Evolução clínica a longo prazo, correlacionando a presença de bloqueios da condução intraventricular em pacientes chagásicos e não chagásicos assintomáticos

Pimenta, João; Valente, Ney; Miranda, Manoel

doi:10.1590/s0037-86821999000600003

Cited by 11 publications

(3 citation statements)

References 27 publications

(8 reference statements)

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“…A study of asymptomatic chronic chagasic patients with CRBBB and non-chagasic patients with CRBBB or a complete left bundle branch block revealed that an alteration in the CSNRT was an important indicator of symptomatic sinus node dysfunction; however, there was only a correlation with cardiac related mortality in non-chagasic individuals. 33 In this study the incidence of CSNRT alterations were proportionally similar to lower results documented in medical literature which could be due to the large number of asymptomatic patients in the sample. The relation of an alteration in this parameter with CVE did not show any statistical signifi cance.…”

Section: Serial Electrophysiological Studies Of the Heart's Excito Cosupporting

confidence: 87%

Estudos eletrofisiológicos seriados do sistema éxcito-condutor do coração de pacientes com cardiopatia chagásica crônica

Valente¹,

Pimenta²,

Paola³

2006

Arq. Bras. Cardiol.

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M a i l i n g A d r e s s :N e y V a l e n t e • R u a 1 º d e M a r ç o , 1 9 3 -0 4 0 4 4 -0 4 0 -S ã o P a u l o , S P -B r a z i l E-mail: pimenta@cardiol. OBJECTIVESTo study the evolution of lesions in conduction system using invasive electrophysiological studies (EPS), the impact of these alterations on cardiovascular events (CVE), and the frequency of these events in chronic chagasic patients. METHODSProspective study, initiated in 1979 with clinical follow-up until 2000, with the participation of 28 chronic chagasic patients that were 18 to 65 years old, with bundle branch and/or atrioventricular blocks. The patients were submitted to two EPS with a minimum interval of four years between the studies in order to assess fi ve electrophysiologis parameters that were correlated with CVE. A 24-hour Holter and echocardiogram were performed. RESULTSThe average follow-up time after the fi rst EPS was 154.5 months while the interval between EPS was 107.5 months. Ages ranged from 25 to 65 years. Twenty seven patients presented complete right bundle branch block associated with a left anterior hemiblock. The echocardiogram showed alteration in twelve patients. During the 24-hour Holter and ventricular stimulation, only one patient presented sustained ventricular tachycardia (SVT). Nine presented CVE during the study and only the HV interval ≥ 70ms presented a signifi cant statistical relationship with CVE. CONCLUSIONSa) The chronic form of Chagas disease presents different progressive abnormality percentages for the electrophysiological variables and WP alterations are the most common. b) Among the electrophysiological fi ndings, only the HV interval ≥ 70ms was associated with CVE. c) The incidence of CVE was 31.1% during the average follow-up period of 154.5 months.

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Section: Serial Electrophysiological Studies Of the Heart's Excito Cosupporting

confidence: 87%

Estudos eletrofisiológicos seriados do sistema éxcito-condutor do coração de pacientes com cardiopatia chagásica crônica

Valente¹,

Pimenta²,

Paola³

2006

Arq. Bras. Cardiol.

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“…Therefore, the following electrocardiographic findings are considered evidence of severe heart disease and a sign of a poor prognosis: left branch block, atrial fibrillation, atrial flutter, electrically inactive zones, and 2 nd and 3 rd degree atrioventricular blocks 17 . Assessment of the risk of sudden death has acquired a great practical and social importance.…”

Section: Discussionmentioning

confidence: 99%

A sixty-four-year-old woman with Chagas' disease, who underwent implantation of a permanent cardiac pacemaker and evolved with rapidly progressive heart failure

Medeiros¹,

Benvenuti²,

Costa³

2001

Arq. Bras. Cardiol.

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A 64-year-old female patient sought medical assistance at our hospital due to dyspnea on light exertion and even at rest.The patient had been experiencing dyspnea on strenuous exertion since the age of 52 years, which progressed in 10 years to dyspnea on light exertion and even orthopnea.On physical examination (9/1/97), her pulse was regular, her heart rate was 56bpm, and her blood pressure was 140/170mmHg. Her lung examination was within the normal range. The cardiac ictus could be felt on the left 6 th intercostal space over the length of 2 fingertips. A systolic thrill was palpated on the 6 th intercostal space. The cardiac sounds were normal. A systolic cardiac murmur (++/4) was heard on the mitral area and a diastolic cardiac murmur was heard on the aortic area. The abdominal examination was within the normal range and no edema of the lower limbs was observed.The chest X-ray showed enlargement of the cardiac silhouette (++++/4) and normal pulmonary fields.Electrocardiography (8/27/97) showed an ectopic atrial rhythm, a P-R interval of 0.12 s, an initial disturbance of ventricular depolarization (initial QRS blurring in II, III, aVF, and V2), disorder of heart conduction of the anterosuperior left bundle-branch and the right branch, and alterations in ventricular repolarization ( fig. 1).The laboratory tests (8/27/97) were as follows: hemoglobin, 13.6g/dL; hematocrit, 39%; serum creatinine, 0.7mg/ dL; serum sodium, 141mEq/L; and serum potassium, 4.5mEq/L. The serum tests for Chagas' disease were positive.The diagnosis of heart failure due to Chagas' cardiomyopathy was established and the patient was prescribed 37.5mg of captopril and 25mg of hydrochlorothiazide daily.Echocardiography (12/18/97) showed diffuse hypokinesia of the left ventricle, ectasia of the aortic root, moderate regurgitation of the aortic and mitral valves, and pulmonary hypertension. The measurements are shown in table I.Chest tomography (3/31/99) revealed ectasia of the aortic root (52.66mm) and the following preserved diameters: ascending aorta (39.79mm), aortic arch (31.12mm and 25.76mm), descending aorta (26.27mm), and thoracoabdominal transition (21.4mm).The symptoms subsided, as did the dyspnea on moderate exertion. After 10 months, however, the dyspnea became more severe, being triggered on minimum exertion, and even orthopnea occurred (Sept '98). The patient then sought medical care, and an irregular cardiac rhythm was observed.Electrocardiography (9/3/98) showed an irregular rhythm of the atrial pacemaker with junctional escapes and ventricular premature depolarizations, QRS duration of 0.12 s, anterosuperior left bundle-branch block and block of the right branch ( fig. 2).Two months later, the patient required hospitalization (from 11/17/98 to 12/10/98) for control of heart failure.On physical examination (11/17/98), the patient had an irregular pulse, heart rate of 56 bpm, blood pressure of 110/ 80mmHg, crepitant rales in the base of her thorax, irregular cardiac rhythm due to frequent premature depolarizations, and a systolic...

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“…Also, the role of RBBB in physiopathology of CD is not well understood. One previous study showed that, in a cohort of asymptomatic patients with RBBB, patients with CD have a worse prognostic regarding cardiac sudden death when compared to other patients with RBBB and no CD [ 58 ]. Although the influence of having CD was not compared with other classic prognostic factors, these data suggest the need for further studies looking specifically to the prognosis of patients with RBBB secondary to CD.…”

Section: Heart Conduction Disturbances In Chagas Cardiomyopathy Anmentioning

confidence: 99%

Imaging Diagnosis of Right Ventricle Involvement in Chagas Cardiomyopathy

Romano

Moreira

Schmidt

et al. 2017

BioMed Research International

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Right ventricle (RV) is considered a neglected chamber in cardiology and knowledge about its role in cardiac function was mostly focused on ventricular interdependence. However, progress on the understanding of myocardium diseases primarily involving the RV led to a better comprehension of its role in health and disease. In Chagas disease (CD), there is direct evidence from both basic and clinical research of profound structural RV abnormalities. However, clinical detection of these abnormalities is hindered by technical limitations of imaging diagnostic tools. Echocardiography has been a widespread and low-cost option for the study of patients with CD but, when applied to the RV assessment, faces difficulties such as the absence of a geometrical shape to represent this cavity. More recently, the technique has evolved to a focused guided RV imaging and myocardial deformation analysis. Also, cardiac magnetic resonance (CMR) has been introduced as a gold standard method to evaluate RV cavity volumes. CMR advantages include precise quantitative analyses of both LV and RV volumes and its ability to perform myocardium tissue characterization to identify areas of scar and edema. Evolution of these cardiac diagnostic techniques opened a new path to explore the pathophysiology of RV dysfunction in CD.

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Evolução clínica a longo prazo, correlacionando a presença de bloqueios da condução intraventricular em pacientes chagásicos e não chagásicos assintomáticos

Cited by 11 publications

References 27 publications

Estudos eletrofisiológicos seriados do sistema éxcito-condutor do coração de pacientes com cardiopatia chagásica crônica

Estudos eletrofisiológicos seriados do sistema éxcito-condutor do coração de pacientes com cardiopatia chagásica crônica

A sixty-four-year-old woman with Chagas' disease, who underwent implantation of a permanent cardiac pacemaker and evolved with rapidly progressive heart failure

Imaging Diagnosis of Right Ventricle Involvement in Chagas Cardiomyopathy

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