Características da morte súbita tida como não esperada na doença de Chagas

Abstract

Trinta e cinco indivíduos falecidos subitamente e de modo inesperado foram necropsiados em Serviços Médico-Legais em Uberaba e Uberlândia. A sorologia do líquido pericárdico e os achados anatomopatológicos estabeleceram o diagnóstico de doença de Chagas. Todos, exceto dois, eram do sexo masculino e tinham idade média de 38 anos. Resolvemos fazer uma investigação retrospectiva procurando obter de familiares e amigos e nos registros médicos informações sobre as circunstâncias do óbito e manifestações que pudessem constituir possíveis indícios de doença cardíaca e de comprometimento de outros órgãos. Em 31,2% não havia quaisquer sintomas ou suspeita de cardiopatia. Contudo, em 57,1% dos casos conseguimos detectar história de tonturas (42,8%), dispnéia de esforço (48%), perda de consciência (34,2%) e palpitações (31,4%). A disfagia e ou a obstipação estavam presentes em 38%. Não houve correlação entre a sintomatologia e a intensidade da miocardite. Em 56% o êxito letal surgiu enquanto desenvolviam esforço físico ou tinham emoção. Pelo modo como ocorreu o óbito pode-se concluir que a iminência deste não foi pressentida pelo paciente ou circunstantes em 43,8% dos casos; no restante, o óbito súbito foi precedido de indícios, tais como gestos, pedidos de ajuda, etc. Somente em 5 dos 35 casos o eletrocardiograma havia sido realizado meses ou anos antes do óbito: todos apresentavam alterações.

Sudden death in Chagas' disease

“…In Chagas' disease, whether the patient dies unexpectedly, with no signs or symptoms of the illness (unexpected sudden death),or the death is preceded by manifestations of the disease (expected sudden death), the final mechanism is usually the same, i.e., an arrhythmic event, most frequently ventricular fibrillation. In addition, in a retrospective more detailed investigation of chagasic patients with unexpected sudden death, Prata et al 15 noticed previous cardiac symptoms (dyspnea, palpitations, seizures, and episodes of consciousness loss) in about 57% of the patients.…”

Sudden death in patients with Chagas disease

“…We did a retrospective investigation (Prata et al 1986) based on data obtained from family members and friends together with the circumstances of the deaths of 35 chagasics who died SED/SUD. This enabled us to verify that 35.2%, while still alive, did not present any symptoms or suspicion of cardiopathy.…”

The impact of syncope during clinical presentation of sustained ventricular tachycardia on total and cardiac mortality in patients with chronic Chagasic heart disease

“…Previous studies reported that, in the presence of structural cardiac impairment, mainly in ischemic heart disease, when sustained ventricular tachycardia is accompanied by syncope or cardiopulmonary arrest, the risk of a fatal recurrence is greater than when this arrhythmia is hemodynamically well tolerated [1][2][3][4][5] . In chronic chagasic heart disease, however, the impact of the presence of syncope during clinical presentation of sustained ventricular tachycardia has been studied less [6][7][8][9][10][11][12][13][14] . Scanavacca et al 9 , studied 35 patients with sustained ventricular tachycardia and chronic chagasic heart disease treated with amiodarone.…”

“…Syncope associated with sustained ventricular tachycardia has a variable incidence reported in the literature [6][7][8][9][10] . In the study by Bestetti et al 6 , 3 out of 15 chagasic patients with sustained ventricular tachycardia had syncope, but only 1 during arrhythmia.…”

“…The importance of syncope during the clinical presentation of sustained ventricular tachycardia, as a prognostic factor, was extensively studied in patients with coronary artery disease, and it was considered a worse prognosis when compared with hemodynamically well-tolerated sustained tachyarrhythmias [1][2][3][4][5] . In chronic chagasic heart disease, however, the relevance of syncope during clinical presentation of sustained ventricular tachycardia is not totally understood, and its incidence is variable according to reports published in the literature [6][7][8][9][10] . The objective of this study was to assess the impact of syncope during the clinical presentation of sustained ventricular tachycardia on total, cardiac, and sudden death in patients with chronic chagasic heart disease.…”