Chagas Disease-induced Sudden Cardiac Arrest

Abstract

Sudden cardiac death (SCD) is the most common cause of death in patients with Chagas disease (ChD). There are over 300,000 ChD-infected individuals living in the United States, of whom 10–15% have undiagnosed Chagas cardiomyopathy (CCM). CCM patients have a higher risk of SCD compared to non-CCM patients, although early and appropriate treatment of CCM patients can result in a 95% relative risk reduction of SCD. Emergency physicians have a unique opportunity to improve outcomes among these patients by becoming more vigilant in recognizing the signs and symptoms of CCM in patients who present in sudden cardiac arrest. We report the case of a patient presenting to the emergency department with pulseless ventricular tachycardia and an undiagnosed history of CCM.

Antiparasitic treatment with itraconazole and amiodarone in 2 dogs with severe, symptomatic Chagas cardiomyopathy

“…The dogs in this report lived in regions where infected insect vectors are common, had evidence of myocardial disease, predominately right heart enlargement, and ventricular arrhythmias, and both died suddenly within 6 months of diagnosis. Sudden death accounts for roughly 55% to 65% of all deaths in people with CCM, and can occur in up to 20% of asymptomatic patients 4,23 . In the majority of people with Chagas disease, sudden death occurs with severe cardiac disease, although in both people and dogs, sudden death is also reported with minimal or no evidence of gross heart disease 5,23 .…”

“…Sudden death accounts for roughly 55% to 65% of all deaths in people with CCM, and can occur in up to 20% of asymptomatic patients. 4,23 In the majority of people with Chagas disease, sudden death occurs with severe cardiac disease, although in both people and dogs, sudden death is also reported with minimal or no evidence of gross heart disease. 5,23 In people with CCM, sudden death is attributed to cardiovascular causes including malignant ventricular arrhythmias, congestive heart failure, and thromboembolic events.…”

“…In the majority of people with Chagas disease, sudden death occurs with severe cardiac disease, although in both people and dogs, sudden death is also reported with minimal or no evidence of gross heart disease 5,23 . In people with CCM, sudden death is attributed to cardiovascular causes including malignant ventricular arrhythmias, congestive heart failure, and thromboembolic events 4,23,24 . Risk scores have been developed to predict sudden death and other adverse outcomes in people with CCM.…”

“…Chronic Chagas cardiomyopathy (CCM) occurs in an estimated 20% to 30% of infected people, and clinical manifestations of CCM include diffuse conduction abnormalities, tachyarrhythmias, bradyarrhythmias, thromboembolism, ventricular aneurysms, heart failure, and sudden cardiac death 3 . Sudden cardiac death accounts for 55% to 65% of deaths in people with CCM, and also occurs in dogs with CCM 1,4‐7 . Dogs infected with T cruzi can remain asymptomatic for life and the proportion of infected dogs that progress to chronic disease is unknown but might be similar to that of people 8 …”

Discovery of Potent N-Ethylurea Pyrazole Derivatives as Dual Inhibitors of Trypanosoma brucei and Trypanosoma cruzi

“…The situation is not as promising in South America, where Chagas disease (American trypanosomiasis) affects 6–7 million people. Among them, 10% will develop digestive and neurological deteriorations and 30% cardiac alterations, which may lead to progressive heart failure and sudden cardiac arrest . The current drugs used to treat Chagas disease have associated toxicity and have variable efficacy in the chronic phase of the disease. , Chagas disease transmission is confined to Latin America, but migration of chronic patients to other continents contributes to the urgent need for control and treatment …”