and biventricular (6/16 cases) types. The pathological lesions were characterised by fibrous thickening of the endocardium at the apex and the ventricular inflow tracts extending to the myocardium and involving the atrioventricular valves. ED is frequently misdiagnosed as rheumatic valvular cardiopathy. The two-dimensional echocardiogram is a very useful procedure for determining the spatial anatomy of ED. The echo findings were closely correlated with ventriculographic and necropsy findings. Even though ED is widely spread around the world, it is most frequently found in tropical and subtropical countries in Africa, Asia and America, such as Venezuela and Brazil. This suggests that there are aetiological factors in these latitudes, about which little is known.


Subject(s)
Endomyocardial Fibrosis/diagnosis , Adolescent , Adult , Aged , Angiocardiography , Echocardiography , Endomyocardial Fibrosis/pathology , Female , Humans , Male , Middle Aged , Venezuela
8.
Postgrad Med J ; 53(623): 527-32, 1977 Sep.
Article in English | MEDLINE | ID: mdl-412174

ABSTRACT

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.


Subject(s)
Cardiomyopathies/diagnosis , Chagas Disease/diagnosis , Cardiac Catheterization , Cardiomyopathies/etiology , Chagas Disease/complications , Echocardiography , Electrocardiography , Exercise Test , Humans , Vectorcardiography
14.
Article in Spanish | PAHO | ID: pah-34614

ABSTRACT

The four-year follow-up study reported herein represents the continuation of a previous cross-sectional study carried out in a rural community (Belen, Venezuela). The earlier study included 1,210 persons out of a total of 1,656 inhabitants, all over five years of age, and demonstrated a high prevalence of Chagas' infection (47.3 per cent) and a high rate of Chagas' disease seropositivity among those with chronic myocardial heart disease (84.8 per cent); heart disease was found in 17.3 per cent of persons studied. It included clinical, electrocardiographic and radiological analyses


The present report describes the results of the four-year follow-up study performed in 812 persons, which permitted to establish the incidence of Chagas' infection (16.3 per cent) and that of chagasic heart disease (2.2 per cent) in four years. The report also included the clinical, electrocardiographic and radiological analyses of cases with previous heart disease as well as new cases. Different evolutive electrocardiographic patterns have been found, including serial electrocardiographic variations ranging from normal to definitely abnormal. The mortality occurred in the sample during the observation period is reported(AU)


Subject(s)
Chagas Cardiomyopathy/diagnosis , Chagas Cardiomyopathy/epidemiology , Longitudinal Studies , Latin America
15.
Bull World Health Organ ; 39(3): 341-8, 1968.
Article in English | MEDLINE | ID: mdl-4974002

ABSTRACT

The paper reports on a 4-year follow-up study that represents the continuation of a previous cross-sectional study on Chagas' disease carried out in a rural community (Belén) in Venezuela. The earlier study included 1210 persons all over 5 years of age out of a total of 1656 inhabitants and demonstrated a high prevalence of Chagas' infection (47.3%) and a high rate of Chagas' disease seropositivity among those with chronic myocardial heart disease (84.8%); heart disease was found in 17.3% of persons studied. The follow-up study was based on 812 persons and established that in the sample the frequency of Chagas' infection was 16.3% and that of heart disease 2.2%. Clinical, electrocardiographic and radiological analyses were made on patients with previous heart disease as well as on new patients. Different evolutive electrocardiographic patterns have been found, including variations ranging from normal to definitively abnormal.


Subject(s)
Chagas Disease/epidemiology , Adolescent , Adult , Age Factors , Aged , Chagas Disease/complications , Child , Child, Preschool , Electrocardiography , Female , Follow-Up Studies , Heart Diseases/epidemiology , Humans , Male , Middle Aged , Rural Population , Sex Factors , Venezuela
18.
Bull World Health Organ ; 34(5): 655-69, 1966.
Article in English | MEDLINE | ID: mdl-4957485

ABSTRACT

It has been estimated that, in vast areas of the American continent, there is a high prevalence of human infection by Trypanosoma cruzi. Such infection can lead to a variety of heart diseases, predominantly with involvement of the myocardium. The aim of the present work was to determine the prevalence of heart disease in two rural areas of Venezuela with a high endemicity of Chagas' disease and to try to determine the natural history of the disease. It is shown that a form of chronic myocardial disease in patients with positive specific serology and good functional capacity is highly prevalent. Electrocardiographic patterns typical of the initial and developing stages of the disease, as well as early abnormalities of the cardiac rhythm, are described and illustrated. The present work forms part of a longitudinal study still in progress.


Subject(s)
Chagas Disease/complications , Heart Diseases/etiology , Adolescent , Adult , Aged , Child , Child, Preschool , Electrocardiography , Female , Humans , Male , Middle Aged , Venezuela
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