Prova do esforço na forma indeterminada da doença de Chagas

Macêdo, Vanize; Santos, Raimundo; Prata, Áluízio

doi:10.1590/s0037-86821973000500004

Cited by 20 publications

(27 citation statements)

References 4 publications

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“…Thus, the cardiac autonomic impairment previously detected in Chagas' heart disease patients by complex and invasive or simple noninvasive tests (Amorim et al, 1982;Gallo et al, 1987;Marin-Neto et al, 1980, 1998Junqueira, 1990;Guzzetti et al, 1991;Dávila et al, 1998) was also presently noted in chagasic patients with the apparent indeterminate form. This observation reinforces previous findings of suggestive cardiac dysautonomia in these chagasics based on different methodologies of cardiac autonomic evaluation (Macêdo et al, 1974;Iosa et al, 1980;Palmero et al, 1980;Guzzetti et al, 1991;Ribeiro et al, 2001). The prolonged time and the reduced velocity of heart interval change from the maximum tachycardia to maximum bradycardia post-manoeuvre may be consequent to delayed inhibition or reversion of the ongoing sympathetic hyperactivity in phases II and III with retarded suppression of tachycardia in phase III and installation of bradycardia in phase IV, or to delayed stimulation of the attenuated or normal parasympathetic activity in phases II and III with slow installation of bradycardia in phase IV.…”

Section: Discussionsupporting

confidence: 92%

“…Few observations employing different functional tests are apparently conflicting, some authors having noted autonomic dysfunction and others did not. Prolongation in the atrium -ventricular conduction at the electrocardiogram following pilocarpine administration (Macêdo et al, 1974), and deficient heart rate response to hyperventilation and tilting test were demonstrated. Depressed heart rate variability analysed in the frequencydomain during standing and handgrip exercise was shown, which suggests sympathetic and parasympathetic dysfunction (Guzzetti et al, 1991).…”

Section: Introductionmentioning

confidence: 97%

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Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Soares

2002

Autonomic Neuroscience

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Background: In the apparent indeterminate form of Chagas' disease, which lacks any overt clinical, electrocardiographic, and radiological manifestations of organ damage, lesions of the intrinsic autonomic innervation of heart are not striking features and evidences for cardiac autonomic dysfunction are elusive and conflicting. Objective: To evaluate the cardiac autonomic modulation based on Valsalva manoeuvreassociated heart interval variation in Chagas' disease subjects with apparent indeterminate form. Subjects and methods: We examined 36 outpatient volunteers aged 15 -51 years old (median: 36.5), in comparison with 52 healthy control individuals aged 17 -49 years old (median: 29) ( p < 0.001). Each subject sequentially performed in the supine position three to four manoeuvres at an intra-oral pressure of 40 mm Hg during 20 s, under continuous DII lead electrocardiographic registration, and rate-and time-dependent indices of Valsalva manoeuvre-associated R -R interval variation were obtained. The t-test or the Mann -Whitney test was employed to compare the data between the groups. Results: No correlation was found between every index and age for the control group ( p = 0.39 -0.71). The chagasic group presented similar basal to phase IV median increment (relative bradycardia) (23.7% vs. 22.7%; p = 0.63) and smaller basal to phase III median decrement of R -R interval (relative tachycardia) ( À 31.7% vs. À 35%; p = 0.02) in comparison to the control group, respectively. The median Valsalva ratio showed a tendency for reduction in chagasics (1.78 vs. 1.90; p = 0.08). Prolonged median time (14.2 vs. 10.3 s; p < 0.001) and slowed median velocity (5.1%/s vs. 8.9%/s; p < 0.001) of the phases III -IV bradycardia were also observed in chagasic group. The majority (58.3%) of the chagasics presented exclusively at least one depressed, and 8.3% presented at least one enhanced index of rateand/or time-dependent heart interval responses beyond the 25th or 75th control percentiles, and 27.8% presented at least one depressed and other enhanced index, while 5.6% showed all indices within the control interquartile range. All the indices outside the 25th or 75th control percentiles were noted in 13.9% of chagasics. Conclusion: Chagas' disease subjects without overt manifestations presented variable and subtle depression and less frequent enhancement or normality of the rate-and time-dependent tachycardia and bradycardia reflex responses related to Valsalva manoeuvre, which demonstrates distinct patterns of finely disturbed cardiac sinus parasympathetic and sympathetic modulation, probably due to inflammatory or autoimmunological damage of intrinsic innervation and/or to autoantibodies-induced derangement in neurotransmitter receptors. D

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 97%

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Soares

2002

Autonomic Neuroscience

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“…Several observational studies mainly conducted in endemic areas in Brazil, Argentina and Venezuela, since the early 1940s disclosed the natural history of Chagas' heart disease 7,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] .…”

Section: Natural History and Prognostic Factorsmentioning

confidence: 99%

“…Thus, no adequate identification of cardiac involvement is usually provided in most of the rural-based studies [27][28][29][30][31][32][33][34][35][36][37] . Conversely, in hospital-based studies the heart disease is usually well characterized, but their results can not be extended to the whole spectrum of the chagasic population 8,[38][39][40][41] .…”

Section: Natural History and Prognostic Factorsmentioning

confidence: 99%

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Chagas' heart disease

Marin-Neto¹,

Simões²,

Sarabanda³

1999

Arq. Bras. Cardiol.

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Exercise electrocardiogram tests in manual workers with and without antibodies to Trypanosoma cruzi: a population-based study

Zicker

Oliveira

et al. 1990

Transactions of the Royal Society of Tropical Medicine and Hygi

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Blood pressure, heart rate and electrocardiographic responses to exercise were compared in a group of 125 subjects with antibodies to Trypanosoma cruzi and in 153 seronegative subjects, randomly selected from persons with no evidence of heart disease in a resting electrocardiogram during a cross-sectional survey among apparently healthy manual workers. The mean heart rates and diastolic and systolic blood pressures of those in each group did not differ statistically at different phases of the exercise test and there was no evidence of a difference in physical fitness between those in the 2 groups. An abnormal test was recorded in 26.2% of seropositive, and in 16.1% of seronegative, subjects (odds ratio adjusted for age, sex and body mass index [OR] = 2.0, 95% confidence interval [95% CI] = 1.1-3.8). No significant difference was observed between the 2 groups in the occurrence of hypertensive response to exercise (6.4% among seropositives and 5.9% among seronegatives), ST depression greater than 1 mm (0.8% and 2.0%), supraventricular premature beats (4.8% and 2.6%) or conduction defects (0.8% and 1.3%). Complex ventricular premature beats were recorded more often in seropositive subjects (12.8% and 3.9%; OR = 3.7, 95% CI = 1.4-9.8, P less than 0.01). The risk of an abnormal test increased with age in both groups. A history of cardiovascular symptoms, gender and body mass was not associated with the risk of an abnormal response in the test. The findings suggest that exercise testing might be a routine procedure when subjects with antibodies to T. cruzi are being assessed for participation in potentially high risk activities, such as heavy manual work.

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Prova do esforço na forma indeterminada da doença de Chagas

Cited by 20 publications

References 4 publications

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Chagas' heart disease

Exercise electrocardiogram tests in manual workers with and without antibodies to Trypanosoma cruzi: a population-based study

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