scholarly journals Studies of the coronary circulation in Chagas' heart disease

1995 ◽  
Vol 113 (2) ◽  
pp. 826-834 ◽  
Author(s):  
José Antonio Marin-Neto ◽  
Marcus V. Simões ◽  
Elias M. Ayres-Neto ◽  
J. Luiz Attab-Santos ◽  
L. Gallo Jr. ◽  
...  
Keyword(s):  
Heart Disease ◽  
Chagas Disease ◽  
Coronary Arteries ◽  
Coronary Circulation ◽  
Myocardial Damage ◽  
Experimental Models ◽  
Chronic Patients ◽  
Chagas Heart Disease ◽  
Artery Disease ◽  
Myocardial Lesions

Pathogenesis of chronic Chagas' heart disease may include various disturbances in the coronary circulation, that could be responsible for the myocardial lesions seen in human hearts and in experimental models of the disease. In this paper we critically reviewed the anatomical and functional abnormalities described in chronic chagasic patients, pertaining to the so-called vascular pathogenetic theory of Chagas' disease. The epicardial coronary arteries are usually free of significant obstructive disease in nonselected groups of chagasic patients examined at autopsy or by coronary angiography. However, chagasic patients who were studied after an episode of acute myocardial infarction, show the same patterns of atherosclerotic coronary artery disease seen in the general nonchagasic population. Studies of chagasic patients with angiographically normal coronary arteries, by several scintigraphy methods, revealed myocardial perfusion abnormalities which may be caused by the microcirculatory derangements described in animals experimentally infected with the T. cruzi. Since hypoperfusion has been detected in regions with normal or mildly impaired wall motion, it is likely that the microvascular disturbances precede and may be a causative mechanism for the subsequent myocardial damage. We speculate that hibernating ventricular areas may occur in chagasic patients, on the basis of the evidence gathered from these studies. Recent investigations of chronic patients with Chagas' disease and chest pain showed attenuation of the vasomotor responses to physiological and pharmacological stimuli, in the epicardial coronary arteries.

scholarly journals Cardiac Autonomic Control Mechanisms in the Pathogenesis of Chagas' Heart Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Diego F. Dávila ◽  
Jose H. Donis ◽  
Gabriela Arata de Bellabarba ◽  
Vanesa Villarroel ◽  
Francisco Sanchez ◽  
...  
Keyword(s):  
Nervous System ◽  
Heart Disease ◽  
Autonomic Nervous System ◽  
Chagas Disease ◽  
Sinus Node ◽  
Myocardial Damage ◽  
Current Status ◽  
Control Mechanisms ◽  
Chagas Heart Disease ◽  
Adrenergic Blockers

Primary abnormalities of the autonomic nervous system had been postulated as the pathogenic mechanisms of myocardial damage, in patients with Chagas disease. However, recent investigations indicate that these abnormalities are secondary and amenable to treatment with beta-adrenergic blockers. Moreover, muscarinic cardiac autoantibodies appear to enhance parasympathetic activity on the sinus node. Therefore, the purpose of this paper is to analyze how knowledge on Chagas' disease evolved from being initially considered as a primary cardioneuromyopathy to the current status of a congestive cardiomyopathy of parasitic origin.

Gender Differences in Non-Obstructive Coronary Artery Disease

2020 ◽  
Vol 26 ◽  
Author(s):  
Maria Bergami ◽  
Marialuisa Scarpone ◽  
Edina Cenko ◽  
Elisa Varotti ◽  
Peter Louis Amaduzzi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Gender Differences ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Ischemic Heart ◽  
Current Evidence ◽  
Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

scholarly journals The Liver and the Hepatic Immune Response in Trypanosoma cruzi Infection, a Historical and Updated View

Pathogens ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1074
Author(s):  
Natalia Vacani-Martins ◽  
Marcelo Meuser-Batista ◽  
Carina de Lima Pereira dos Santos ◽  
Alejandro Marcel Hasslocher-Moreno ◽  
Andrea Henriques-Pons
Keyword(s):  
Immune Response ◽  
Trypanosoma Cruzi ◽  
Chagas Disease ◽  
Clinical Signs ◽  
Cell Types ◽  
Experimental Models ◽  
Chronic Patients ◽  
The Usa ◽  
Multiple Cell ◽  
Underlying Mechanisms

Chagas disease was described more than a century ago and, despite great efforts to understand the underlying mechanisms that lead to cardiac and digestive manifestations in chronic patients, much remains to be clarified. The disease is found beyond Latin America, including Japan, the USA, France, Spain, and Australia, and is caused by the protozoan Trypanosoma cruzi. Dr. Carlos Chagas described Chagas disease in 1909 in Brazil, and hepatomegaly was among the clinical signs observed. Currently, hepatomegaly is cited in most papers published which either study acutely infected patients or experimental models, and we know that the parasite can infect multiple cell types in the liver, especially Kupffer cells and dendritic cells. Moreover, liver damage is more pronounced in cases of oral infection, which is mainly found in the Amazon region. However, the importance of liver involvement, including the hepatic immune response, in disease progression does not receive much attention. In this review, we present the very first paper published approaching the liver’s participation in the infection, as well as subsequent papers published in the last century, up to and including our recently published results. We propose that, after infection, activated peripheral T lymphocytes reach the liver and induce a shift to a pro-inflammatory ambient environment. Thus, there is an immunological integration and cooperation between peripheral and hepatic immunity, contributing to disease control.

scholarly journals Endomyocardial biopsy in Chagas' heart disease: pathogenetic contributions

1995 ◽  
Vol 113 (2) ◽  
pp. 821-825 ◽  
Author(s):  
Maria de Lourdes Higuchi
Keyword(s):  
Chagas Disease ◽  
Endomyocardial Biopsy ◽  
Clinical Stage ◽  
Myocardial Damage ◽  
Myocardial Inflammation ◽  
Biopsy Specimens ◽  
The World ◽  
Chagas Heart Disease ◽  
Myocardial Fibers

Endomyocardial biopsy procedure has been performed in many centers around the world, allowing a better treatment and follow up of the patients with myocardial disease. In Chagas' disease, it has been performed in São Paulo Heart Institute since 1978 and has brought important contributions to the understanding of the disease and consequently of the patient's clinical stage. In the present work we summarize the principal findings regarding the pathogenesis of Chagas' disease obtained mainly from the studies using endomyocardial biopsy specimens. Nowadays we do not have doubts that the inflammatory infiltrate aggressing myocardial fibers has fundamental role in the progression of the myocardial damage in Chagas' disease what culminates in chronic heart failure. The parasite seems to have active participation in the maintenance of such myocardial inflammation.

scholarly journals Ethiological treatment of acute and chronic Chagas' heart disease

1995 ◽  
Vol 113 (2) ◽  
pp. 867-872 ◽  
Author(s):  
Abílio Augusto Fragata Filho ◽  
Marco Aurélio Dias da Silva ◽  
Elias Boainain
Keyword(s):  
Heart Disease ◽  
Chagas Disease ◽  
Acute Phase ◽  
Randomized Trials ◽  
Research Protocol ◽  
Infection Route ◽  
End Of Treatment ◽  
Toxic Agents ◽  
Chagas Heart Disease

The uncertaintties in the ethiological treatment of Chagas' Disease are consequence of the lack of entire knowledge of its pathogeny and the no existence of a healing criterium. There is a consensus that antiparasite drugs should be used in the acute phase of the infection, regardless of the infection route, in new crisis, in patients under immunossuppression and in organs transplantation. There is still controversy regarding subacute, chronic or indetermined phase or cases with mild cardiac/digestive forms, not included in the situations listed above neither in a research protocol. The treatment includes oral benzonidazol 5 mg/kg/day, bid or tid for 60 days. In 71 patients monitored in this fashion, the authors have found 60% of negative xenodiagnostic at the end of treatment. It is still necessary, however, to continue to investigate and accomplishing more randomized trials to confirm the efficacy of such method, and also to try to obtain effective and less toxic agents. It is also fundamental to standardize a more reliable healing criterium.

scholarly journals A doença de chagas e a cardiopatia chagásica crônica: uma revisão de literatura / Chagas disease and chronic chagas heart disease: literature review

2021 ◽  
Vol 7 (12) ◽  
pp. 112598-112615
Author(s):  
Camila Maria Braga Tameirão ◽  
Luiza Junqueira de Miranda ◽  
Maria Eduarda Ferreira Gomes ◽  
Maria Gabriela Elias D’Assumpção ◽  
Milton Henriques Guimarães Junior
Keyword(s):  
Heart Disease ◽  
Literature Review ◽  
Chagas Disease ◽  
Chagas Heart Disease

scholarly journals Heart transplants for patients with Chagas' heart disease

1995 ◽  
Vol 113 (2) ◽  
pp. 873-879 ◽  
Author(s):  
Edimar Alcides Bocchi
Keyword(s):  
Heart Disease ◽  
Chagas Disease ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Heart Transplants ◽  
Ventricular Ejection Fraction ◽  
Chagas Heart Disease ◽  
The Mean ◽  
Cruzi Infection

The role of heart transplants for treating Chagas' heart disease is not quite clear. Immunosuppression could lead to resurgence of T. cruzi infection with acute or chronic damage to the allograft. There are few publications regarding this issue. Thus we reported the follow-up of 18-patients with Chagas' heart disease submitted to orthotopic heart transplants from 1985 to 1993 at The Heart Institute. The patients were in functional class IV or III, or II, with sustained ventricular tachycardia episodes. The mean left ventricular ejection fraction was 25 ± 9% and the mean right ventricular ejection was 22 ± 6% (MUGA). Immunosuppression was based on cyclosporin, azathioprine and corticosteroids. For specific post-transplant monitoring of T. cruzi infection, blood tests were performed (examination of blood or leukocyte concentrate, Giemsa-stained blood smears, blood culture, xenodiagnosis, mouse inoculation) and tissue biopsy (skin or myocardium). In addition, complement fixation hemagglutination and immunofluorescence assays were performed. T. cruzi parasitemias were detected in 18 circumstances in 13 patients. Resurgence of Chagas' disease was diagnosed in 11 circumstances in 5 patients. Fever, subcutaneous nodules and myocarditis predominated in these episodes. All episodes of parasitemia and Chagas' disease resurgence were successfully treated with benzonidazole. All surviving patients had normal cardiac function despite left ventricular function worsening during some myocarditis episodes. Neoplasias were important findings and 3 patients developed lymphoproliferative disease, 2 developed Karposi's sarcoma and 1 patient developed skin cancer. The survival rates at 4 and 12 months were 83% and 49% respectively. The survival of patients who underwent heart transplants from August 1991 to April 1993 was 100% at 4 months and 75% at 12 months. Heart transplants for Chagas' heart disease may be associated with episodes of parasitemia and a reoccurrence of episodes of Chaga's disease. The survival of heart transplanted patients has improved when associated with lower doses of cyclosporins and thus, fewer resurgences of the disease.

scholarly journals Effects of an exercise program on blood pressure in patients with treated hypertension and chronic Chagas' heart disease

2012 ◽  
Vol 45 (6) ◽  
pp. 727-731 ◽  
Author(s):  
Claudia Rosa de Oliveira ◽  
Andréa Silvestre de Sousa ◽  
Bráulio Santos ◽  
Paloma Hargreaves Fialho ◽  
Carla Cristiane Soares dos Santos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Disease ◽  
Chagas Disease ◽  
Blood Pressure Monitoring ◽  
Exercise Program ◽  
Study Results ◽  
Before And After ◽  
Chagas Heart Disease ◽  
Blood Pressures ◽  
Chronic Chagas Disease

INTRODUCTION: Previous studies describe an imbalance of the autonomic nervous system in Chagas' disease causing increased sympathetic activity, which could influence the genesis of hypertension. However, patients undergoing regular physical exercise could counteract this condition, considering that exercise causes physiological responses through autonomic and hemodynamic changes that positively affect the cardiovascular system. This study aimed to evaluate the effects of an exercise program on blood pressure in hypertensive patients with chronic Chagas' heart disease. METHODS: We recruited 17 patients to a 24-week regular exercise program and used ambulatory blood pressure monitoring before and after training. We determined the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) from the beginning to the end of the study. RESULTS: The blood pressures were evaluated in general and during periods of wakefulness and sleep, respectively: SBP (p = 0.34; 0.23; 0.85), DBP (p = 0.46; 0.44; 0.94) and MBP (p = 0.41; 0.30; 0.97). CONCLUSIONS: There was no statistically significant change in blood pressure after the 24-week exercise program; however, we concluded that physical training is safe for patients with chronic Chagas' disease, with no incidence of increase in blood pressure.

scholarly journals Effects of an exercise program on the functional capacity of patients with chronic Chagas' heart disease, evaluated by cardiopulmonary testing

2012 ◽  
Vol 45 (2) ◽  
pp. 220-224 ◽  
Author(s):  
Paloma Hargreaves Fialho ◽  
Bernardo Rangel Tura ◽  
Andréa Silvestre de Sousa ◽  
Claudia Rosa de Oliveira ◽  
Carla Cristiane Santos Soares ◽  
...  
Keyword(s):  
Heart Disease ◽  
Chagas Disease ◽  
Functional Capacity ◽  
Severe Heart Failure ◽  
Exercise Program ◽  
Public Health Problem ◽  
Cardiopulmonary Exercise Test ◽  
Regular Exercise ◽  
Aerobic Activity ◽  
Chagas Heart Disease

INTRODUCTION: Despite all efforts to restrict its transmission, Chagas' disease remains a severe public health problem in Latin America, affecting 8-12 million individuals. Chronic Chagas' heart disease, the chief factor in the high mortality rate associated with the illness, affects more than half a million Brazilians. Its evolution may result in severe heart failure associated with loss of functional capacity and quality of life, with important social and medical/labor consequences. Many studies have shown the beneficial effect of regular exercise on cardiac patients, but few of them have focused on chronic Chagas' heart disease. METHODS: This study evaluated the effects of an exercise program on the functional capacity of patients with chronic Chagas' disease who were treated in outpatient clinics at the Evandro Chagas Institute of Clinical Research and the National Institute of Cardiology, Rio de Janeiro, Brazil. The exercises were performed 3 times a week for 1 h (30 min of aerobic activity and 30 min of resistance exercises and extension) over 6 months in 2010. Functional capacity was evaluated by comparing the direct measurement of the O2 uptake volume (VO2) obtained by a cardiopulmonary exercise test before and after the program (p < 0.05). RESULTS: Eighteen patients (13 females) were followed, with minimum and maximum ages of 30 and 72 years, respectively. We observed an average increase of VO2peak > 10% (p = 0.01949). CONCLUSIONS: The results suggest a statistically significant improvement in functional capacity with regular exercise of the right intensity.

scholarly journals Ventricular function in Chagas' heart disease

1995 ◽  
Vol 113 (2) ◽  
pp. 814-820 ◽  
Author(s):  
Benedito Carlos Maciel ◽  
Oswaldo César de Almeida Filho ◽  
André Schmidt ◽  
José Antonio Marin-Neto
Keyword(s):  
Heart Rate ◽  
Heart Disease ◽  
Ventricular Function ◽  
Chagas Disease ◽  
Loading Conditions ◽  
Noninvasive Methods ◽  
Ventricular Performance ◽  
Chagas Heart Disease

Invasive and noninvasive methods used to evaluate ventricular function in Chagas's disease are reviewed. The traditional indices of overall ventricular performance reflect interaction of preload, contractility, afterload and heart rate. Therefore, they are unable to distinguish changes in contractility from modifications of loading conditions. The role of ventricular function as a predictor of mortality in chronic Chagas' heart disease is discussed. Ventricular function abnormalities in patients with indeterminate and digestive forms of Chagas' disease are especially emphasized. Finally, the evidence of early impairment of diastolic performance in patients with Chagas' disease is presented.

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