A modified and unifying neurogenic hypothesis can explain the natural history of chronic Chagas heart disease

Dávila, Diego F.; Donis, José H.; Torres, Argenis; Ferrer, José Antonio Possato

doi:10.1016/j.ijcard.2003.06.015

Cited by 37 publications

(37 citation statements)

References 61 publications

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“…Despite this, it is not possible to eliminate the possibility that autonomic and contractile dysfunction mutually influence or worsen one another to some extension 37,58 . However, an isolated alternative hypothesis considers that cardiac autonomic dysfunction is the result of contractile ventricular dysfunction and other primary pathophysiological mechanisms 59 .…”

Section: Junqueira Jr Lf -Significance Of Cardiac Autonomic Dysfunctimentioning

confidence: 99%

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS: Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS: We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS: Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.

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Section: Junqueira Jr Lf -Significance Of Cardiac Autonomic Dysfunctimentioning

confidence: 99%

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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“…16,17 However, the contribution of autonomic dysfunction to the pathophysiology of Chagas cardiomyopathy is less welldefined, and its significance in the absence of other cardiac findings is controversial. 18,19 Although risk factors for T. cruzi infection have been studied in a number of rural settings, there are few data from urban foci of transmission. [20][21][22][23][24] Our group's investigations in periurban Arequipa showed increased risk of triatomine infestation associated with domestic animals, unplastered house walls, and animal pens, and showed the highest prevalence of human T. cruzi infection to be located on the densely populated hillsides outside the city.…”

Section: Introductionmentioning

confidence: 99%

Autonomic Dysfunction and Risk Factors Associated with Trypanosoma cruzi Infection among Children in Arequipa, Peru

Bowman¹,

Kawai²,

Gilman³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Chagas disease affects an estimated 8 million people in Latin America. Infected individuals have 20–30% lifetime risk of developing cardiomyopathy, but more subtle changes in autonomic responses may be more frequent. We conducted a matched case-control study of children in Arequipa, Peru, where triatomine infestation and Trypanosoma cruzi infection are emerging problems. We collected data on home environment, history, physical examination, electrocardiogram, and autonomic testing. Signs of triatomine infestation and/or animals sleeping in the child's room and household members with Chagas disease were associated with increased infection risk. Electrocardiogram findings did not differ between cases and controls. However, compared with control children, infected children had blunted autonomic responses by three different measures, the Valsalva maneuver, the cold pressor test, and the orthostatic test. T. cruzi-infected children show autonomic dysfunction, although the prognostic value of this finding is not clear. Sustained vector control programs are essential to decreasing future T. cruzi infections.

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“…A modified neurogenic hypothesis has been presented aimed at unifying the bulk of theories to explain the chronic lesions of Chagas heart disease (Dávila et al 2004). Some believe that impairment of the parasympathetic nervous system and permanent activation of the sympathetic nervous system and of other neuro-hormonal circuits explains the lesions (Bestetti et al 1995, Dávila et al 2002.…”

Section: Unifying Neurogenicmentioning

confidence: 99%

Evolution and pathology in Chagas disease: a review

Teixeira

Nascimento

Sturm³

2006

Mem. Inst. Oswaldo Cruz

193

195

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A modified and unifying neurogenic hypothesis can explain the natural history of chronic Chagas heart disease

Cited by 37 publications

References 61 publications

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Autonomic Dysfunction and Risk Factors Associated with Trypanosoma cruzi Infection among Children in Arequipa, Peru

Evolution and pathology in Chagas disease: a review

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