I Diretriz Latino-Americana para o diagnóstico e tratamento da cardiopatia chagásica: resumo executivo

Abstract

and Venezuela have the domestic, peridomicile and sylvatic cycles, with high prevalence of human infection and prevalence of chronic Chagas' cardiomyopathy (CCC).Group II -Colombia, Costa Rica and Mexico, characterized by domestic and peridomicile cycles with presence of CCC.Group III -El Salvador, Guatemala, Nicaragua and Panama have domestic, peridomicile and sylvatic cycles with poor clinical information. AbstractMuch has been achieved in one century after Carlos Chagas' discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations.

Matrix Metalloproteinases 2 and 9 Are Differentially Expressed in Patients with Indeterminate and Cardiac Clinical Forms of Chagas Disease

“…Although the classification of the cardiac form into stages helps to distinguish patients with worse prognosis (34), sudden death and other major clinical events still occur among patients in the initial stages of Chagas heart disease. Therefore, one of the most important goals of studying physiopathological mechanisms in Chagas disease is the identification of potential risk factors for the occurrence of major clinical events (sudden death, heart failure, malignant arrhythmias, and stroke) or disease progression among patients still in the indeterminate form or in initial stages of the cardiac form (5,6).…”

Emerging and under-recognized Chagas cardiomyopathy in non-endemic countries

“…The average prevalence of malignant arrhythmias in these patients is unknown, but risk factors have been identified: regional contractile abnormalities and mild left ventricle dysfunction [12] , apical lesions [13] , moderate or severe LV systolic dysfunction [14] , exercise-induced ventricular arrhythmia [15] , non-sustained ventricular arrhythmia [16] , New York Heart Association functional class Ⅲ-Ⅳ and absence of β-blocker treatment [17] . According to the Ⅰ Latin American guidelines for the diagnosis and treatment of Chagas cardiomyopathy [18] , the patient's drug therapy would have the following classes of recommendation and levels of evidence: angiotensin receptor blocker (I-C); β-blocker, oral anticoagulants (I-C); amiodarone (I-B); and nitrate (Ⅱa-C). Further therapy can be introduced in the future if the patient develops congestive symptoms and deteriorates into Ⅲ or Ⅳ NYHA class: spironolactone (I-B); diuretic (I-C) for congestive symptoms; and digitalis (Ⅱa-C).…”

I Diretriz Brasileira de Miocardites e Pericardites

“…Em outras formas de infecção não viral, podemos ter o desenvolvimento de miocardite por Clostridium e Corynebacterium diphtheria, Meningococcus, Streptococcus, Listeria e Borrelia burgdorferi, que se manifesta como doença de Lyme 11 . Na América do Sul e especialmente em algumas regiões do Brasil a miocardite chagásica causada pelo protozoário Trypanosoma cruzi, é a forma mais prevalente de miocardite ou cardiomiopatia dilatada 12 .…”

“…Roque Figueira (7,8), João David de Souza Neto (9), Lídia Ana Zytynski Moura (10,11), Luiz Antônio de Almeida Campos (12,13), Marcelo Imbroinise Bittencourt (1,12), Márcia de Melo Barbosa (14), Maria da Consolação Vieira Moreira (15), Maria de Lourdes Higuchi (3), Pedro Schwartzmann (16), Ricardo Mourilhe Rocha (1,12), Sabrina Bernardez Pereira (2), Sandrigo Mangini (3,17), Silvia Marinho Martins (18), Solange Bordignon (19,20), Vitor Agueda Salles (21,22). …”